Disability & Accommodations Paperwork
Provider payment for medically necessary form completion will be provided by Rula. Do not invoice the patient directly for this service. Disability paperwork (includes FMLA and state disability certifications) will be paid at a flat rate of $150, and medical accommodations letters will be paid at a flat rate of $50. For Rula’s full policy and an outline of how to receive payment, please see this help center article.
Registering with CA EDD
Providers must be registered with CA EDD in order to complete state disability paperwork. Avoid agreeing to form completion until this step has been completed as this process involves multiple steps which can delay timely form completion. For instructions on how to register with CA EDD, please see this help center article.
Stimulant Prescribing Restrictions
Kaiser pharmacies do not permit sending consecutive controlled substance prescriptions at one time, even when indicating a future do not fill date on each prescription. You must send each schedule II controlled substance monthly as these medications are not permitted to be "refilled" per DEA regulations. When prescribing stimulants, advise your patient they must reach out to you 7 days before they will run out of their medication. This will allow time for processing the request and avoid delays in treatment.
Medical Consultation
Under this agreement, HLOC requests for medical consultation by a Kaiser MD related to the use of stimulants or other situations involving medical complexity require additional coordination with your collaborating MD prior to submission.
Please follow the below steps prior to HLOC submission:
- Thoroughly document the rationale for the Kaiser MD consult in your note
- Have your collaborating MD review and sign a note confirming medical necessity
- Upload the MD signed document as an addendum to your note
- Submit your HLOC request for Kaiser MD consult via the Care Coordination form.
After submission, Rula takes care of the next steps. Please ensure the collaborating MD review process is completed within 7 days of the visit to avoid care delays.
Neuropsychiatric Testing
Routine referrals for neuropsychiatric evaluation/testing are not indicated for the straightforward diagnosis of ADHD and are not covered by Kaiser. If you have a complex case with diagnostic uncertainty, suspect cognitive impairment or need further evaluation of a child with suspected ASD, be sure to consult with your supervising MD before submitting an HLOC request. See this link for more information about neuropsych testing.
Tip: If the outcome of the neuropsychiatric testing will not change the treatment plan, it will not be covered by Kaiser.
Kaiser Epic Access
As part of this agreement, each provider must register for view-only access to Kaiser's EHR (EPIC) via the Kaiser community portal. It is expected that these records will be reviewed prior to each session to ensure safe, effective and coordinated patient care. Review this article for instructions on how to access the portal. Review this video for an overview of how to use the portal.
Kaiser Medication Formulary
Before prescribing, always consult the KP formulary to ensure that the medication you are prescribing is covered by Kaiser and that all step wise requirements have been met and thoroughly documented in your note.
Checking the formulary before prescribing helps ensure the prescription is covered by Kaiser, reduces delays in starting treatment, and supports consistent, evidence-based prescribing practices across the network. For additional guidance on Kaiser Permanente drug formularies, refer to the Southern California Drug Formulary resource.
Patients in Crisis
KP has a dedicated crisis line for their members: (866) 205-3595. Be sure to provide this information at each session along with other crisis resources (988, Rula Crisis Line - (877) 371-5488). For more information on how to support patients in crisis, please see this help center article.
If a patient is assessed to be higher acuity than can be safely managed in this setting, please submit the Higher Level of Care (HLOC) form so appropriate support and next steps can be initiated. This form is also linked in the resources section of the Rula provider portal.
Ordering Labs
When labs are ordered at a Kaiser medical facility, they are transmitted directly to the lab. When labs are ordered by a Rula 1099 contractor, the lab requires the physical lab order slip be presented to the lab to process the request. Please advise the patient that they must print the lab order slip and physically bring it directly to the lab in order for the request to be processed.