Tuesday, July 18, 2017


DMHC, Kaiser Reach Agreement to Address Access to Behavioral Health Care Services

(Sacramento) – The California Department of Managed Health Care (DMHC) announced today that it has reached an agreement with Kaiser Foundation Health Plan, Inc. (Kaiser Permanente) to correct identified issues with the plan’s oversight of and access to behavioral health services.

“The DMHC and Kaiser Permanente have worked diligently over the past two years to craft an agreement designed to ensure the plan’s enrollees receive timely access to behavioral health services,” said DMHC Director Shelley Rouillard. “Our goal has always been to compel the plan to fix the access problems we have identified and ensure that enrollees receive timely access to behavioral health services. We believe this agreement will achieve that goal.”

This agreement confirms Kaiser Permanente’s ongoing commitment to resolve deficiencies regarding access to behavioral health services, identified in the DMHC’s 2015 and 2017 Routine Survey Reports. The surveys identified access issues and problems with the information provided to enrollees regarding behavioral health services. This agreement will ensure continued progress, building upon Kaiser Permanente’s recent investments to improve behavioral health access including hiring additional mental health providers, investing in additional office space and carrying out a mental health awareness campaign.

“Over the past several years, we have improved access to care, and we are continuously working hard to lead and improve not only the way mental health and wellness is provided in America today, but how we measure outcomes,” said Dr. Patrick Courneya, Chief Medical Officer of Kaiser Foundation Health Plan. “Kaiser Permanente is able to offer more mental health and wellness appointments, and we are working to expand our hours and days of operation and make it easier for patients to choose or change therapists to find the best fit. We are extremely grateful for the dedication and expertise that the Department of Managed Health Care demonstrated throughout this work to reach a resolution. We all want the same thing: to improve mental health and wellness for our members.”

Under the terms of the agreement, Kaiser Permanente will continue to revamp its Behavioral Health Quality Assurance Program to ensure that access problems are quickly identified and addressed. 

Kaiser Permanente will contract with an expert consultant to advise the plan on how it can improve its oversight of its behavioral health system and quickly address access problems. The agreement outlines deliverables and benchmarks the plan must meet. These include improved behavioral health appointment availability monitoring and tracking and a comprehensive Behavioral Health Quality Assurance program including the development and implementation of policies and procedures to address real time access issues. Failure to meet the deliverables and benchmarks may result in financial penalties described in the agreement.

The full agreement can be found here: http://wpso.dmhc.ca.gov/enfactions/docs/2895/1602861252108.pdf

If a consumer is experiencing difficulty accessing care they should file a grievance with their health plan. If they are not satisfied with their health plan’s resolution of the grievance or have been in their plan’s grievance system for 30 days, they should contact the DMHC Help Center for assistance by calling 1-888-466-2219 or at www.HealthHelp.ca.gov. If they are experiencing an imminent or serious threat to their health, they should contact the DMHC Help Center immediately.

About DMHC:

The DMHC protects the health care rights of approximately 26 million Californians and ensures a stable health care delivery system. The Department has helped more than 2 million Californians resolve health plan problems through the Help Center. Information and assistance are available at www.HealthHelp.ca.gov or by calling 1-888-466-2219.