Plain English Breakdown
The official source states 'specified documents' and 'specified procedures' but does not detail what those specific items or steps must be.
Requiring Kaiser to Reimburse Members for Out-of-Network Behavioral Health Costs
This law requires Kaiser Foundation Health Plan to pay members back for out-of-pocket costs they paid for mental health and substance use care from non-Kaiser providers starting May 1, 2022, until the state confirms Kaiser has finished a corrective action plan.
What This Bill Does
- Requires Kaiser to fully reimburse members who paid their own money for behavioral health services or medications from non-Kaiser doctors, facilities, or pharmacies on or after May 1, 2022.
- Sets an end date for this requirement when the Department of Managed Health Care tells lawmakers that Kaiser has finished a corrective action plan from its 2023 settlement agreement.
- Requires members to submit specified documents showing their expenses and requires Kaiser to pay them back within 60 calendar days after receiving those papers.
- Orders Kaiser to pay the original amount plus 10% yearly interest, plus a $5,000 fine for each incident if it fails to provide the required reimbursement on time.
- Requires Kaiser to create specified procedures and send monthly reports with specific information to the Department of Managed Health Care.
Who It Names or Affects
- Kaiser Foundation Health Plan
- Enrollees who use non-Kaiser providers for behavioral health care or medications
- The Department of Managed Health Care
Terms To Know
- Reimburse
- To pay someone back money they spent.
- Enrollee
- A person who is signed up for a health insurance plan.
- Nonplan provider
- A doctor, facility, or pharmacy that does not belong to the Kaiser network.
Limits and Unknowns
- The law only applies until the Department of Managed Health Care certifies that Kaiser has successfully completed its corrective action work plan.
- Members must submit specified documents to get their money back; the text does not list exactly which papers are needed.