Facility Site Review

Facility Site Reviews are the application of prescribed standards by the California Department of Health Care Services (DHCS) for all primary care provider (PCP) sites who wish to participate in the Medi-Cal Managed Care Program. Per the California Code of Regulations 22 CCR § 56230 and the DHCS All Plan Letter 22-017, all participating PCPs are required to 1) complete an initial facility site review and subsequent periodic full scope reviews and 2) complete corrective action plans (CAPs) within the DHCS-specified timeline for cited deficiencies. Full scope reviews are comprised of a completed DHCS facility site review (FSR), medical record review (MRR) and the Physical Accessibility Review Survey (PARS).

All network PCP sites receive:

  • An Initial Facility Site Review (FSR) which is part of the credentialing process.
  • New PCP sites must pass their Initial FSR and correct any noted deficiencies before being added to the Molina Medi-Cal network and receiving Molina member assignments.
  • An Initial MRR is conducted approximately 3-6 months following the first member assignment.
  • A Periodic Full Scope FSR and MRR are conducted every 36 months.  If a site fails either the FSR or MRR audit, then site will undergo an annual full scope review.
  • An Interim Monitoring Review is conducted every 18-months via an attestation form.
  • Focused Reviews may be conducted as needed.
 
Facility Site Review (FSR) Audit

FSRs are conducted to ensure that all contracted primary care provider (PCP) sites have sufficient capacity to provide appropriate primary health care services and can maintain patient safety standards and practices. The FSR also confirms the PCP site operates in compliance with all local, state, and federal laws and regulations. FSRs are conducted by DHCS-Certified Nurse Reviewers.

 
Facility Site Review (FSR) Audit Resources
Bleach Comparison Chart

Bleach Labels
Civil Rights Notice – Less Than 15 Employees Sample
Civil Rights Notice – More Than 15 Employees Sample
Cleaning Log
Drug Inventory List
Emergency Earthquake Plan
Emergency Fire Plan
Emergency Kit Inventory Log Sample
Emergency Medication Dosage Chart
Emergency Phone List
Facility Site Review Standards
Facility Site Review Tools
Grievance Log
Informed Consent
Instrument Sterilization Log
Medical Assistant Letter of Competency
Monthly Expiration Date Log
Outside Housekeeping Cleaning Schedule
Policy and Procedure Signature Page
Referral Tracking Log Blank
Referral Tracking Log Sample
Site Evacuation Plan
Staff Training Checklist
Where Is VIS Date Located Info Sheet
Workplace Violence Protocol

 

Medical Record Review (MRR) Audit

MRRs are conducted to review medical records for format, legal protocols and documented evidence of the provision of preventive care and coordination and continuity of care services. The medical record provides legal proof that the patient received care. MRRs are conducted by DHCS-Certified Nurse Reviewers.

Medical Record Review (MRR) Audit Resources

Medical Record Review Audit Standards
Medical Record Review Audit Tool

 

Physical Accessibility Review Survey Audit

PARS is a physical evaluation of a healthcare facility (“site”) that provides care to Medi-Cal members who are seniors and/or persons with disabilities (SPDs). These sites are Primary Care Provider sites, Community Based Adult Services sites, High Volume Specialist sites, or other Ancillary sites (as appropriate). PARS are conducted by DHCS Certified Auditors and other designated staff.

The onsite evaluation includes six areas: Parking; Exterior Building; Interior Building; Restroom; Exam Room; and Exam Table/Scale. The review establishes if the facility has Basic Access or Limited Access for members with disabilities.

PARS Standards and Tool and APL 12-006

 

Medi-Cal Managed Care Letters

Medi-Cal Managed Care communicates with Medi-Cal managed care plans (MCPs) by means of All Plan and Policy Letters.

All Plan Letters (APLs) are the means by which Medi-Cal Managed Care conveys information or interpretation of changes in policy or procedure at the Federal or State levels, and provides instruction to contractors, if applicable on how to implement these changes on an operational basis.

Policy Letters (PLs) provide guidance to MCPs about changes in Federal or State law and Regulation that affect the way in which they operate or deliver services to Medi-Cal beneficiaries.

Below are APLs and PLs that pertain to the Facility site review process and/or DHCS standards for FSR/MRR/PARS audit.

APL

Title

APL 16-014

Comprehensive Tobacco Prevention and Cessation Services for Medi-Cal Beneficiaries (Supersedes PL 14-006)

APL 18-016

Readability and Suitability of Written Health Education Materials (Supersedes APL 11-018)

APL 18-004

Immunization Requirements (Supersedes PL 96-013 and APL 07-015)

APL 18-018

Diabetes Prevention Program

APL 20-016

Blood Lead Screening of Young Children (Supersedes APL18-017)

APL 21-004

Standards for Determining Threshold Languages, Nondiscrimination Requirements, and Language Assistance Services

APL 21-009

Collecting Social Determinants of Health Data

APL 21-014

Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment (Supersedes APL 18-014)

APL 22-017

Primary Care Provider Site Reviews: Facility Site Review and Medical Record Review (Supersedes APL 20-006)

APL 22-025

Responsibilities for Annual Cognitive Health Assessment for Eligible Members 65 Years of Age or Older

APL 22-030

Initial Health Appointment (Supersedes APL 13-017and Policy Letters 13-001 and 08-003)

APL 23-005

Requirements For Coverage of Early and Periodic Screening, Diagnostic, and Treatment Services for Medi-Cal Members Under the Age of 21 (Supersedes APL 19-010)

APL 23-017

Directed Payments for Adverse Childhood Experiences Screening Services (Supersedes APL 19-018)

APL 24-001

Street Medicine Provider: Definitions and Participation in Managed Care (Supersedes APL 22-023)