{"id":96077,"date":"2019-12-18T12:29:27","date_gmt":"2019-12-18T20:29:27","guid":{"rendered":"https:\/\/calmatters.org\/?post_type=tnp_long_form&p=96077"},"modified":"2026-03-27T08:56:25","modified_gmt":"2026-03-27T15:56:25","slug":"mental-health-care-outcry-targets-kaiser-california-parity-regulators","status":"publish","type":"tnp_long_form","link":"https:\/\/calmatters.org\/_zh\/projects\/mental-health-care-outcry-targets-kaiser-california-parity-regulators\/","title":{"rendered":"Mental health care outcry targets Kaiser \u2014 and state regulators"},"content":{"rendered":"

The state is facing mounting pressure to enforce parity laws that are supposed to guarantee equal care for physical and mental health issues<\/a> \u2014 with a spotlight this week on mental health care problems at health giant Kaiser Permanente.<\/p>\n\n\n\n

This week, Kaiser mental health clinicians are on a five-day strike, protesting long patient wait times and strenuous working conditions for providers. They say children and adults with serious mental health needs, including schizophrenia, anxiety and severe depression, are often waiting 6 to 8 weeks \u2014 sometimes longer \u2014 to see a therapist. And they contend that Kaiser\u2019s behavioral health services have in many ways worsened in recent years, despite being under a corrective plan overseen by the state Department of Managed Health Care<\/a>.<\/p>\n\n\n\n

Striking clinicians on Thursday plan to march from the Capitol to the state agency to protest what they called \u201cthe agency\u2019s failure to enforce parity legislation.\u201d They specifically criticized the agency for not releasing reports from an outside monitor that would show whether Kaiser is meeting mental health access benchmarks outlined in a 2017 settlement agreement.<\/p>\n\n\n\n

\u201cI\u2019m very disappointed with the DMHC \u2014 it\u2019s just stunning,\u201d said Fred Seavey, research director for the National Union of Healthcare Workers, which organized the strike. \u201cIt\u2019s just criminal in my mind that they\u2019re not holding Kaiser accountable.\u201d<\/p>\n\n\n\n

\u201cIf these were cardiac catheterization services that were not functioning, if a health plan was screwing those up, (the state) would jump on that and require those to be fixed right away. Meanwhile they\u2019re just sitting on their hands. “<\/p><\/blockquote><\/figure>\n\n\n\n

\u201cIf these were cardiac catheterization services that were not functioning, if a health plan was screwing those up, (the state) would jump on that and require those to be fixed right away,\u201d he said. \u201cMeanwhile they\u2019re just sitting on their hands. We have people who are dying in the course of this failed enforcement by the DMHC.\u201d  <\/p>\n\n\n\n

Seavey criticized Kaiser\u2019s \u201cmassive influence\u201d with the department, and said the union may call an open-ended strike in early 2020 if Kaiser does not improve mental health services.<\/p>\n\n\n\n

After the state\u2019s agreement with Kaiser in 2017, the health plan created a process to ensure that follow-up appointments are available in a timely manner, the state agency said in an emailed statement. Providers who cannot get their patients in for follow-up care are supposed to notify their managers. 
<\/p>\n\n\n\n

The department fined Kaiser $4 million in 2013, but the plan did not agree to a settlement with corrective actions until 2017. That settlement agreement<\/a> is publicly available. But while the state department receives regular updates about the plan\u2019s progress,it says it keeps that information confidential \u201cin compliance with federal and state laws.\u201d <\/p>\n\n\n\n

Kaiser spokesman Marc Brown called the strikes \u201cdisruptive to patient access, operational care and service and\u2026frankly irresponsible.\u201d In an emailed statement, he said this is the union\u2019s sixth strike this year (Seavey said most of these strikes were done at individual clinics, as opposed to statewide). <\/p>\n\n\n\n

\u201cWe take any concern raised about our care very seriously, and always investigate and respond thoroughly,\u201d Brown said. \u201cHowever, it is inappropriate for the union to file multiple, often unwarranted complaints, and attack Kaiser Permanente\u2019s reputation.\u201d<\/p>\n\n\n\n

\u201cThis is not an issue or an area that we can solve overnight,\u201d she said. \u201cWe can’t just throw more money at it. We can’t throw more effort at it. We’re doing the things that we feel are the most important.”<\/p><\/blockquote><\/figure>\n\n\n\n

More than a dozen complaints the union has filed with the DMHC in the past year \u2014 and sought to publicize \u2014 decry violations of network adequacy rules, timely access rules and long appointment wait times, among others. One complaint said patients in Pasadena with schizophrenia, serious major depression and bipolar disorder were waiting three or four months for an appointment. Another complaint said therapists in San Francisco were being told to keep alternative paper wait lists \u2014 or tell patients to call back later \u2014 to hide its failure to see  children in a timely manner.<\/p>\n\n\n\n

Frustration with access to mental health services at Kaiser<\/a> extends beyond the HMO as well. According to a statewide poll<\/a> by the Kaiser Family Foundation and the California Health Care Foundation released earlier this year, more than half of those surveyed thought that most people with mental health conditions are unable to get the services they need. A recent analysis by healthcare consultants Milliman Inc.<\/a> showed that California patients were more than five times more likely to have office visits for mental health or addiction problems from providers outside their insurance plan\u2019s network compared with their counterparts seeking medical or surgical care.<\/p>\n\n\n\n

Concerned about these access problems, State Controller Betty Yee, who sits on the board of the California Public Employees\u2019 Retirement System, wrote a letter to its executive officer requesting a series of hearings with its largest plans:  Kaiser, Anthem, Blue Shield and United Healthcare. Kaiser, with more than 640,000 enrollees, has by far the highest membership.<\/p>\n\n\n\n

\u201cWe negotiate contracts; we have leverage,\u201d Yee said Tuesday, as the CalPERS board was conducting its third hearing on the subject. \u201cTo the extent that parity is not guaranteed, we need to make sure that our plans are living up to the law.\u201d<\/p>\n\n\n\n

State Treasurer Fiona Ma, who also sits on the board, said she\u2019s seen firsthand how her own mother and brother have struggled to get adequate, timely care for depression. She\u2019s been writing letters asking plans to explain the long wait times and high cost of care, and the growing numbers of people suffering from mental illnesses. Plans need to get more creative in finding solutions, she said.<\/p>\n\n\n\n

\u201c<\/strong>Kaiser is out on strike again today,\u201d she said. \u201cWhy is that? Is it because everything is going well? No, it\u2019s because things are not going well in the system and patients are getting sicker and sicker.\u201d<\/p>\n\n\n\n

Kaiser and the Department of Managed Health Care both sent representatives to speak at a  November meeting of the CalPERS Pension and Benefits Committee.<\/p>\n\n\n\n

DMHC director Shelley Rouillard told board members that day that the department takes its responsibility as a consumer protection agency very seriously, and outlined some of its offerings: a consumer help center, independent medical review process, regular monitoring of plans to ensure they have enough providers and enforcement actions against plans that violate timely access requirements. She said Kaiser has met all of the benchmarks of the 2017 settlement agreement so far.
<\/p>\n\n\n\n

But she also acknowledged that, in some cases, it takes years to correct problems with plans.<\/p>\n\n\n\n