Two years after being hit with the largest mental health fine in California history, Kaiser Permanente misses deadline to fix its mental health deficiencies
Not only is Kaiser still under state monitoring, it’s now trying to set the stage to lay off therapists, push patients into AI-based therapies and further outsource care
When Kaiser Permanente reached a record $200 million Settlement Agreement with California regulators on Oct. 11, 2023 for violating state mental health laws, Kaiser was given a two-year window to correct deficiencies, which include understaffed clinics that leave patients waiting too long for therapy appointments.
However, that two-year window expired over the weekend with Kaiser not only still under state monitoring, but now seeking dramatic changes to its service model in Northern California that would open the door to laying off therapists, pushing patients into AI-based therapies and outsourcing more services – further segregating mental health from Kaiser’s integrated model of care.
“The Settlement Agreement should have been a wake up call for Kaiser to work with therapists to improve patient care, but instead it’s moving in a dangerous direction that would further cement behavioral health as a separate and unequal part of the Kaiser system,” said Sal Rosselli, president emeritus of the National Union of Healthcare Workers, which represents Kaiser mental health professionals in California and Hawaii. “Our members are doing their part to hold Kaiser accountable, and we expect authorities in California to make Kaiser honor its commitments and comply with state law.”
Kaiser, which provides health insurance to more than 9 million Californians, has been cited multiple times for violating state mental health laws. The California Department of Managed Health Care fined it $4 million in 2013 for denying patients timely access to care. After finding more violations in 2023, the agency reached the $200 million Settlement Agreement with Kaiser that included a $50 million fine as well as $150 million in other investments from Kaiser to improve mental health services across the state.
As part of the Settlement Agreement, Kaiser also had to produce a Corrective Action Work Plan to address numerous deficiencies in its mental health services. The state-monitored corrective action process was supposed to be completed on Saturday, Oct. 11, but Kaiser was nearly a year late in producing its work plan, and the agency has still not released any of the required quarterly reports documenting Kaiser’s progress as required by the Settlement Agreement.
In the agency’s most recent report, issued in February, it found that Kaiser still had not remedied 19 out of 20 deficiencies from a non-routine survey that contributed to the Settlement Agreement. Kaiser is seeking to further outsource mental health care to external provider networks despite it being cited in the survey for failing to “maintain an adequate system to document external provider referrals and monitor the follow-up of enrollees’ health care documentation to ensure services are furnished in a timely and appropriate manner.”
“At this point, it’s hard to see the Settlement Agreement as anything other than a disappointment,” said Anjahni Davi, a therapist for Kaiser in the Bay Area. “We’re two years removed from Kaiser paying the biggest fine in state history for mental health violations, and now Kaiser is trying to make the system even worse for patients with no clear repercussions from state regulators.”
The Settlement Agreement required Kaiser to “undertake a systemic overhaul and transformational change” of its mental healthcare system. However, despite reserves totaling $66 billion and expansions into Pennsylvania, North Carolina and Nevada, Kaiser is seeking to cut costs, outsource care and roll back patient protections.
After Kaiser mental health professionals in Southern California waged a nearly 7-month strike earlier this year to secure benefits that Kaiser already provided to nearly its entire workforce, Kaiser is now seeking dramatic takeaways — with major patient care ramifications — from its nearly 2,400 mental health therapists in Northern California, whose contract expired at the end of September.
- In previous contracts, Kaiser had agreed that its contracting with outside therapists would “not result in the elimination” of jobs held by Kaiser therapists. However, Kaiser is now proposing that using non-Kaiser therapists may result in laying off Kaiser therapists, and even details the severance packages for therapists that are laid off.
- In the recent Southern California contract, Kaiser agreed that the use of new technologies, including artificial intelligence, “is not to replace but to assist bargaining unit employees in providing safe therapeutic and effective patient care and support.” However, Kaiser, which is investing millions in AI mental health initiatives, is now proposing to eliminate the language about new technology not replacing workers.
“These proposals would open the door for Kaiser to layoff therapists, push patients into AI-based treatments, and further outsource care,” said Jennifer Browning, a social worker for Kaiser in the Sacramento region and a member of the union’s bargaining team. “We asked Kaiser point blank about taking out language that new technology won’t replace workers, and they said they wanted to maintain ‘flexibility.’ As therapists, we want the flexibility to treat Kaiser patients in a way that best meets their needs, but Kaiser wants the flexibility to layoff its therapists.”
That’s not all Kaiser is proposing. Kaiser has proposals that would undo patient care safeguards that therapists secured in previous contracts including:
- Sufficient time to respond to patients and coordinate care.
- Ratios that help existing patients get timely follow-up therapy appointments.
- Model of Care committees where therapists and managers have worked together to improve patient care.
On Friday, Kaiser therapists in Northern California began tabling outside their clinics to inform patients about what Kaiser is proposing during bargaining sessions, which are continuing this month.
