Kaiser Permanente Whacked Again on Lack of Timely Access

From our legislative and policy advocate Beth Capell:

The Department of Managed Health Care has again taken Kaiser Permanente to task for lack of timely access to mental health care.

DMHC did a follow-up survey after its enforcement actions last year, which included a $4 million, one of the biggest fines ever. But apparently $4 million is not enough to get Kaiser to fully fix the problem. Apparently Kaiser is doing better but not well enough to comply with the law. DMHC found that in Northern California 22% of patients waited too long for treatment and in Southern California 9% did. California regulations specify that non-urgent appointments must be made available in 10 days for most mental health professionals or 15 days for a psychiatrist. (Urgent appointments must occur within 48 hours for mental health care.)

Kaiser has a new system for tracking mental health appointments, one of the requirements imposed by DMHC last year. But at a recent public meeting on enforcement of timely access, mental health providers from Kaiser Oakland described how Kaiser scrubs its books by deleting the original appointment request if a patient fails to follow up within five days of receiving a call back to schedule the appointment—whether the patient is suffering debilitating depression or even expressing suicidal thoughts. In contrast, patients seeking physical health appointments can often schedule such appointments over the telephone or on-line.

Kaiser also failed to provide accurate information about what mental health benefits are covered. Adding mental health and substance abuse treatment to coverage in the individual and small employer market was one of the important improvements wrought by the Affordable Care Act but as with many other changes, consumers (and sometimes providers) are confused about what is covered when. Getting the information right is important so consumers know what care they should be able to get.

DMHC found some improvements but as DMHC Director Shelley Rouillard said, “That is not a good performance. Fundamentally it comes down to there are not enough providers in the Kaiser system to serve everyone who needs mental health services.”

Health Access sponsored the original legislation that required timely access to care in 1997, almost twenty years ago. When the law governing HMOs and most PPOs passed in 1975, forty years ago (when Jerry Brown was governor the first time), the law required that “all services shall be readily available at reasonable times to each enrollee consistent with good professional practice”. Forty years later DMHC is still trying to enforce that promise.