(BCN) – Kaiser Permanente must overhaul behavioral health care services and pay a $50 million fine under a settlement agreement announced Thursday by the California Department of Managed Health Care.
As part of the settlement, Kaiser will also make investments totaling $150 million over five years to improve behavioral health care services.
Gov. Gavin Newsom praised the settlement Thursday, saying it will give Kaiser enrollees full and timely access to the services they are entitled to under state law.
“Today’s actions represent a tectonic shift in terms of our responsibility to deliver behavioral health services,” Newsom said. “Private sector accountability is fundamental to ensuring our entire behavioral health care system works for all Californians,” said Governor Newsom.
The $50 million fine is the largest ever imposed by the state health care agency, said DMHC Director Mary Watanabe.
The agreement stems from two state agency actions: an enforcement investigation and a non-routine investigation.
These actions revealed several violations and deficiencies in Kaiser’s provision of behavioral health care services to enrollees, including timely access to care and oversight of the plan’s providers and medical groups.
The state agency found that Kaiser Permanente canceled behavioral health appointments and, in many cases, failed to give enrollees appointments that met timely access and required clinical standards despite a strike by mental health clinicians in August 2022.
In addition to wait times for appointments, the state found violations including a shortage of contracted high-level behavioral health care facilities in the plan’s network and inadequate oversight of the plan’s medical groups. plan in assessing appropriate care.
Under the terms of the settlement agreement, Kaiser Permanente will hire an outside consultant to focus on remedial actions and provide expert advice.
The settlement was welcomed by the National Health Care Workers Union, which represents more than 4,000 psychologists, social workers and marriage and family therapists employed by Kaiser Permanente in California.
“This agreement is a monumental victory for Kaiser Permanente patients and its mental health therapists who have led numerous strikes over the past decade to force Kaiser to fix its failing behavioral health system,” said Sal Rosselli, president. of the union.
The managed health care agency’s report “confirms everything Kaiser therapists have said about their patients’ failure to receive adequate and timely mental health care,” Rosselli said.
In a statement about the deal Thursday, Kaiser CEO Greg Adams said there has been “an unprecedented increase in demand for mental health care services over the past three years, largely due to the global pandemic and its consequences.”
Kaiser has seen a 33 percent increase in need during the pandemic, and 20 percent more people are seeking care in 2023 compared to the same time last year, Adams said.
“The ongoing shortage of qualified mental health professionals, clinician burnout and turnover, and even a 10-week strike last year by 2,000 mental health clinicians in California, have all contributed to making it very difficult meeting this growing need for care,” Adams said. .
Kaiser has increased its workforce and facilities and, since 2020, has invested an additional $1.1 billion to provide mental health treatment to members, Adams said.
Kaiser hired nearly 600 additional therapists, expanded its networks to include thousands of community therapists and invested an additional $195 million in new clinical facilities including 329 mental health provider offices.
“Even so, during the period of the DMHC investigation, we failed to meet our members’ expectations and our own expectations,” Adams said.
“Our agreement with DMHC takes full responsibility for our performance during the investigation period, including our deficiencies, recognizes our work to improve mental health care, and ensures that our continued investments not only help members of Kaiser Permanente, but also to build a stronger mental system. foundation of health in the communities we serve,” Adams said.
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