Kaiser Permanente has reached a $200 million settlement with the California Department of Managed Health Care to resolve deficiencies in its delivery and management of behavioral healthcare.
The $200 million settlement agreement includes a $50 million fine and requires Kaiser Permanente to take corrective action to repair Kaiser Foundation Health Plan's access and oversight of enrollees' behavioral healthcare. Kaiser Permanente also agrees to a $150 million investment, over five years, toward behavioral healthcare programs "for all Californians beyond Kaiser Permanente's existing obligations to its members under the law," according to the state agency.
The settlement stems from a non-routine survey and investigation conducted by the California DMHC, beginning in August 2022 when the health system was in midst of a strike with the National Union of Healthcare Workers. The state found Kaiser Permanente canceled behavioral health appointments and, in many instances, failed to provide health plan enrollees with timely and clinically adequate behavioral health appointments, which were required during a strike by 2,000 mental health workers that started in August 2022 and lasted 10 weeks.
"The timing of the DMHC's nonroutine survey corresponded with the staffing shortages and strike, the high demand for care, and the pandemic's lingering effects, yet it provides an opportunity for Kaiser Permanente and all health plans to step up in a new way, to ensure that we are meeting the mental health care needs of our communities," Kaiser Permanente Chair and CEO Greg Adams said in a statement.
Corrective actions the system must take under the settlement include: enhancement of its quality assurance program with continuous performance review and greater oversight of the health plan's medical groups and contracted providers; improved policy and process for initial, follow-up, and rescheduled behavioral health appointment access; and making it easier for enrollees to access the health plan's network of providers, including contracted providers, for behavioral health services and better access to out-of-network providers for behavioral health services when in-network providers cannot offer timely care.
Mr. Adams said that since 2020, Kaiser Permanente has invested an additional $1.1 billion to provide mental health treatment for its members. The five-year, $150 billion investment will go toward programs for the mental health needs of youth and teens; digital wellness tools for mental wellness and substance abuse; partnerships with schools and universities to address the students' mental health needs; workforce development programs; and initiatives to better integrate mental healthcare services into primary and specialty care.
"Our agreement with the DMHC takes full accountability for our performance during the survey period including our shortcomings, acknowledges our work to improve mental health care, and ensures that our ongoing investments not only help the members of Kaiser Permanente but also build a stronger mental health foundation in the communities we serve," Mr. Adams said.