Kaiser Foundation Health Plan has agreed to a settlement with the Department of Labor that resolves multiple investigations into access for mental health and substance abuse services.
The settlement resolves allegations that Kaiser Permanente did not offer adequate provider networks for key mental health and substance abuse disorder (SUD) services, which prevented patients from receiving critical care.
Instead, if they needed behavioral health or SUD treatment, many patients were forced to seek care out-of-network, according to an announcement from the department.
As part of the settlement, Kaiser will pay $28.3 million to cover the costs that members incurred in receiving mental health and substance abuse treatment out-of-network. The healthcare giant will also pay a $2.8 million fee to the feds.
In addition to the fees, Kaiser Permanente agreed to changes to improve mental health access. The insurer will take steps to better monitor network adequacy to address the access issues as well as reduce the wait times for appointments and adjust care review processes to ease barriers.
Kaiser will reach out to members in California who enrolled beginning on Jan. 1, 2021 and who may have been impacted by the network adequacy issues, letting them know they are potentially eligible for a reimbursement.
A spokesperson for Kaiser Permanente noted in a statement to Fierce Healthcare that the settlement “does not involve current practices or issues.” The DoL review covers a period ending in 2023, they said.
The spokesperson also said that the COVID-19 pandemic created a situation where demand for mental healthcare surged, which significantly worsened barriers to access for these services. Kaiser Permanente is committed to the reimbursements required under the settlement and has made “great strides” in the past several years in improving access to mental healthcare.
“Today we are consistently meeting California requirements to provide members with mental health care appointments within specific timeframes — within 48 hours for urgent care, and within 10 business days for nonurgent care,” the spokesperson said. “We are pleased that the investments we’ve made over the last several years have resulted in significant improvements in access for our members.”
The National Union of Healthcare Workers, which represents the healthcare giant’s 4,800 health workers in California and Hawaii, weighed in on the settlement. NUHW President Sophia Mendoza said in a statement that the settlement “confirms what therapists have been saying about Kaiser for the past 15 years.”
Allegations by the union had played a key role in triggering the Department of Labor’s investigation.
“Kaiser keeps paying huge penalties and pretending that it’s fixed its mental healthcare problems,” Mendoza said. “Kaiser denied there were any issues while these investigations were taking place, and it’s still claiming that nothing is wrong even though therapists report they’re still understaffed and that many patients are still waiting too long for care.”