Kaiser Permanente's health plan and California's Department of Managed Health Care have come to an agreement to settle years-long allegations that the plan fell short on access to mental health services.
The Kaiser Foundation Health Plan allegedly did not not provide enrollees with timely access to behavioral health treatment. This was in violation of California law that requires insurers to provide patients access to a medical appointment within 48 hours for an urgent problem, or within 10 business days for a non-urgent issue.
The Kaiser health plan was fined millions, and on July 12 and 18, it signed a stipulated settlement agreement with the state.
The agreement sets deadlines for benchmarks for a corrective action plan that if not reached, will result in Kaiser Foundation Health Plan being fined $75,000 to $100,000 for each violation.
Since the California's Department of Managed Health Care issued a final report on March 6, 2013, Kaiser has taken steps to beef up its behavioral health services.
[Also: CMS to address telehealth reimbursement in future behavioral health payment and delivery models]
Kaiser Foundation Health Plan has invested in hiring 850 additional behavioral health therapists statewide, about 188 behavioral health physicians and made contracts with additional external behavioral health provider groups to improve access, according to the agreement. It has made capital investments in additional buildings, medical offices, leased office space and remodeled space to accommodate the new hires and has implemented a mental health awareness campaign aimed at reducing the stigma and expanding the number of enrollees who seek mental health services.
The agreement was signed on July 12, signed by the Kaiser Foundation Health Plan and on July 18 by the Department of Managed Health Care.
In 2013, Kaiser agreed to pay a $4 million fine for several deficiencies in the plan's delivery of mental health services. In 2015, the state found that some Kaiser patients still had to wait weeks or even months to see a psychiatrist or a therapist.
[Also: After $4 million fine in 2013, Kaiser Permanente cited again for mental health access problems]
The Centers for Medicare and Medicaid Services Innovation Center is in the process of designing a payment model to reimburse Medicare and Medicaid providers for telehealth behavioral health services and to address issues such as treatment for opioid abuse, mental health and Alzheimer's disease.
Twitter: @SusanJMorse