Despite some improvements, Kaiser Foundation Health Plan is still not providing timely appointments for a significant portion of the HMO’s patients in Northern California, state regulators said Tuesday.
The Department of Managed Health Care reported that appointments for mental health services did not occur within the required regulatory time frame in 22 percent of the medical records it reviewed in Kaiser’s Northern Region. In Kaiser’s Southern Region, timely appointments did not occur in 9 percent of the medical records regulators reviewed.
The agency also found that Kaiser continued to give some patients “inaccurate and misleading” information about the scope of mental health coverage.
“Although Kaiser has taken substantial steps to identify and monitor issues related to timely access to behavioral health services, significant and serious concerns remain,” DMHC Director Shelley Rouillard said in a statement. “Kaiser’s actions have not been sufficient to ensure enrollees have consistent timely access to behavioral health services.”
Kaiser responded positively to the findings, focusing on areas where the health care provider has made progress.
The DMHC’s findings are part of a follow-up report to a routine survey of Kaiser conducted in 2013, which found four principle deficiencies in the health plan. Among other things, the survey found Kaiser was not accurately tracking patients’ access to its therapists and not providing timely initial appointments with therapists for non-urgent matters, in violation of state regulations.
The survey also found Kaiser was providing inaccurate information about available services, effectively discouraging patients from seeking certain mental health treatments.
The state later fined Kaiser $4 million for these deficiencies. Kaiser at first challenged the penalty but last fall opted to pay the fine, though it did not concede the state’s findings of wrongdoing.
In the follow-up survey, which was conducted in 2013 and 2014, the DMHC found that Kaiser has “made significant system changes” to correct data issues, and performed audits to ensure the effectiveness of its corrective actions.
The agency said it has confirmed that system data used by the HMO appears to reflect accurate dates of requests for appointments and occurrences.
The agency also found that the health plan has created a new measure for tracking and reporting appointment wait times and developed reports to monitor its compliance with timely access.
John Nelson, Kaiser’s vice president of government relations, said the HMO is “proud” of actions it has taken to improve access to mental health services since the initial survey and that it continues to take more steps, including hiring mental health therapists and aggressively recruiting for more.
“We are pleased the DMHC has deemed two of its prior findings corrected,” Nelson said in a statement. “Our very concrete efforts to improve monitoring of access, and improve access itself through traditional and innovative means, are recognized by the DMHC throughout its findings.”
For years, Kaiser has been criticized by both its therapists and patients for not having enough psychotherapists and for favoring group therapy over one-on-one therapy. Critics argue that there is a host of serious mental health issues for which group therapy is both inappropriate and ineffective.
The National Union of Health Care Workers, which represents Kaiser therapists and is currently in labor negotiations with the health care provider, has been one of the most vocal critics. Last January, about 60 Santa Rosa mental health workers walked off the job as part of a weeklong strike across the state to protest stalled contract negotiations and what union members said was inadequate staffing to serve a growing number of patients. At least 2,600 mental health professionals represented by the union participated in the statewide protests.