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Legislative Analyst Pushes for Better Oversight of Health Care Services

A state legislative analyst last week said his department has “numerous concerns” about a lack of public reporting at the state’s Department of Health Care Services.

The Legislative Analyst’s Office released a report last month raising questions about the department’s failure to report on monitoring measures in its fee-for-service access data.  In a Feb. 24 hearing of the Assembly Budget Subcommittee on Health and Human Services, LAO fiscal and policy analyst Felix Su laid out some of those concerns.

Legislative leaders asked the LAO to make a recommendation about a proposal before the Legislature to reverse a 10% Medi-Cal provider rate cut made in 2011. Su said his office was unable to do that, given the dearth of data from DHCS.

“For our office to be able to make such a recommendation, we would require some reliable data or evidence that can inform the state of access to services,” Su said. “There are only a handful of potential sources we can turn to. The most obvious candidate is DHCS’ public reporting system.”

That reporting system is flawed, Su said.

“Our office has reviewed these reports,” he said, “and we’ve come away with numerous concerns. … We’ve encountered numerous problems regarding the data and methodology that is being employed.”

That lack of data, he said, not only limits the LAO’s ability to make a recommendation, but it’s perhaps a more serious problem than the rate reduction itself, Su said.

“In lieu of reliable public administrative data, we’re really faced with an information gap in trying to make a recommendation,” Su said. “The problem is, as an institution the Legislature … has largely remained on the outside sidelines, trying to peer in to the internal process [of DHCS monitoring]. For the most part, it’s been quite opaque.”

The data provided by state health officials doesn’t help policy analysts at LAO get to the heart of access concerns, he said.

“The information the administration has given us regarding its internal monitoring is too broad and general for us to incorporate into our own meaningful assessment of access to care,” Su said.

The question of provider rates may be an important one, Su said, but in the long run, being able to meaningfully monitor access issues might serve the state better than raising rates, he said.

“We think the Legislature would be better served by examining the state’s monitoring system for accessing managed care,” Su said.

“One of the things that struck me most … is the lack of clear research and data concerning this issue of access,” said Shirley Weber, chair of the subcommittee hearing. “As an elected official, I was somewhat taken aback by the lack of clarity in regard to the relationship between the rates and access and availability for individuals.”

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