California Enforcement

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)