California's Department of Managed Health Care has levied a $4 million fine against Kaiser Foundation Health Plan, Inc. of California for failing to provide timely access to and accurate information about behavioral health services for its 6.8 million members. The DMHC fined the insurer for its failure to promptly correct "four serious deficiencies" that were first identified in a preliminary DMHC report in fall 2012 and reissued to the insurer in a final report this spring.
"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. "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."
Three of the deficiencies involved the insurer's failure to ensure timely access to behavioral health services, access comparable to that offered for physical health care services. In announcing the fine, DHMC officials stated that Kaiser’s appointment systems: 1) failed to properly track provider availability as required, 2) illegally underreported the wait times experienced by patients seeking non-emergency behavioral health appointments and made them wait too long between visits, and 3) were not repaired within 45 days as required by state law.
The fourth deficiency involved information that Kaiser provided to its members about plan benefits. DMHC officials said that some of the language was excessively difficult to understand while other information was inaccurate. Officials expressed concern that such information might “dissuade an enrollee from pursuing medically necessary care.”
Kaiser officials acknowledged the deficiencies upon receipt of the report and stated that they were involved in taking remedial actions. However, one Kaiser official called the recent $4 million fine “unwarranted and excessive.”
Meanwhile, some Kaiser behavioral health employees hailed the fine, pointing to a lengthy November 2011 report by the National Union of Healthcare Workers (NUHW) that said “the HMO’s mental health services are sorely understaffed and frequently fail to provide timely and appropriate care.” This report went on to detaill care-access concerns that parallelled the DMHC's findings in late 2012 and 2013.