Northern California Spotlight: What’s Up At Kaiser?
By Barbara Griswold, LMFT
Sept 3, 2020 (Updated 9/23/20)
Northern Californians: Have you heard that something is going on over at Kaiser? Did you get an invitation from Kaiser asking to join their therapist network? Did you get an announcement from Magellan, saying they weren’t dealing with Kaiser anymore?
The skinny: In addition to Kaiser’s own mental health staff, Kaiser has for a number of years been contracting with Beacon Health and Magellan Healthcare to provide care to Kaiser members who have gotten authorization. However, after October 25, 2020, Magellan Health will no longer be covering behavioral health services for Kaiser (Beacon will be continuing).
Will Kaiser be replacing Magellan? According to Magellan’s email, “effective Oct. 26, 2020, Kaiser Permanente will assume management and placement of all behavioral health referrals previously managed by Magellan in Northern California.” In fact. Kaiser is now contracting directly with additional therapists in Northern California in areas where they need more providers (Southern California did the same a few years back). If you are treating a Kaiser client through Magellan you may want to consider applying to be on the new Kaiser Direct Network.
Are there any exceptions? According to an email to Magellan providers, Magellan will continue to cover “continuity-of-care cases where determined to be clinically appropriate, (i.e. an acute or serious chronic condition as defined, specified, and limited by Cal. Health & Safety Code section 1373.96).” Unfortunately, the definition is very vague (Read Code 1373.96 (c) 1 and 2, click here), but it says “completion of covered services shall be provided for a period of time necessary to complete a course of treatment and to arrange for a safe transfer to another provider… Completion of covered services under this paragraph shall not exceed 12 months from the contract termination date or 12 months from the effective date of coverage for a newly covered enrollee.”
What about my Magellan claims? For dates of service prior to Oct. 26, 2020, continue to submit claims to Magellan within 90 days. After that only providers with exemptions can continue to submit to Magellan.
How will it work with the new Kaiser Direct Network? I interviewed a Director of Medical Services Contracting at Kaiser. He said that before the first session, a client would need pre-authorization from a Kaiser Psychiatry screener or other staff member The screener could then use a Kaiser scheduling system to book a member’s intake session with you. I was assured that with this system (called Kaiser Permanente Entry Path, or KPEP), therapists would have the ability to control their own schedule, and make available (or block out) any time slots they wished.
But what will happen to current clients who have a Kaiser authorization through Magellan? According to the Kaiser Contracting Director, if the therapist contracts with Kaiser, at some point Kaiser will issue a new authorization. The provider will not need to do anything, Kaiser will be converting the referrals to Kaiser.
What about my progress notes? A statement from Kaiser stated that Kaiser directly-contracted providers would “use Kaiser Permanente systems to…..create confidential documentation of sessions which are only available to that patient’s therapist.” From what I’m hearing from another therapist who uses this program, Kaiser staff might have access to very limited information you might enter into the Kaiser system (ex. at intake, about symptoms). According to the Kaiser Contracting Director I talked to, “a provider can keep notes separately if they’d like, but could print out the notes they keep in the Kaiser system at any time.”
How much will Kaiser be paying? As always, reimbursement rates are not shared publicly, though will be shared with potential applicants. However, I was able to get my hands on a rate sheet, and they were well above Magellan’s typical reimbursement rate. Some codes were almost double.
One provider’s opinion: One provider working directly with Kaiser in Southern California raved about the new system. “Since I am working more directly with Kaiser, I can more easily fast-track a client appointment with a psychiatrist there, if needed, or get authorization to see a client more frequently. Clients fill out a mini-assessment for Kaiser each time they come in. The downside is they don’t cover couples counseling.”
Want to find out more? If you are a Northern California therapist interested in joining or finding out more about working with the Kaiser network, contact MSCProviderContractInBox@kp.org . To verify active authorizations, call the Referrals Authorization Hub at 1-844-359-5661. Questions can also be directed to MentalHealthExternalProviderQA@kp.org. For questions about your Magellan contract, contact Magellan at CaliforniaProvider@MagellanHealth.com or 1-800-788-4005.
9/23/20 UPDATE: After hearing from many providers that they were unable to get through to Kaiser or get responses, I reached out to my Kaiser contact to see what was up. He said, ” The situation is that we are simply very busy right now. Since Magellan sent out letters to providers telling them that the relationship with Kaiser is ending, we have gotten a little overwhelmed. We expect to catch up soon as all of our mailings have gone out and we are trying to contact and re-contact everyone.”
10/20/20 UPDATE FROM BEACON in email to providers: Effective 10/25/20, Kaiser Permanente of Northern California will have only one behavioral health vendor, Beacon Health Options. Kaiser Permanente has started transitioning members to Beacon and will continue to do so over the next several weeks. Beacon will send providers new authorization for these members. Providers will follow the same process for authorizations, and will be reimbursed according to their contracted rates with Beacon Health Options, Inc. Please check the ProviderConnect portal to find authorization details and start billing Beacon once the Beacon authorization period begins. Beacon will not pay for services that took place before the authorization period begins. For any additional questions, providers can contact Beacon’s National Provider Services Line at (800) 367-6143. Sincerely, Beacon Health Options Provider Relations Department
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