For the second time in two years, California regulators slammed HMO giant
The state Department of Managed Health Care said in a report Tuesday that some Kaiser patients continue to wait weeks to see therapists and psychiatrists. The agency also criticized Kaiser for giving patients misleading information about the extent of their mental health coverage.
To illustrate the problem, state officials cited several stark examples of patients in serious distress, including a sexual assault victim and a young girl with significant behavior problems, facing troubling delays.
The report was a follow-up to a 2013 survey that found four major deficiencies in Kaiser's handling of mental health patients. The agency fined Kaiser $4 million that year and ordered it to improve its performance.
Tuesday, regulators said Kaiser had corrected two of the four areas but that it still fails to meet state standards for the others.
"Even with all the changes Kaiser has made, there are still serious concerns about patients' ability to get timely access to mental health services," said Shelley Rouillard, director of the Department of Managed Health Care. "I want Kaiser to fix the problem and do what they need to do to make sure their members get the mental health services they need."
Kaiser said it had made significant improvements and had been on a hiring spree to make sure it had enough staff to meet demand. The healthcare provider said it increased its roster of therapists 25% from 2011 through early last year.
In a rare move, the Oakland-based HMO also contracted with an outside group of providers known as ValueOptions. Kaiser typically shuns those out-of-network arrangements and prefers using its own network of in-house providers and facilities.
"We are proud of the progress we have made," Kaiser said in a statement. "Since the follow-up review was conducted, we have made even more progress."
The state agency hasn't determined what penalties, if any, will be imposed on Kaiser, and its investigation is ongoing.
For 2014, Kaiser reported annual revenue of $56.4 billion and operating income of $2.2 billion.
In Tuesday's report, the agency described several cases in which patients ran into potentially dangerous delays:
• A Northern California teenager with a history of depression and suicidal thoughts waited 24 days before getting an initial appointment with a therapist.
• A sexual assault victim was diagnosed with post-traumatic stress disorder and major depression, but had difficulty getting follow-up care. At one point, a Kaiser psychiatrist suggested the patient seek treatment outside the plan at her own expense. The patient waited five months for an appointment.
• A family pleaded with Kaiser to treat a troubled child with aggressive behavior, but was forced to wait seven weeks before the child was seen for therapy.
State regulators said they reviewed medical records of nearly 300 patients and found a continuing problem with long wait times. In Northern California, patients didn't get initial or follow-up appointments within the required time frame of 10 to 15 business days in 22% of the records reviewed. In Southern California, Kaiser failed to meet that standard in 9% of cases reviewed. That didn't pertain to urgent care that must be provided within 48 hours.
"That is not a good performance," Rouillard said. "Fundamentally it comes down to there are not enough providers in the Kaiser system to serve everyone who needs mental health services."
Officials also faulted Kaiser physicians and staff for misleading patients about their covered benefits and in some instances suggesting they seek care elsewhere.
In one instance, Kaiser staff told a patient that "longer-term therapy is not a covered benefit" and referred the patient to private therapists in the community at the patient's own expense, the report said.
"No one ever sees a therapist once a week in the Kaiser health plan" another patient was told by Kaiser, according to the report. "Not a covered benefit for the past 20-something years and will not be a benefit in the future."
Rouillard said those responses were inappropriate.
"Kaiser must provide mental health services to people who need them based on medical necessity," she said, "and as long as people need them."