On October 12, 2023, the California Department of Managed Health Care (DMHC) announced a settlement agreement with Kaiser Foundation Health Plan, Inc. (Kaiser Permanente) to make significant changes to the plan’s delivery of behavioral health care services. 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.
The DMHC opened a non-routine survey of Kaiser Permanente in May of 2022 to review the plan’s broader compliance with providing timely behavioral health appointments to enrollees. A non-routine survey is an investigatory survey when the DMHC has good cause to investigate issues of compliance with the law. The non-routine survey is examining Kaiser Permanente’s behavioral health operations, including but not limited to the Plan’s internal and external provider networks, timely access to care, processes for intake and follow-up appointments, appointment scheduling processes, levels of care and associated decision-making processes, medical record documentation and retention practices, and monitoring of urgent appointments. The DMHC Help Center saw a 20% increase in behavioral health complaints for Kaiser Permanente in 2021 compared to 2020, which is part of what prompted the DMHC to open the non-routine survey of the plan.
The DMHC also opened a targeted enforcement investigation on August 22, 2022 to examine if Kaiser Permanente was providing timely access to appointments during a behavioral health care worker strike that started on August 15, 2022 in Northern California. State law requires health plans provide enrollees with medically necessary care within timely access and clinical standards at all times, including during a strike.
The DMHC’s actions found 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. In addition to the length of time enrollees had to wait to get appointments, the DMHC’s actions found violations in the plan’s behavioral health care delivery system including 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, not making out-of-network referrals consistent with requirements under the law when in-network providers are not available, and inadequate handling of enrollee grievances.
If you or a family member were harmed as a result of behavioral health malpractice in California or in another U.S. state, you should promptly find a California medical malpractice lawyer, or a medical malpractice lawyer in your state, who may investigate your behavioral health malpractice claim for you and represent you or your family member in a behavioral health malpractice case, if appropriate.
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