22-1094 Facility Site Review and Medical Record Review Changes
Date: 12/29/22
New regulatory changes for your office
The Department of Healthcare Services (DHCS) updated the site review process, which includes facility site review (FSR) and medical record review (MRR) policies, per All Plan Letter (APL) 22-017.1 This APL supersedes APL 20-006 and APL 14-004.
DHCS updated the FSR and MRR standards and criteria to reflect current guidelines of professional organizations by expanding certain criteria, re-organizing the criteria groups to help better identify deficiencies, and adjusting the scoring methods to better generalize the scores.
Changed or expanded criteria
Changed or expanded criteria for MRR include, but are not limited to:
- Initial Health Assessment within 120 days of member enrollment.
- Blood lead screening, anticipatory guidance and testing.
- Autism disorder screening.
- Maternal depression screening by primary care physicians (PCPs).
Corrective action plan timeline changes
A corrective action plan (CAP) is required for all cited deficiencies for PCP sites that have an FSR and/or MRR conditional pass or non-passing score. Below are timelines for a CAP:
- CAPs must be submitted to Health Net* within 30 calendar days from the date of the review.
- All non-critical CAPs must be closed within 90 calendar days, except for extenuating circumstances.
- Beyond 120 calendar days for extenuating circumstances, Health Net can request an extension to allow the PCP to complete the CAP and/or verify CAPs have been completed.
Resources
For more information on FSR, go to the Provider Library > Provider Manual > Quality Improvement > Facility Site Review.
FSR Training is available at: Provider Webinar Information and Training Materials
For questions on FSR or MRR, please contact your Health Net Facility Site Review representative or Pam Carpenter, Quality Improvement Manager-FSR via email.
Additional information
Relevant sections of the provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library after logging in to the provider website > Provider Library, under Quick Links, or go directly to provider library.
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center within 60 days at 800-675-6110.
1 www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-017.pdf.
This information applies to Physicians and Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.