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Timely Access Compliance and Annual Provider Network Reporting

Timely Access Report

The Measurement Year ("MY") 2015 Timely Access Report, published by the DMHC pursuant to Health and Safety Code 1367.03, subd. (i), the corresponding MY 2015 Timely Access Data, the Timely Access Fact Sheet, and ALL Plan Letter, issued February 14, 2017 are posted below.

Annual Provider Network Report Forms and Grievance Report Forms for Measurement Year 2016 

Pursuant to California Code of Regulations, title 28, section 1300.67.2.2, subd. (g)(2)(G) and Health and Safety Code sections 1367.03, subd. (f)(2) & 1367.035, by March 31, 2012 and by March 31 of each year thereafter, all full service and mental health plans are required to submit provider network reports and timely access and network adequacy grievance reports to the DMHC.

2016 Annual Provider Network Report Forms

The DMHC has made changes to the Annual Provider Network Report Forms (previously known as "Timely Access Report Forms") for Measurement Year 2016 (MY 2016).  To clearly illustrate the changes in data elements required and requested for MY 2016, the DMHC has summarized them in an At-A-Glance table format for each Annual Provider Network Report Form. The tables display the following:

  • The name of the Annual Provider Network Report Form (template), (e.g., PCP or Enrollment);   
  • The affected data field (columns) from each Report Form;
  • The action taken, e.g. whether a previously required or requested data field was removed or a new data field added; and
  • A brief description of the new data field or a description of the previously requested/required data field that is no longer required.    

Links to the Annual Provider Network Report Forms for MY 2016 are provided below.  The following report forms are in a “locked” Excel format. Plans must utilize these forms to compile network data as of December 31, 2016. As a reminder, network templates are due to the Department no later than March 31, 2017.

For reference, see the GENERAL Network Report Form Instructions from Measurement Year 2016. See also the Frequently Asked Questions for Measurement Year 2016 for additional information regarding how to report provider network data.

 

As a courtesy to health plans, the Department has developed an Annual Provider Network Reporting Clarifications Grid (Issued 03/17/17) for the purpose of distributing information derived from individual plan telephone and email inquiries. In preparation for the MY 2016 Annual Provider Network Report submission, the Department will be continually updating this grid. Please check the website regularly for updates to this grid in advance of submitting the Plan’s MY 2016 provider network data.

 

2016 Timely Access and Network Adequacy Grievance Report Form

The link to the Timely Access and Network Adequacy Grievance Report Form for MY 2016 is provided below. The following report form is provided for informational purposes only. This report form cannot be populated and is only intended to provide health plans with notice of the data fields required and requested for 2016.

2016 Annual Timely Access Compliance Report Templates and Tools

Plans are required to submit a Timely Access Compliance Report on March 31 of each year. For MY 2016, the Timely Access Compliance Report due date has been extended to May 26, 2017. The items required to be submitted as part of this annual report are set forth in the Timely Access Compliance Report Instructions below. DMHC has published two standardized methodologies, the Provider Appointment Availability Survey Methodology and the Audit Methodology, for reporting rates of compliance, pursuant to Section 1367.03, subd. (f)(3).

Survey Tools

Steps for submitting Timely Access Compliance Report (A-F data):

1. Read the MY 2016 Timely Access Compliance Report Instructions. (Rev. 03/17/17)

2. Read the MY 2016 Provider Appointment Availability Survey Methodology.

3. Conduct the survey utilizing the DMHC’s tools and reporting templates provided below. The following reporting templates are in a "locked" Excel format. All plans utilizing the survey methodology must submit Raw Data and Provider Contact List for each provider type using these templates in section B.2: Raw Data and Provider Contact List in the DMHC's web portal.

MY 2016 Provider Appointment Availability Survey - Provider Contact List templates (Issued 02/14/17):

MY 2016 Provider Appointment Availability Survey - Survey Tool (Rev. 02/14/17):

The Survey Tools for MY 2016 have been revised as of February 14, 2017. The Survey Tools no longer incorporates a Raw Data template. Please see step 2 for the updated Raw Data template.

MY 2016 Provider Appointment Availability Survey - Raw Data templates (Issued 02/14/17):

4. Use the MY 2016 Results Templates (Issued 02/01/17) by relevant provider type when reporting results for section B.3: Rate of Compliance with the Time-Elapsed Standards in the DMHC's web portal.

5. Submit documents per instructions via the DMHC's web portal. (You may download the D. Advanced Access Form (optional) to report provider groups.)

Audit Templates

Pursuant to SB 964 and Section 1367.03, subd. (f)(3), DMHC has adopted two standardized methodologies that plans may use to report compliance with the required appointment wait time standards for Measurement Year 2016 (“MY 2016”). Plans have not elected to use the manual audit methodology for MY 2016.  As a result, the DMHC has not selected the dates in each calendar quarter to collect the data.

 

Related Links:

Sections 1367.03 and 1367.035 of the California Health and Safety Code

Section 1300.67.2.2 in Title 28 of the California Code of Regulations

List of Licensed Health Plans

Timely Access and Annual Network Report Form Archive

To view previously issued report forms, methodologies, instructions, and other reference material for timely access compliance and annual network review reports, please see the

Timely Access Archive