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Tuesday, June 25, 2013

 

DMHC Fines Kaiser $4 million for Deficiencies that Limit Access to Mental Health Services

Fine levied as a result of issues uncovered during a routine medical survey released in March

(Sacramento) – The California Department of Managed Health Care (DMHC) announced today that it issued a $4 million fine against Kaiser Foundation Health Plan (Kaiser) for four serious deficiencies in providing access to mental health services.

"The Department's actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them," said DMHC Director Brent Barnhart, in announcing the substantial fine. "The Department is taking this action to ensure that Kaiser promptly corrects these deficiencies and provides its patients with the mental health care promised to them by their health plan."

The deficiencies are that the Plan does not:

  • Ensure that its quality assurance systems accurately track, measure, and monitor the accessibility and availability of providers.
  • Sufficiently monitor the capacity and availability of its provider network to ensure that appointments are offered within the regulatory timeframes.
  • Ensure that effective action is taken to improve care where deficiencies are identified.
  • Provide accurate and understandable mental health education materials, including information regarding the availability and optimal use of mental health care services provided by the plan.

The Plan's mental health educational materials, including "Frequently Asked Questions" (FAQ) sheets, Web site postings, and new patient presentations included inaccurate information that could dissuade an enrollee from pursuing medically necessary care. The DMHC also found examples of member materials that, while consistent with the law, did not convey coverage in language understandable to the average member.

The DMHC will conduct a follow-up survey in October of 2013 to ensure that Kaiser has corrected each of the deficiencies and is complying with the law. The DMHC will continue to monitor the Plan as necessary.

The full survey report can be found here: http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_behavioral_030613.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 approximately 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 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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