Months after Kaiser Permanente reached a sweeping agreement with state regulators to improve its mental health services, the healthcare giant is facing union allegations that patients could be improperly losing such care.

The National Union of Healthcare Workers, which represents thousands of Kaiser mental health professionals, complained earlier this year to state regulators that Kaiser appeared to be inappropriately handing off decisions about whether therapy is still medically necessary.

The union alleged that Rula Health, a contracted network of therapists that Kaiser uses to provide virtual care to its members, had been directed by Kaiser to use "illegal criteria" to make those decisions during regular reviews.

California requires such decisions about mental health care to be based on criteria developed by professional groups, but the union said there was no evidence that was happening. Instead, the union complained that documents indicated Rula was relying on questions answered by Kaiser patients about their own symptoms.

The risk is that patients "have a psychological disorder that requires additional treatment and Kaiser is unfairly and improperly terminating their access to care," said Fred Seavey, a researcher for the union.

The union also alleged that regularly requiring such "clinical care reviews" violated laws barring insurers from putting up barriers to mental healthcare that don't exist for other health conditions. Kaiser does not subject other outpatient care to such reviews, "let alone at such frequencies," the union said in its complaint.

The union called on the California Department of Managed Health Care to order Kaiser to immediately halt that review process and notify any Kaiser patients whose treatment was "illegally terminated" by Rula.

Kaiser said in a statement that it does not set limits on the number of therapy sessions, and that "the level of therapy needed and the frequency and number of sessions for any patient is a decision made by our mental health care providers in consultation with patients and as appropriate based on the patient's clinical needs."

It added that "the self-assessment tools do not determine whether treatment remains medically necessary. ... Patient self-assessment tools may be used as one aspect of gathering information from the patient but are never the only factor."

A Department of Managed Health Care spokesperson said its enforcement office was looking into the issues raised by the union under its recent settlement with Kaiser. That agreement, reached last fall, required Kaiser to pay a $50-million penalty and invest $150 million over five years into improving its mental healthcare.

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