New DMHC Examination

Monday, the Department of Managed Health Care (DMHC) notified Kaiser Foundation Health Plan, Inc. (the Plan) that DMHC will commence a non-routine survey to examine enrollees’ access to behavioral health services.

This nonroutine survey is based on complaints received from enrollees, providers, and other stakeholders concerning the Plan’s behavioral health operations. DMHC will examine the Plan’s behavioral health operations, including but not limited to the Plan’s internal and external provider networks, timely access to care, processes for intake and follow-up appointments, appointment scheduling processes, levels of care, and associated decision-making processes, medical record documentation and retention practices, and monitoring of urgent appointments.

This survey will be conducted pursuant to the Knox-Keene Health Care Service Plan Act of 1975 (Health and Safety Code section 1382 and California Code of Regulations, title 28, section 1300.82.1). Please note, this is a separate survey from the Behavioral Health Focused Investigations scheduled for 2022. For more information on the DMHC’s survey process, please click here.  

The timing of this, with the Administration’s proposed contract with Kaiser under scrutiny by the Legislature, seems remarkable. Apparently complaints about Kaiser increased by 20% from 2020 to 2021. 

As Politico reported, “The state Department of Managed Health Care in 2013 fined Kaiser $4 million for inadequate access to mental health care, and in 2017 released a survey that found continuing problems with those deficiencies. A 2021 report on a routine surveyconducted by the department in 2019 found seven deficiencies, including that Kaiser lacked the required systems to properly monitor whether it was providing enrollees with appropriate levels of behavioral health care. Meanwhile, demand for mental health services has increased dramatically throughout the country as a result of the Covid-19 pandemic.

Amanda Levy, a deputy director with the department, said in a letter to policymakers and health advocates that investigators will examine Kaiser’s external and internal provider network as well as such issues as whether patients received timely access to care, the processes for making initial and follow-up appointments, record documentation and the monitoring of urgent appointments.

Kaiser officials said Wednesday they welcomed the opportunity to work with the agency on a “thoughtful, impartial review” of the health system’s care. “We look forward to working collaboratively to identify ways to improve, so we can better help our members with all of their mental health needs,” Kaiser spokesperson Steve Shivinsky said in a statement.”

State Contract

There is updated trailer bill language this week to implement the single Medi-Cal contract for Kaiser. Of note, changes include:

  • Clarify that former foster youth are included in the enrollment provisions related to foster youth.
  • Add that default enrollment is part of the growth in Medi-Cal enrollment.
  • Specify that Kaiser cannot deny or disenroll any individual that meets the specified enrollment or default criteria.
  • Specify that Kaiser is subject to all the same standards and requirements, except those related to beneficiary enrollment, as required for other Medi-Cal managed care plans, including the requirements pursuant to CalAIM.
  • Require that DHCS and Kaiser enter a Memorandum of Understanding (MOU) describing the requirements that are different than those imposed on other Medi-Cal managed care plans. The MOU shall include, but not be limited to, the commitment of Kaiser to increase its enrollment of new Medi-Cal members over the course of the contract term and requirements related to Kaiser’s collaboration with safety net providers, including Federally Qualified Health Centers.
  • Require that DHCS post this MOU and publish a report describing the implementation of the requirements imposed by the MOU.
  • Provide that Kaiser shall implement the California Children Services Whole Child Model in counties where the Whole Child Model currently exists.
  • Ensure Kaiser maintain Knox-Keene licensure from the DMHC.

Recent Stories