Kaiser Permanente is facing allegations from the National Union of Healthcare Workers that it improperly denied members mental healthcare.
The allegations come after Kaiser Permanente reached a $200 million settlement with the California Department of Managed Health Care, after an investigation found Kaiser violated timely access and clinical standards, and in some cases canceled members' behavioral health appointments.
The system paid $50 million in fines and pledged a $150 million investment in its behavioral health infrastructure.
In a March 24 press release, the National Union of Healthcare Workers alleged Kaiser directed Rula Health to use improper criteria based on patient self-assessments to determine if behavioral health services were still medically necessary for members. Kaiser contracts with Rula Health to provide behavioral telehealth care to members.
The National Union of Healthcare Workers, which represents thousands of Kaiser behavioral providers, alleged Rula Health is not authorized to perform these reviews and uses criteria in violation of state law to decide if members should continue receiving insurance coverage for behavioral health services. The union called on the managed healthcare department to investigate cases where patients' care was terminated by Rula Health.
"The findings of our investigation are alarming because they call into question whether Kaiser truly intends to honor last year's settlement agreement," Sophia Mendoza, president of the National Union of Healthcare Workers, said in the news release.
A spokesperson for California's managed healthcare department told the Los Angeles Times it was looking into the issues raised by the union.
A spokesperson for Kaiser Permanente told Becker's the system is making significant investments in improving access to care across the behavioral health ecosystem.
"Our programs adhere to evidence-based clinical standards that are designed to meet our patients' needs. We respect and follow the treatment recommendations of our providers and do not set specific limits on the number of sessions a patient may receive. Our contracted providers are paid fee-for-service, with no penalty for providing more visits," the spokesperson said.
Self-assessment tools are used to help providers better understand a patient's individual needs, the spokesperson said.
"Contrary to NUHW's allegations, our providers never rely solely on patient self-assessment tools to determine the level of clinically appropriate care," the spokesperson said. "Our Feedback Informed Care model is designed to ensure that therapy is effective for the individual patient by incorporating the patient's perspective about the therapy, whether it is effective and whether the goals of the therapy are being met."