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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 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 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.
Access Assessment Report Initial Draft Feedback July 19, 2019-August 19, 2019
An initial draft of the
report is available at the hyperlink below:
CA 2017-18 Access Assessment Draft Report
Your feedback is very important to the Access Assessment. Please include the following language in the email subject line “CA Access Assessment Report Feedback" and email your feedback using the structure below by August 19, 2019 to:
|Page and Reference||Question/Comment|
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 (Updated August 11, 2016)
Final Advisory Committee Meeting
On Thursday, June 20, 2019, Health Services Advisory Group, Inc. (HSAG) hosted an Access Assessment Advisory Committee Meeting to review the access assessment results and provide guidance to the committee for submitting its feedback to HSAG.
Past Advisory Committee Meetings
March 28, 2017 - Review Assessment Design
January 31, 2017 - Assessment Outline Review Meeting Agenda
November 18, 2016 - Entrance Meeting Agenda
Resources and Information
CMS Access Assessment Design Approval Letter (September 19, 2018)
Access Assess Design DRAFT (Submitted April 21, 2017)
Access Assessment Design Outline (January 27, 2017)
Medi-Cal 2020 Waiver Special Terms & Conditions (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: