It’s time for the annual report on Kaiser Permanente’s failure to provide timely access to mental health care and accurate information to its patients.

This month’s report (pdf) from California’s Department of Managed Health Care (DMHC) reiterated findings in previous reports that Kaiser has not resolved the “significant and serious concerns” that resulted in a $4 million fine by the state in 2013. Patients are forced to wait too long for appointments with therapists and psychiatrists, and they are given incorrect information about services available to them.

After giving Kaiser a pat on the back for trying (“the Plan has taken steps in good faith to try to correct issues related to timely access to behavioral health services”), the report said it had failed to correct two of the four deficiencies detailed two years ago. Or make that three years ago, or four years ago.

The department’s 2013 report—expanding on an August 2012 preliminary report—echoed, in more bureaucratic terms, a scathing 2011 report by the National Union of Healthcare Workers that alleged Kaiser “often violates California laws” which require “timely access” to mental health services, and “falsified patient scheduling records.”   

The department found four broad areas where the HMO, which has more than 7 million members in the state and probably services more mentally ill patients than anyone besides the government, fell short of the mark.

One of them was that, “The Plan does not sufficiently monitor the capacity and availability of its provider network in order to ensure that enrollee appointments are offered within the regulatory timeframes.”

In other words, the department couldn’t tell from Kaiser’s records whether patients were seeing doctors in a timely fashion, but there was reason to believe they were not. Kaiser acknowledged that its tracking system needed to be fixed and that some patients were being forced to wait longer than 14 days for their first non-urgent appointment.

DMHC Director Shelley Rouillard told the San Francisco Chronicle that Kaiser still hasn’t fixed the problem: “Kaiser’s actions have not been sufficient to ensure enrollees have consistent timely access to behavioral health services.”

Although Kaiser has reportedly hired 25% more mental health workers since 2011, Rouillard told the Los Angeles Times, “Fundamentally it comes down to there are not enough providers in the Kaiser system to serve everyone who needs mental health services.”

And then there’s that pesky problem of misinforming patients. Kaiser “must take additional steps to ensure its providers immediately cease disseminating inaccurate information to enrollees concerning behavioral health benefits and coverage,” the report said. “That misleading health education information is disseminated verbally, and in writing, to patients by providers is of great concern to the Department.”

Kaiser’s non-compliance has been referred to the department’s Office of Enforcement for “further investigation and possible disciplinary action.” The department scheduled regular follow-up reports as part of the action taken against Kaiser in 2013. This won’t be the last.

–Ken Broder

To Learn More:

Kaiser Improves, but Mental Health Appointments Still Lag (by Victoria Colliver, San Francisco Chronicle)

Kaiser Still Doesn't Meet Standards on Mental Health Care Access, Report Says (by Kathy Robertson, Sacramento Business Journal)

Kaiser Mental Health Services Improve, but More Needs to Be Done, Agency Finds (by Rebecca Parr, Oakland Tribune)

State Again Faults Kaiser Permanente for Mental Health Treatment Delays (by Stuart Pfeifer and Chad Terhune, Los Angeles Times)

Kaiser Record Keeping Obscures Mental Health Care Deficiencies (by Ken Broder, AllGov California)

Routine Follow-up Report of Kaiser Foundation Health Plan, Inc. Behavioral Health Services (California Department of Managed Health Care) (pdf)