The California Department of Managed Health Care (DMHC) issued a $4 million fine against Kaiser for not providing enough access to mental health services. DMHC Director Brent Barnhart, said, “The Department’s actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them.” DMHC says that Kaiser does not do the following:
• Make sure that quality assurance systems accurately track, measure, and monitor the accessibility and availability of providers.
• Monitor its provider network to ensure that appointments are offered within regulatory timeframes.
• Provide effective action to improve care where deficiencies are identified.
• Provide accurate and understandable mental health education materials, including information about the availability and optimal use of the plan’s mental health care services.
The plan’s mental health educational materials, including frequently-asked-question sheets, Website 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 to make sure that Kaiser has corrected the deficiencies and is complying with the law. The full survey report can be found here:http://www.dmhc.ca.gov/library/reports/med_survey/surveys/055bh031813.pdf.
