California Enforcement

(10/2023) – DMHC, Kaiser Permanente Reach Settlement Agreement to Transform Plan’s Behavioral Health Care Delivery System and Improve Behavioral Health Statewide

State law requires health plans provide enrollees with medically necessary care within timely access and clinical standards at all times, including during a strike. Through a DMHC targeted enforcement investigation and non routine survey, several violations and deficiencies were found in the behavioral health care services offered by Kaiser Permanente. KP has reached a settlement to transform their behavioral healthcare delivery system statewide and must develop processes to ensure compliance with all behavioral health parity laws. The settlement agreement includes a $50 million fine and requires Kaiser Permanente to take corrective action to address deficiencies in the plan’s delivery and oversight of behavioral health care to enrollees. Kaiser Permanente has also pledged to make additional significant investments, totaling $150 million over 5 years, into programs to improve the delivery of behavioral health services for all Californians beyond Kaiser Permanente’s existing obligations to its members under the law.

California – State Requires Kaiser Permanente to Enter into a Corrective Action Plan to Ensure Parity Compliance with Potential Fines (July 2017)

California Department of Managed Health Care reached settlement with Kaiser to address repeated failures to provide patients with timely access to mental health services.  The Stipulated Settlement Agreement can be viewed online here.

Kaiser agreed to make corrections in six (6) areas: 1) improved documentation of Plan’s quality improvement efforts for access compliance and development of Behavioral Health Quality Assurance document; 2) improved transparency in behavioral health appointment access compliance measurement; 3) improved monitoring of member impact of access insufficiency and associated real time member remediation; 4) full implementation of systematic process to monitor follow-up appointment access adherence to member’s treatment plan; 5) improved internal corrective action plan development; and 6) improved integration of external provider access data and oversight. If Plan does not meet benchmarks in Agreement, fines will be incurred (up to $1 million).

Kaiser agreed to hire an outside consultant for three (3) years to help address access problems and improve oversight of behavioral health program.

This Settlement follows years of warnings to Kaiser for violating state law (Examples: In 2013,  Kaiser agreed to pay $4 million fine for failing to get patients into appropriate treatment soon enough; In 2015, CA Department of Managed Health Care found some Kaiser patients still had to wait weeks or months to see psychiatrists or therapists; In June 2017, CA Department of Managed Health Care found Kaiser continued to have  deficiencies)