The written order, as filed, says that Kaiser denied these services with written letters of denial to at least 70 enrollees since 2009. An agency spokeswoman said on Tuesday that the number is now up to 106. Kaiser has at least eight million enrollees in the state.
The DMHC subjected those 70 cases to an independent medical review for evaluation of medical necessity of the requested therapy services. That review found that in excess of 75% of the cases the services indeed were medically necessary, and 10% were not. The remainder are still under review.
Yet, the order says, "Kaiser continues to illegally deny enrollee requests seeking services for physical therapy, speech therapy, and/or occupational therapy."
"The DMHC is taking this action to ensure Kaiser follows the law," DMHC's chief of enforcement, Anthony Manzanetti, said in a public statement. The order says that Kaiser's actions violate eight provisions of state law, health and safety codes or codes of regulation.
John Nelson, a spokesman for Kaiser Permanente, responded to a HealthLeaders Media query by e-mail: