In California, Not All EAP Plans Are Created Equal: An Empathia Report


 
 

IN CALIFORNIA, NOT ALL EAP PLANS ARE CREATED EQUAL

AN EMPATHIA REPORT

 

For employers who have or are considering an employee assistance program (EAP) for their workers in California, it is important to understand the requirements of the Knox-Keene Health Care Service Plan Act of 1975 and how it applies to EAPs operating in the state.

Originally, this law was directed at regulating HMOs; however, it now also applies to EAP plans that provide services to employers and their employees in California. In order to deliver services in California, EAP plans must either be registered under an exemption or licensed in accordance with the Knox-Keene Act. Which is necessary for you?

An EAP plan may request exemption from some requirements of the Knox-Keene Act if services consist solely of identification of problems and referral to counseling, treatment, or therapy, i.e. the provider does not actually provide the counseling, treatment or therapy, and the number of sessions with any client does not exceed three (3) within any six-month period.

A licensed EAP plan is eligible to provide mental health services, i.e. counseling, shortterm treatment or brief therapy on an unlimited basis, based on the session model chosen by the employer. The objective of brief counseling through a licensed EAP is to resolve or significantly improve issues within the EAP benefit without referral to insurance, or to provide support until the client can be connected with a longer-term treatment resource through their insurance plan or a community program.

Aside from compliance, there are sound reasons to work with an EAP provider that is licensed. A licensed EAP plan maintains standards for clinical and business operations that directly impact the delivery of services. These standards, which are reviewed by the California Department of Managed Health Care (DMHC) on a routine basis, benefit clients, purchasers, and EAP network providers by ensuring that licensed plans provide:

-A clinical quality management program including standards for access and availability of services and EAP provider quality assurance reviews for easily accessible, high quality services;

-A formal system for handling concerns expressed by clients about services including follow up with clients about the resolution of their concerns, and reporting to the DMHC to ensure that client concerns are addressed and resolved promptly and tracked in a manner which provides for continuous quality improvements;

-A language assistance program to ensure that EAP services and outreach materials are provided for clients whose preferred spoken or written language is not English;

-Policies and procedures for management of its financial systems including claims processing and provider disputes to foster positive working relationships with EAP providers, and attract highly skilled and experienced EAP counselors;

-Tests of specific financial solvency requirements: Under the Knox-Keene Act, only licensed EAP plans are eligible to deliver counseling services on a pre-pay or periodic (per employee per month) basis.

So how do you know if your EAP plan is licensed and can, therefore, provide mental health counseling services? Well, if you have an EAP provider, you can simply ask. In addition, the California Department of Managed Health Care, which is the regulatory agency over health care plans in California, maintains a web site at www.hmohelp.ca.gov with information for consumers including a list of licensed health care plans.

If you have employees living or working in California, be an informed purchaser and ensure that your EAP is operating according to the letter of the law.

 

Empathia Pacific, Inc. is a licensed EAP plan headquartered in Agoura Hills, California. We partner with employers to optimize employee health and well being, workforce engagement, productivity, risk management and disaster mitigation. If you would like to receive a proposal for services, please contact us at 1-866-332-9595 or info@empathia.com. Please contact Barbara Weir at bweir@empathia.com or 818-707-0544 with any questions about this information sheet.