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Tuesday, February 24, 2015

 

DMHC Issues Follow-up Report on Kaiser’s Behavioral Health Services

(Sacramento) – Today the California Department of Managed Health Care (DMHC) issued a follow-up report to the routine medical survey of behavioral health services for Kaiser Foundation Health Plan (Kaiser) conducted in 2013. The follow-up survey determined that two of the four deficiencies identified during the 2013 survey have been corrected. The two uncorrected deficiencies have been referred to the DMHC’s Office of Enforcement for further investigation. The next routine survey of Kaiser, which will include both medical and behavioral health services, is tentatively scheduled to commence in late 2015.

“Although Kaiser has taken substantial steps to identify and monitor issues related to timely access to behavioral health services, significant and serious concerns remain,” said DMHC Director Shelley Rouillard. “Kaiser’s actions have not been sufficient to ensure enrollees have consistent timely access to behavioral health services.”

The corrected deficiencies are:

  • Deficiency 1: The Department finds that the Plan has made significant system changes and conducted training to address data problems, and performed audits to verify the effectiveness of its corrective actions. The Department confirmed that data being recorded in the Plan’s system appears to reflect accurate dates of appointment requests and occurrences.
  • Deficiency 2: The Department finds that the Plan created a new measure for tracking and reporting appointment wait times, developed reports that identify this data by Plan medical center and department, and uses the reports for ongoing monitoring and reporting of its compliance with timely access.

The uncorrected deficiencies are:

  • Deficiency 3: Although the Plan has made significant strides toward correcting deficiencies concerning its obligation to monitor and provide access to behavioral health services, the Department concludes that the Plan’s corrective actions have not sufficiently fixed the access-related problems identified.
  • Deficiency 4: Although the Plan implemented policies requiring internal review of printed and on-line health education materials prior to making those materials available to enrollees, the Department’s review revealed individual cases in which providers disseminated inaccurate and misleading health education information to enrollees regarding the scope of their coverage for behavioral health services.

The DMHC found that in Kaiser’s Northern Region, appointments for mental health services did not occur within the required regulatory timeframe in 22 percent of the medical records reviewed. In Kaiser’s Southern Region, appointments did not occur within the required regulatory timeframe in 9 percent of the medical records reviewed. Further, the DMHC found that Kaiser providers relayed inaccurate and misleading information to enrollees regarding the scope of behavioral health services available.

The full survey report can be found here:
http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_behavioral%20follow% 20up_021315.pdf

Californians with questions about access to care can contact the DMHC Help Center at 1-888-466-2219 or visit www.HealthHelp.ca.gov.

About the DMHC

The DMHC regulates managed care health plans in California, protects the rights of more than 20 million health plan enrollees, educates consumers on their health care rights and responsibilities, and preserves the financial stability of the managed health care system. Since 2000, the department has helped more than 1.5 million Californians resolve health plan problems through its Help Center. Information and assistance is available 24/7 at www.HealthHelp.ca.gov or by calling 1-888-466-2219.


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