Kaiser Permanente Ordered to Halt Denial of Care
Kaiser Foundation Health Plan is illegally denying some of its California enrollees physical, speech and occupational therapy services, says a cease and desist order filed Monday by the state.
According to the order, Kaiser "categorically denies coverage" for these services on the basis that certain enrolleess do not have a physical condition or physical impairment that triggers the coverage, and does not provide these patients with a medical necessity review, says the Department of Managed Health Care, which regulates managed care plans serving 21 million lives.
ACCESS. INSIGHT. ANALYSIS.
Join the HealthLeaders Media Council
Get members-only access to industry-wide intelligence, forecasts, and analysis positions your organization to benchmark against your peers, identify and respond to key trends shaping healthcare, and make sound business decisions.
California's Knox-Keene Act specifies that speech therapy, physical therapy and/or occupational therapy "are required basic health services, and therefore Kaiser's denial of coverage for physical therapy, speech therapy, and/or occupational therapy based on a lack of physical impairment is illegal and contrary to the Act," the order says.
- Reform Puts Vise Grips on Physicians
- Medicare Opt-Out a Viable Physician Strategy
- Look Beyond Nurse-Patient Ratios
- Boston Marathon Bombing Yields Lessons for Hospitals
- The Flourishing Medical Tourism Business in America
- Physicians as Economic Powerhouses and Tech Laggards
- NPP Demand Rising Under Value-Based Care Models
- How Physicians Can Help Ease Mental Health Provider Shortages
- Providers Lag as Consumers Set Agenda
- Hospital Groups Back NQF Report on Patient Sociodemographics