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Kaiser Permanente will need to make significant changes to its behavioral health services plan after reaching a $200 million settlement with the California Department of Managed Health Care.(Video player above: Kaiser Permanente workers strike ends with no resolve)The settlement, announced on Thursday by the DMHC, includes a fine of $50 million and requires Kaiser to address shortcomings with the delivery and oversight of the behavioral health plan to enrollees. Kaiser has also agreed to spend $150 million over the span of five years on programs to improve behavioral health programs for Californians beyond Kaiser Permanente’s existing obligations to its members under the law. “In addition to paying the highest fine the DMHC has ever levied against a health plan, Kaiser Permanente has agreed to make significant improvements to the plan’s operations, processes and procedures and business model to better assist enrollees with accessing care,” said DMHC director Mary Watanabe. “The DMHC is committed to using its full authority to hold Kaiser accountable and ensure enrollees have access to behavioral health care when they need it.” The settlement agreement comes after an enforcement investigation and survey on Kaiser’s practices was conducted by the DMHC.According to the DMHC, Kaiser Permanente canceled behavioral health appointments and, in many cases, did not provide enrollees with behavioral health appointments that met timely access and clinical standards that were still required regardless of a strike by mental health clinicians that was initiated in August of 2022. The DMHC also said it found a shortage of contracted high-level behavioral health care facilities in the plan’s network, inadequate oversight of the plan’s medical groups in evaluating appropriate care, inconsistencies with out-of-network referrals and inadequate handling of enrollee grievances.The settlement requires Kaiser to improve the following:OversightAccessNetwork and ReferrralsGrievances and Appeals Mental Health Parity “This settlement agreement aims to provide Kaiser patients with the care they are entitled to in a timely manner. Today’s actions represent a tectonic shift in terms of our accountability on the delivery of behavioral health services. Accountability of the private sector is foundational to ensuring our entire system of behavioral health care works for all Californians,” said California Gov. Gavin Newsom.Kaiser Permanente CEO Greg Adams released a statement on the settlement agreement.”California and the nation have seen an unprecedented rise in demand for mental health care services over the past three years, largely driven by the global pandemic and its aftermath. We saw a 33% increase in need during the pandemic and have seen 20% more people come in for care in 2023 than at this point last year. An ongoing shortage of qualified mental health professionals, clinician burnout and turnover, and even a 10-week strike last year by 2,000 mental health clinicians in California, have all contributed to make it very difficult to meet this growing need for care,” Adams said. For the entire settlement agreement announced by the DMHC, click here.
Kaiser Permanente will need to make significant changes to its behavioral health services plan after reaching a $200 million settlement with the California Department of Managed Health Care.
(Video player above: Kaiser Permanente workers strike ends with no resolve)
The settlement, announced on Thursday by the DMHC, includes a fine of $50 million and requires Kaiser to address shortcomings with the delivery and oversight of the behavioral health plan to enrollees.
Kaiser has also agreed to spend $150 million over the span of five years on programs to improve behavioral health programs for Californians beyond Kaiser Permanente’s existing obligations to its members under the law.
“In addition to paying the highest fine the DMHC has ever levied against a health plan, Kaiser Permanente has agreed to make significant improvements to the plan’s operations, processes and procedures and business model to better assist enrollees with accessing care,” said DMHC director Mary Watanabe. “The DMHC is committed to using its full authority to hold Kaiser accountable and ensure enrollees have access to behavioral health care when they need it.”
The settlement agreement comes after an enforcement investigation and survey on Kaiser’s practices was conducted by the DMHC.
According to the DMHC, Kaiser Permanente canceled behavioral health appointments and, in many cases, did not provide enrollees with behavioral health appointments that met timely access and clinical standards that were still required regardless of a strike by mental health clinicians that was initiated in August of 2022.
The DMHC also said it found a shortage of contracted high-level behavioral health care facilities in the plan’s network, inadequate oversight of the plan’s medical groups in evaluating appropriate care, inconsistencies with out-of-network referrals and inadequate handling of enrollee grievances.
The settlement requires Kaiser to improve the following:
- Oversight
- Access
- Network and Referrrals
- Grievances and Appeals
- Mental Health Parity
“This settlement agreement aims to provide Kaiser patients with the care they are entitled to in a timely manner. Today’s actions represent a tectonic shift in terms of our accountability on the delivery of behavioral health services. Accountability of the private sector is foundational to ensuring our entire system of behavioral health care works for all Californians,” said California Gov. Gavin Newsom.
Kaiser Permanente CEO Greg Adams released a statement on the settlement agreement.
“California and the nation have seen an unprecedented rise in demand for mental health care services over the past three years, largely driven by the global pandemic and its aftermath. We saw a 33% increase in need during the pandemic and have seen 20% more people come in for care in 2023 than at this point last year. An ongoing shortage of qualified mental health professionals, clinician burnout and turnover, and even a 10-week strike last year by 2,000 mental health clinicians in California, have all contributed to make it very difficult to meet this growing need for care,” Adams said.
For the entire settlement agreement announced by the DMHC, click here.
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