Dive Brief:
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A new California Department of Managed Health Care report found that Kaiser Permanente (KP) is not providing appropriate access to mental healthcare, which violates California law. California requires payers provide patients access to a medical appointment within 48 hours for an urgent need and 10 business days for a non-urgent issue.
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This isn’t the first time that access to mental healthcare has been an issue for KP, which is one of the largest nonprofit health insurers in the U.S. with 11.8 million members, including about 8.5 million members in California. The integrated healthcare system agreed to pay $4 million for “several deficiencies in the plan’s delivery of mental health services” in 2013.
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The state department forwarded the latest issues with KP to the California Office of Enforcement, which will review the case and decide a course of action and possible punishment. In response to the report, KP listed more than 10 interventions it put into place to improve members’ access to mental healthcare since its 2013 issues. KP said a “corrective action plan is not warranted.”
Dive Insight:
The California Department of Managed Health Care conducts surveys of healthcare delivery systems at least once every three years. The department made onsite visits of KP's healthcare delivery system for full service and behavioral health systems. Investigators reviewed files from March 1, 2014 to Jan. 15, 2016 for full service and Dec. 1, 2014 to Jan. 1, 2015 for behavioral health.
The department reviewed: quality assurance, grievances and appeals, access and availability of services, utilization management, continuity of care, access to emergency services and payment, prescription drug coverage and language assistance.
The survey found six deficiencies in four of those areas: quality assurance, access and availability of services, grievances and appeals and utilization management.
California isn’t the only state to hit payers for mental health access issues, although action is rare. New York settled a case in 2015 with Excellus Health Plan for denying addiction and mental health benefits to 3,300 members. New York’s AG’s office has also settled cases with HealthNow New York, Cigna, MVP Health Care, EmblemHealth and ValueOptions over parity issues. HHS has also worked on several initiatives making sure payers are following provisions of the Mental Health Parity and Addiction Equity Act.
The Mental Health Parity and Addiction Equity Act sought to improve mental healthcare and access to services, but issues remain with the mental healthcare system. A study released in April found that adults with serious psychological distress are more likely to lack money for medication and healthcare, and experience more delays in care than adults without it.