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Extracted from Consolidated Report
This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings 3 findings
F1
Page 99
The Department of Health Services responded to all 16 questions put to it by the committee. Its responding document is reproduced in full as Attachment A to this report. The questions are listed and DHS’s responses are summarized on the following table.
F2
Page 99
The table lists the committee’s questions on the left and categorizes the DHS responses as either implemented, in progress, no progress, or decline to implement. Of the 16 2 Online Real-Time Centralized Health Information Database. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT
F3
Page 100
With 15 out of 16 recommendations either completed or underway, clearly a good faith effort is being made by DHS. The department is to be complimented on its rapid progress. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT Summary of Responses to Civil Grand Jury questions by the Department of Health Services Questions to DHS Implemented In Progress No Progress Decline Comments 2.1 Have both the new ORCHID system and the current system incorporated codes on all accounts for classifying and explaining reasons for denial? X 2.2 Has DHS updated the procedure to include new Reason for denial codes? X 2.3 Has the availability of Patient Financial Services worker staff been increased at all hospitals? X 2.4 What method, if any, has DHS implemented to replace the discontinued method of identifying write-offs for denied or late claims that are billed by the DHS Consolidated Business Office? X Replaced with new process (see Attachment A) 2.5 Has DHS determined the staffing required to review Medi- Cal fee-for-service accounts for patients still in DHS hospitals? X 2.6 Has DHS conducted a staffing analysis to determine if additional staffing will reduce backlogs and reduce billing time? X 2.7 What is the projected date by which DHS expects to fully implement the original
Recommendations 1
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R2Page 1065 below; as a result, the Utilization Review Units in the hospitals have been able to timely review accounts to enable timely billing. Also, DHS has developed an inventory status report to identify and prioritize accounts that need a TAR in order to be billed for stronger control. DHS does not bill any accounts that do not have a TAR. RECOMMENDATION No. 2.5 Formalize the point at which Medi-Cal fee-for-service accounts are retrospectively reviewed for patients still in the Department hospitals. 7/18/14 RESPONSE DHS agrees with this recommendation. An assessment will be conducted to determine the staffing needs to perform the concurrent reviews recommended. If necessary, DHS will submit a budget request for additional staffing needed to fully implement this recommendation. Completion of the assessment is anticipated by December 31, 2014. CGJ QUESTION 2.5 Has DHS determined the staffing required to review Medi-Cal fee-for-service accounts for patients still in DHS hospitals? 90 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT 1/30/15 RESPONSE Implemented - Currently Medi-Cal Fee-for-Service patients are reviewed on a daily basis when receiving acute care. DHS utilizes a State approved evidence based proprietary software program (InterQual) for determination of medical necessity. A second level review of the account is completed by a physician to evaluate the medical necessity if InterQual criteria are not met. DHS Utilization Review (UR) Committee has implemented an action plan; where UR nurses are reassigned from other County hospitals should a backlog develop at a DHS facility, to assist in the reviews using approved overtime. Also, additional Physician Advisors are recruited to complete second level reviews. Based on this strategy and assessment, DHS has been able to mitigate the effect of staff shortage at its facilities. RECOMMENDATION No. 2.6
Commendations 1
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CM1Based on observations of the group homes visited, the committee commends the efforts of these group home providers in delivering services and promoting the safety and well-being of the home residents. 11 Information obtained from http://ChronicleofSocialChange.org. 12 Board of Supervisors Statement of Proceedings, March 3, 2015. 106 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT The committee also applauds the Los Angeles County Board of Supervisors’ decision to participate in the Approved Relative Caregiver Funding Program. It will be a tremendous savings for the county and a win-win situation for all parties. ACRONYMS ARC Approved Relative Caregiver Funding Program CAP Corrective Action Plan CCL Community Care Licensing Division DCFS Department of Children and Family Services GH Group Home RCL Rate Classification Level PPQA Placement Permanency and Quality Assurance unit COMMITTEE MEMBERS Wesley C. Thompson, chair Larry Lyman, vice chair Earline Parker, secretary Doris K. Reed Joyce Simily Margaret Yasuda 107 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT This page intentionally left blank. 108 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT METRO RIDERSHIP Jim Contreras, chair Simeon Zano, vice chair Shari E. Pearce, secretary METRO RIDERSHIP TOPIC The Los Angeles County 2014–2015 Civil Grand Jury (CGJ) formed the Metro Ridership Committee (committee) to look into increasing the ridership within the Los Angeles County Metropolitan Transportation Authority (Metro) system and investigate the efforts of Metro to do the same. The committee also looked into whether Metro would receive maximum funding from federal sources based on achieving the farebox recovery goal of 33 percent.1
No Responses Found 1
Government entities assigned to respond to this report. No response documents have been linked in our database.
Los Angeles County Board of Supervisors
Elected County Office