Months after Kaiser Permanente reached a comprehensive agreement with state regulators to improve mental health services, the medical giant is responding to allegations that patients may be unfairly losing such care. confronting.
Earlier this year, the National Health Care Workers Union, which represents thousands of Kaiser's mental health professionals, complained to state regulators that Kaiser appeared to be improperly handing over decisions on whether treatments were still medically necessary.
The union said Lula Health, the contracted network of therapists Kaiser uses to provide virtual care to its members, was instructed by Kaiser to use “unlawful standards” to make these decisions during routine reviews. claimed that it had been done.
California requires such decisions about mental health care to be based on standards developed by professional associations, but the union said there is no evidence that this is happening. Instead, the union complained that the documents showed Lula relied on questions answered by Kaiser patients about their symptoms.
Fred Seavey, a researcher at the union, said there was a risk that patients “have mental illnesses that require additional treatment and that Kaiser is unfairly and unfairly cutting off their access to treatment.”
The union also says that requiring such periodic “clinical care reviews” violates laws that prohibit insurers from putting up barriers to mental health care that don't exist for other health conditions. insisted. The union said in its complaint that Kaiser does not subject other outpatient services to such frequency, much less such reviews.
The union asked the California Department of Managed Care to order Kaiser to immediately halt the review process and notify Kaiser patients whose treatment was “unlawfully discontinued” by Lula.
Dr. Kaiser said in a statement that there is no limit to the number of treatment sessions and that “the level of treatment needed and the frequency and number of sessions for the patient will be determined by the mental health provider in consultation with the patient.” Provided as needed based on the patient's clinical needs. ”
It added: “The self-assessment tool does not determine whether treatment is still medically necessary.” …Patient self-assessment tools are sometimes used as one aspect of collecting information from patients, but they are by no means the only element. ”
A spokesperson for the Department of Managed Care said the department's Enforcement Bureau is investigating issues raised by the union based on the recent settlement with Kaiser. The agreement, reached last fall, requires Kaiser to pay a $50 million penalty and invest $150 million over five years to improve mental health care.
State officials found Kaiser's deficiencies related to failure to provide timely appointments, insufficient oversight of medical organizations in determining “appropriate treatment,” inadequate response to patient complaints, and more. said.
The issues pointed out by DMHC include: The patient's medical records do not show the use of legally required guidelines to make decisions about mental health treatment. Instead, patient records showed “self-assessment scores” from the questionnaire, according to the settlement agreement.
Greg A. Adams, Kaiser Permanente's chief executive officer, said last year that the organization had seen a surge in demand for mental health care during the pandemic, which had led to “a continued need for qualified mental health professionals.” shortages, clinician burnout and turnover, and another decade of workforce growth. One day strike by mental health doctors.
Kaiser said in a recent statement that it is “implementing the changes contemplated in the settlement agreement,” including “significantly increasing the number of providers available to see our members, including both newly hired and contracted therapists.” He said that.
A Rula spokesperson said in a statement that the company's therapists “work with patients to make all clinical decisions regarding treatment.”
Jaclyn Fuentes Soto of Chino said her therapist told her earlier this year that her sessions with Lula providers would soon end, even though “my therapist thought I should continue treatment.” Told. The 25-year-old said if she wanted to continue seeing a therapist, she would have to pay out of pocket.
“I don't think it would be financially possible,” as she is a student and works part-time.
Fuentes-Soto said she has been diagnosed with major depressive disorder and other mental health conditions. She said she has been seeing a therapist regularly since one episode when her mother took her to the emergency room.
“If I don't get the help I need for my mental health, I regress into a very dark place,” she said.
