By Kathy Robertson, Sacramento Business Journal:
State regulators have levied a $4 million fine against Kaiser Permanente for four serious deficiencies in providing access to mental health services.
The fine, announced Tuesday morning, relates to problems uncovered in a routine medical survey in March by investigators at the Department of Managed Health Care. Their report concluded Kaiser is not meeting state health plan standards for timely access to mental health treatmentand expressed concern about the adequacy of Kaiser’s provider network for this kind of care.
The matter was forwarded to the agency’s enforcement unit for action, which resulted in the $4 million fine. The report is available here.
“The department’s action (is) a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them,” department director Brent Barnhart said in a news release.
Kaiser has worked with the agency for more than a year and corrected most of the problems, health plan spokesman John Nelson said in a statement. The company will dispute the fine, which officials feel is excessive.
The agency found Kaiser does not:
- Ensure its quality assurance systems accurately track, measure and monitor the accessibility and availability of providers
- Sufficiently monitor the capacity and availability of its provider network to ensure that appointments are offered within regulatory time frames
- Ensure that effective action is taken to improve care where deficiencies are identified
- Provide accurate and understandable mental health education materials, including information regarding the availability and optimal use of mental health care services provided by the plan
Kaiser’s mental health education materials, including “frequently asked questions”, website postings and new patient presentations include inaccurate information that could dissuade a member from pursuing medically necessary care, state regulators concluded.
The agency also found examples of member materials that, while consistent with the law, did not convey coverage in language understandable to the average member.
The DMHC survey did not identify shortcomings with members’ ability to get urgent or emergency mental health care, Kaiser spokesman John Nelson stressed in a statement. The survey did not find problems with the quality of mental health care provided either.
Kaiser has been working with DMHC on the issue for more than a year, Nelson said. The problems identified by the agency have “already been corrected, or is very far along toward resolution,” he added.
New providers have been hired and Kaiser is recruiting for more, Nelson said. Outdated or incomplete materials describing Kaiser’s mental health services have been updated or removed.
Given the steps Kaiser has taken, the amount of the penalty is “unwarranted and excessive” and “unnecessary to ensure our corrective actions,” Nelson said. “We will review this with the DMHC.”
The agency plans a follow-up survey in October to ensure Kaiser has corrected each of the deficiencies and is complying with the law. DMHC will continue to monitor the plan as necessary, officials said.
Consumers with questions about access to care can call the agency’s help center at 888-466-2219 or go to HealthHelp.ca.gov.