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As required by the Special Terms and Conditions (STCs) of California’s 1115 Waiver Renewal, Medi-Cal 2020, the Department of Health Care Services (DHCS) will contract with its External Quality Review Organization (EQRO), Health Services Advisory Group, to complete an Access assessment. This one-time assessment will evaluate primary, core specialty, and facility access to care for managed care beneficiaries based on the current health plan network adequacy requirements set forth in the state’s Knox-Keene Health Care Service Plan Act of 1975 (KKA) and Medicaid managed care contracts, as well as reporting on the number of providers accepting new beneficiaries.
The EQRO will produce and publish an initial draft and a final Access assessment report that includes a comparison of health plan network adequacy compliance across different lines of business; and recommendations in response to any systemic network adequacy issues. The initial draft and final report will also describe the state’s current compliance with the access and network adequacy standards set forth in the recent Medicaid Managed Care proposed rule.
The state has established an Advisory Committee to provide input into the structure of the Access assessment. The Advisory Committee includes representatives from consumer advocacy organizations, providers, provider associations, health plans, health plan associations, and legislative staff. The Committee's role is to provide input into the assessment structure including network adequacy requirements and metrics, as well as provide feedback on the initial draft and Access assessment report.
Advisory Committee Selection
Access Assessment Advisory Committee Member Selections (PDF) (Updated August 11, 2016)
Upcoming Advisory Committee Meetings
*Please continue to check back for updates
Past Advisory Committee Meetings
March 28, 2017 - Review Assessment Design (PDF)
January 31, 2017 - Assessment Outline Review Meeting Agenda (PDF)
November 18, 2016 - Entrance Meeting Agenda (PDF)
Resources and Information
Access Assess Design DRAFT.pdf (Submitted April 21, 2017)
Access Assessment Design Outline.pdf (January 27, 2017)
Medi-Cal 2020 Waiver Special Terms & Conditions (PDF) (for the Access Assessment & Committee, see STCs 65-69 on pages 44-46)
Questions and Comments
Please direct your comments, questions or suggestions regarding the Access Assessment to the following email address: