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Kaiser Permanente to face state mental health probe

Press ReleasesMay 18, 2022

In a highly unusual move, California’s Department of Managed Health Care (DMHC) is launching a comprehensive “non-routine survey” to examine whether Kaiser Permanente is providing adequate mental health coverage to the 9.4 million Californians enrolled in its health plan. In a statement issued Tuesday to policymakers and mental health advocates, DMHC Deputy Director Amanda Levy explained:

“This nonroutine survey is based on complaints received from enrollees, providers, and other stakeholders concerning the Plan’s behavioral health operations. We will examine the Plan’s behavioral health operations, including but not limited to the Plan’s internal and external provider networks, timely access to care, processes for intake and follow-up appointments, appointment scheduling processes, levels of care and associated decision-making processes, medical record documentation and retention practices, and monitoring of urgent appointments.”

Kaiser has a long track record of failing patients who seek behavioral health care. In 2013, the DMHC fined Kaiser $4 million for failing to provide timely access to mental health care appointments and required it to accept outside monitoring of its mental health services. In a 2021 routine survey, the DMHC cited Kaiser for seven violations of state law and found that it lacked required systems to monitor whether it was providing enrollees with appropriate levels of behavioral health care.

The DMHC’s upcoming survey of Kaiser’s mental health services comes on the heels of concerns raised by Kaiser members, health care advocates and Kaiser’s own mental health clinicians that wait times for mental health therapy appointments were growing even longer as Kaiser failed to boost staffing to meet soaring demand during the COVID pandemic.

Kaiser mental health clinicians, represented by the National Union of Healthcare Workers, have warned that the healthcare giant is unprepared to comply with a new state law, SB 221, which starting July 1 will require all health plans, including Kaiser, to provide return mental health therapy appointments within ten business days unless the treating clinician determines that a longer wait would not be detrimental. Kaiser is frequently making patients wait one to two months between appointments. In a survey of Kaiser mental health clinicians released last year, 65 percent of respondents reported that, on a daily basis, they must schedule their patients’ return appointments further into the future than is clinically appropriate.

“We have been pushing Kaiser Permanente to increase staffing and invest more in behavioral health care so that we can actually address the needs of our patients, but Kaiser keeps refusing,” said Ken Rogers, a psychologist for Kaiser in Sacramento. “Hopefully this investigation will finally force Kaiser to stop denying that it’s failing its behavioral health patients and start working with us to improve its services.”

The DMHC’s investigation comes at a highly sensitive time for Kaiser. It was revealed earlier this year that Kaiser had struck a direct contracting agreement with the Newsom Administration outside of the normal open bidding process to expand its Medi-Cal enrollment. The agreement, which still needs final legislative approval, could result in Kaiser enrolling Medi-Cal patients who are less likely to require medical care while county health plans and health systems receive a greater share of Medi-Cal recipients who are more likely to require care. Under this direct contracting agreement, over the next five years, as many as 200,000 Medi-Cal beneficiaries, including many who require mental health services, could be involuntarily enrolled with Kaiser.

Despite repeated promises by Kaiser that it will become “fully compliant” with behavioral health access laws by July 1, legislators have expressed serious concern over the HMO’s ongoing failure to provide timely care. “One of the biggest challenges we have seen over and over again is around behavioral health,” Assembly Health Committee Chairman Jim Wood told Kaiser officials last month during a hearing about the tentative agreement for Kaiser to accept more Medi-Cal enrollees. “I’m worried about that, and now we’ll have foster youth, and a great number of those children are going to need behavioral health services.”

NUHW has urged California legislators not to approve any expansion of Kaiser’s Medi-Cal enrollment unless and until the state obtains ironclad guarantees that the HMO will be able to meet the minimum behavioral health access standards required by law. In the wake of Tuesday’s announcement, the union is redoubling its call on Kaiser to invest in the staffing necessary to deliver patients the quality behavioral health care they need.

“Kaiser Permanente has been in denial for too long about the suffering it has inflicted on its own members by under-funding its mental health services and making patients wait months between therapy appointments,” NUHW President Sal Rosselli said. “We commend the DMHC for heeding the call of Kaiser patients and caregivers to hold Kaiser accountable, and we remain ready to work with Kaiser to achieve real parity for mental health care.”