Welfare and Institutions Code section 14042.2
(a)
The Legislature finds and declares the following:(1)
The Medi-Cal Managed Care Ombudsman helps resolve issues between Medi-Cal managed care members and health plans, assists members with managed care related questions and problems, and answers questions from members.(2)
A pattern of inquiries, complaints, and grievances may be indicators of systemic problems regarding coverage and problems with access to care and warrant consideration.(b)
On a quarterly basis, the State Department of Health Care Services shall report on calls received by the Medi-Cal Managed Care Ombudsman. At a minimum, the report shall include the following:(1)
The number of contacts received, separated by inquiries and complaints.(2)
The average wait time for callers to answer.(3)
The number of calls abandoned.(4)
The result of contacts, including destination of referred calls, when possible.(5)
The average call time.(6)
Complaints, by issue type.(7)
The number of calls referred to another area of the department or to the Department of Managed Health Care for resolution.(c)
All data collected and reported shall include demographic information of beneficiaries, including race, ethnicity, age, gender, preferred language, language members were assisted in, and county of residence, and health plans of beneficiaries, to the extent known to the department at the time of the call. The department shall request, but not require, this information from members during the calls.(d)
The quarterly report shall include contacts from county mental health plan beneficiaries, as defined in Section 14700, including the requirements of subdivisions (a) and (b).(e)
The quarterly report shall be posted on the department’s internet website.(f)
The fourth quarterly report issued each year also shall include information pertaining to the following:(1)
Training protocols for staff, including cultural and linguistic competency.(2)
Assessment of contacts trends and actions taken by the State Department of Health Care Services as a result of contacts received.(3)
Consumer assistance protocols, procedures, and referral tools.
Source:
Section 14042.2, https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14042.2. (accessed Apr. 24, 2025).