Parity

Kaiser mental health patients waiting months for appointments in Sacramento-area, employees say

As reported in the Sacramento Bee, “Sacramento resident Jasmin Hakes said her daughter Riana Mutabdzija has attempted suicide several times but their family still can’t manage to get a Kaiser Permanente therapist to see her on a regular basis. “We were told multiple times that they did not have a therapist that she could see regularly and she was given pamphlets for meditation and sent home and told to go to the emergency room if it got worse.” Hakes and her daughter joined a press briefing with Kaiser therapists, union leader Sal Rosselli and state Sen. Scott Wiener, D-San Francisco, Thursday morning to urge Kaiser to reduce excessive wait times for follow-up appointments that therapists said currently extend at least 2.5 months in the Sacramento region. Read more here.

SB 221 (Weiner) Goes Into Effect July 1

Related to this recent press conference, we want to remind you that the provisions of SB 221 (Wiener), regarding parity and timely access to care, go into effect today, July, 1. One state budget item not mentioned above (we saved it for this part of the newsletter) is that the Legislature just approved 8.0 permanent positions and expenditure authority of $1,320,000 ($660,000 General Fund (GF); $660,000 Federal Fund (FF)) in fiscal year (FY) 2022-23, and $1,248,000 ($624,000 GF; $624,000 FF) in FY 2023-24 and ongoing to perform compliance oversight of Medi-Cal managed care plan timely access to care requirements for follow-up behavioral health services, as required by SB 221 (Wiener, Chapter 724, Statutes of 2021).

It is more important than ever that if you are aware of a plan not following the law that you inform Paul Yoder at SYASL as soon as possible. At the request of many members in Southern California, SYASL has already initiated contact with the Department of Managed Health Care to discuss recent actions and inactions by a particular health plan, even before SB 221 went into effect. The meeting with DMHC will occur sometime in mid-July. In the meantime, as a reminder, SB 221:  

1) Requires a health plan that provides or arranges for the provision of hospital of physician services, including a specialized mental health plan that provides physician or hospitals services, or that provides mental health services pursuant to the contract with a full service plan to comply with timely access requirements pursuant to this bill, and for contracts issued, renewed, or amended on or after July 1, 2022, to provide information to an enrollee regarding the standards for timely access to care, including information related to interpreter services at the time of the appointment without imposing delay on scheduling of the appointment, and in a timely manner, no less than annually.

2) Codifies many of the requirements of the DMHC and CDI timely access regulations described in 2) of the comments section below and adds a new standard, commencing July 1, 2022, for nonurgent follow-up appointments with a nonphysician mental health care or substance use disorder provider of within ten business days of the prior appointment for those undergoing a course of treatment for an ongoing mental health or substance use disorder condition, except when the provider has determined and noted in the record that a longer time will not have a detrimental impact, as specified. States that this does not limit coverage to once every 10 business days. Requires a health plan that uses a tiered network to demonstrate compliance based on providers available at the lowest cost-sharing tier.

3) Clarifies that 2) above, does not permit nonurgent follow-up appointments with a nonphysician mental health care or substance use disorder provider to be limited to once every 10 days.

4) Requires a health plan to arrange coverage outside the plan’s contracted network in accordance with existing law, if medically necessary treatment of a mental health or substance use disorder is not available in network within the geographic and timely access standards set by law or regulation, as specified.

5) Applies the DMHC timely access requirements to Medi-Cal managed care plans. Requires a referral to a specialist by a primary care provider or another specialist to be subject to relevant time elapsed standards, except as specified.

6) Requires DMHC’s timely access report to include demonstration of the average waiting time for each class of appointment regulated under the law.

7) Requires a health insurance policy that is issued, renewed, or amended on or after July 1, 2022, that provides benefits through contract with providers for alternative rates, to provide information to an insured regarding the standards for timely access to care, as specified, including information related to receipt of interpreter services in a timely manner, no less than annually.

8) Requires an insurer to ensure timely access to covered heath care services, including applicable time-elapsed standards, by assisting an insured to locate available and accessible contracted providers in assisting in a timely manner appropriate for the insured’s health needs. Requires an insurer to arrange for the provision of services outside the insurer’s contracted network if unavailable within the network if medically necessary for the insured’s condition. Requires an insureds costs for medically necessary referrals to non network providers to not exceed applicable in-network copayments, coinsurance, and deductibles.

9) Prohibits a plan or insurer from preventing, discouraging or disciplining a contracting provider or employee for informing enrollees or insureds about timely access standards.