For weeks, Cornerstone has been grappling with Kern Behavioral Health and Recovery Services. The issues began several weeks ago when a signed claim for payment was rescinded. Multiple attempts were made to expedite payment or issue it based on detrimental reliance and reasonableness. In the process of trying to collect the payment, Cornerstone has faced retaliation and discovered that our clients’ rights are being violated. KernBHRS appears to prioritize their numbers and statistics over the lives at stake. Furthermore, after filing a grievance, KernBHRS's response contained inaccuracies. They allow a disparity in services that enables contracted entities to exploit clients through network adequacy requirements.

Several weeks ago, there was a payment claim signed by Ana Olvera, Director of Drug Medi-Cal at KernBHRS. It turned out to be an error, but we were relying on those funds. They informed us of the mistake on the day I was supposed to pick up the check. When Jessica Armstrong, one of KernBHRS's Deputy Directors, contacted me, she apologized and stated it was a mistake. The best they could do was expedite the next billing cycle. They could not provide a specific date or estimate of when we would receive the check, only suggesting it could take two weeks to a month. We cannot afford to wait that long, having already made financial commitments based on the expected claim. Today, I received an email stating that expediting the billing contains a major discrepancy in the amount owed. The check will not be available until mid-July 2024. I am currently investigating the reason for this significant billing disparity because fewer funds mean fewer services we can provide to our community.
Since filing a grievance, KernBHRS responded by requiring a large amount of new paperwork before processing payment, paperwork not previously required. KernBHRS has also requested information suggesting an attempt to revoke treatment approvals for already approved clients, which seems reflected in their estimated billing statement. They are also refusing to renew our continuity of care contract expiring on June 30, 2024.

Much of the retaliation from KernBHRS began when I pointed out a contract error benefiting Cornerstone. This retaliation itself infringed upon clients’ rights. Immediately after informing Ana Olvera that we would adhere to the contract as written, she stated they would initiate reassessments for approved clients. Some clients were overdue for reassessment, and remained un-assessed for four months. Those reassessed did not receive the standard ASAM assessment (30-45 minutes) but instead a five-hour assessment over several days, which did not address their substance use issues. These clients have yet to receive results and decisions from KernBHRS after two months.

The reassessment aimed to determine if clients were still eligible for continuity of care to continue treatment with Cornerstone, an out-of-network provider. Instead of granting continuity of care, KernBHRS decided not to renew Cornerstone's contract, effectively cutting off services to all our Drug Medi-Cal clients. The eight Medi-Cal clients under our care have not received notice of service discontinuation, violating their continuity of care rights. I learned about the non-renewal after questioning the rescinded payment claim. Clients only know because I am ethically obligated to inform them. The stress and anxiety caused to clients have been immense, with some on the brink of relapse, and one client missing for two days. KernBHRS, the County Supervisors, and County Counsel have refused to address this issue, stating they can contract with whomever they choose. However, if any other health insurance company behaved similarly, heavy fines would ensue.

When we reopened in May 2022, KernBHRS should have initiated single-case agreements or a master agreement with Cornerstone to meet network adequacy standards. Instead, they deferred because another company was contracted but not operational. Such actions would incur fines for any other insurer. Between May 2022 and March 2023, before the other company opened, more than 20 people, that we know of, died from overdoses. KernBHRS and the Board of Supervisors are potentially liable for these deaths and possible wrongful death suits for failing to provide timely services despite a willing and able provider willing to accept current rates. Two years ago when I first approached Ana Olvera I told her that people were dying and services were needed. She told me there was nothing she could do.

KernBHRS's response has been inadequate. They cite county and state policies for their inability to contract with more providers and for their responsibility to use taxpayer funds appropriately. Kern County is unique in this approach. Other counties follow the same five-year contracting schedule but recognize client-centered care and the right to choose a provider, necessitating single-case and master agreements. The majority of Drug Medi-Cal funding comes from the state, with excess costs the county’s responsibility.

KernBHRS's response to my grievance seemed dismissive. Initially, they claimed we were denied a contract because we did not apply during the original cycle. Cornerstone did not apply because, in 2020, we were informed that we needed Drug Medi-Cal approval to do so. Upon receiving approval in 2022 upon reopening, we were informed another program had been awarded the contract, even without their Drug Medi-Cal approval. Such disparities seem commonplace. Large national corporations receive preferential treatment in contracting processes. A year ago, Ana Olvera informed me she did not renew a small clinic’s contract because a larger corporation could cover a wider area by opening multiple clinics. The decision favored larger companies over smaller ones, regardless of care type or quality.
Disparities extend to service availability in West and East Kern County. West Kern County has 20+ substance abuse treatment clinics, while East Kern County has only 4, three owned by the same provider. I identified only two non-large/national organization treatment facilities in Kern County. County bias against nonprofits and smaller clinics limits client access to diverse care styles tailored to individual needs. Lack of competition drives inflated profits, overworked counselors and therapists, and abusive practices hindering client care.

I called and emailed Ana Olvera multiple times about these issues. Responses from management suggest everything is fine. There appears to be no inquiry directed to clients or direct care providers. KernBHRS focuses on clinic statistics and numbers, enabling providers to exploit clients. For instance, in substance abuse the first 48 hours are essential to a clients willingness to get treatment. Several studies, that can be found in the National Library of Medicine, have shown that ‘treatment on demand’ models are the most successful in client retention, though they do acknowledge that it is a difficult task. That difficulty has meant that Drug Medi-Cal’s network adequacy requirement allows 15 business days between the request for treatment and the time a client must be seen. As I understand it, this length of time is to protect insurance companies from fines when treatment is unavailable in an area, but that services are to be provided as soon as possible. Because there is a lack of competition several companies schedule everyone 10 to 15 days out, so some drop out. After their initial assessment it can take another 10 to 15 days for the second appointment, and at times another 10 to 15 days before they can begin program. Very few clients that I am aware of have the luxury to wait. This abusive approach allows companies to meet their statistical and numerical requirements to satisfy the county and prevent the need for more services to be seen. I believe that most companies understand that someone with a substance abuse issue is most likely not in a place or state of mind to file a complaint. Even if they are, the company is covered by the adequacy standards. Such practices meet county statistical needs but neglect urgent service gaps.
Last night, I planned to share this with the Behavioral Health Board, hoping for action. I had been scheduled for a month to present Cornerstone’s current and future programs. I intended to pivot during this presentation, addressing KernBHRS's actions potentially halting programs. Moments after raising these issues, Alison Burrowes, KernBHRS Director, intervened with the BHB Chairman, halting my presentation. I was given the choice to continue with Cornerstone's programs or step down. Assurance of questioning KernBHRS’s grievance response afterward was unmet, as County Counsel left promptly. Worse, after my presentation, the Brown Act public speaking opportunity was overlooked, denying clients a chance to air grievances on KernBHRS’s rights violations.