Facility Site Review Guidelines

CenCal Health conducts facility site reviews for new primary care providers as a requirement for participation in all CenCal Health programs. Corrective Action Plans are required for those providers who do not meet the minimum required score.

Attention Primary Care Practitioners - NEW Facility Site Review (FSR) & Medical Record Review (MRR) Regulatory Requirement Standards starting January 1, 2022

The Department of Healthcare Services (DHCS) has made updates to the site review process, which includes Facility Site Review (FSR) and Medical Record Review (MRR) policies. DHCS has 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.

DHCS has released a new All Plan Letter (APL) 20-006 to reflect these updates. This APL supersedes Policy Letters (PL) 14-004, PL 03-002, and APL 03-007. DHCS recognizes the extent and impact of these changes. Providers and staff should remain informed and begin training on the updates to FSR and MRR criteria and standards.

In the spirit of collaboration, 22 California Managed Care Plans (MCP) have partnered through Collaborative efforts to provide training and resources to our Primary Care Physicians (PCP). This video series will explain changes to the current guidelines corresponding to the APL 20-006 and release date of the “New Standards”. 

Click here to watch the FSR Provider Training Video, or download the presentation slides for more resources.The Medical Record Review (MRR) Provider Training video will be available soon.

 

Tools Used: 

  • California Department of Health Services Medi-Cal Managed Care Full Scope Site Review Survey. 
  • Medical Record Survey Tool.
  • Physical Accessibility Review Survey.
    • To assess whether a provider has Basic Access, Limited Access or Medical Equipment Access for persons with special needs. This information will be used in CenCal Health’s provider directory to indicate areas of accessibility at a provider office/site. There is no Corrective Action Plan required for this survey.

Required Score: 

  • A pre-contractual provider must score above 80% on the site review survey to be counted as a network provider.  
  • Providers who score below 80% will be re-surveyed and must pass the site review survey at 80% or higher.  
  • Providers that score 80—89% will be required to complete a Corrective Action Plan within specified timelines.

Monitoring

After the initial site review, the maximum time period before the next required site review is three years. Interim monitoring will occur within this time period to assess compliance to the critical elements of the site review or to follow up with findings from previous reviews. CenCal Health may review sites more frequently, or when determined necessary based on prior findings. 

Please refer to the Facility Site Review Binder for forms to assist your office in preparing for site visits.