The Department of Labor announced a settlement with Kaiser Foundation Health Plans Inc. to resolve investigations into the company’s failure to provide timely and appropriate access to mental health and substance use disorder (MH/SUD) services.

The details:

The agreement resolves allegations that Kaiser did not maintain adequate provider networks for MH/SUD care and used patients’ responses to questionnaires to improperly prevent patients from receiving care.
Why it’s important: Many members were unable to access in-network MH/SUD care and were forced to seek care outside the network, often at higher out-of-pocket costs.

Next steps: The settlement affects millions of members in California who receive coverage through their employer and sets up a claims process for members to seek reimbursement for certain out-of-network expenses.

Kaiser will pay over $28 million for costs its members incurred when seeking out-of-network MH/SUD services and a more than $2.8 million penalty to the federal government.
Kaiser agreed to reform policies and practices to improve access to MH/SUD care. That includes steps to reduce appointment wait times, improve care review processes to ensure members receive medically necessary care, and monitor network adequacy to ensure members have access to appropriate MH/SUD providers and facilities.