Kaiser Permanente fined $300,000 by state for inadequate behavioral health coverage
Kaiser Permanente was fined $300,000 for not ensuring its behavioral and medical coverage remain at parity.
The health insurer allegedly failed to provide documentation showing they comparably reimburse behavioral health benefits to medical and surgical benefits, according to the state Office of the Insurance Commissioner. According to Kaiser, the issues have been fixed since being brought to their attention by the state.
Under federal law, health insurers are required to provide documentation explaining the treatment limitations within the plan and how those limitations impact coverage for mental health and substance abuse treatment. The law was passed in 2008 in an attempt to improve health insurance coverage and benefits for behavioral health issues.
“I’ve seen a trend among our state’s largest health insurers of mental health parity issues,” state Insurance commissioner Patty Kuderer said in a statement. “The market scans that started our work on these violations was an important step and I’m glad to see these issues corrected so Washingtonians have the access they deserve to these important services.”
If Kaiser commits no other similar violations in the next two years and fixes the deficits found by the OIC, $100,000 of the fine will be suspended. More than 650,000 Washingtonians are covered by Kaiser Permanente, and 1,300 providers offer in-network care in the state.
In a statement, Kaiser Permanente Washington spokesperson Linnae Riesen said the insurer took “immediate action” to improve their coverage and services for behavioral health patients.
“Over the past several years, we’ve significantly reduced wait times by increasing the number of therapists and nurse practitioners, and we’ve integrated treatment for depression and anxiety into the primary care setting at 25 of our clinics,” she wrote.
Kaiser also added to its external provider network by more than 50% and increased provider reimbursement rates related to mental health, according to Riesen.
“We continue to work closely with our external mental health providers to understand the challenges our members experience and remain committed to these ongoing efforts,” she wrote. “Our work to build a better model of mental health care continues. Kaiser Permanente remains dedicated to transforming our mental health care program and improving the care experience for our patients and members.”
The fines for Kaiser Permanente are the latest in a series of OIC fines on similar grounds. Kuderer previously fined Regence BlueShield $550,000 in November and Premera $550,000 in August for mental health parity violations.