State regulators once again critical of Kaiser mental health access

Despite efforts to hire more therapists, Kaiser Permanente continues to fall short in delivering timely and appropriate access to mental health services, according to state regulators.

In its latest routine survey of the HMO, the state Department of Managed Health Care, which regulates and monitors health plans, identified several deficiencies in Kaiser’s Northern and Southern California mental health operations. Among other findings, the state said Kaiser does not adequately track the “availability and timelines” of follow-up mental health appointments, nor does it take effective and timely action when it finds problems.

John Nelson, Kaiser’s vice president of government relations, said in a statement that the health plan has taken steps to address issues raised by the state since the survey was conducted and Kaiser has “demonstrated high compliance levels for the past year.”

The state agency agreed Kaiser had undertaken “substantial actions” to improve access to follow-up mental health appointments. Nonetheless, it said Kaiser has not proven with “verifiable results” that it is complying with state access laws, which call for urgent appointments to be made within 48 hours and nonurgent appointments within 10 days.

The agency found Kaiser “failed in some of its facilities” to meet its own internal compliance standards for initial appointments and “did not have a mechanism in place to ensure it provided timely follow-up appointments” for mental health service.

The finding comes less than two years after Kaiser agreed to pay a $4 million fine levied by state regulators for “serious deficiencies” in providing timely access to mental health services. That fine was the result of a routine survey by the state agency in 2012.

The current survey, published June 12, also found Kaiser does not immediately tell its members who file expedited grievances of their right to also notify the state Department of Managed Health Care of their grievance. DMHC’s Office of Enforcement is looking into some of the deficiencies cited in the report and that could result in more fines.

The agency visited Kaiser facilities in 2016 and 2017, and reviewed mental health files from December 2014 to January 2015.

Since the survey began, Kaiser has hired 1,030 new psychiatrists and therapists, expanded its network of community practitioners and introduced more convenient avenues for treatment, Nelson said.

“We do disagree with the department’s finding regarding behavioral health appointment availability and tracking,” he said.

In the case of follow-up appointments, Kaiser has reached a 90 percent treatment plan compliance rate among nearly 3,000 cases reviewed by state regulators, Nelson said.

“We are committed to continually assess results, and to improve access for this critically important service,” he said.

The Department of Managed Health Care will conduct a follow-up review within 14 to 16 months. Kaiser, in its formal response to the latest survey, said it is aggressively working to meet all of the agency’s requirements and is confident the follow-up survey will find no deficiencies.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @renofish.