Behavioral health reimbursement.

Assembly Member Bains' behavioral health reimbursement legislation requires Kaiser Foundation Health Plan to fully compensate enrollees for out-of-pocket costs incurred when obtaining mental health services or medications from non-Kaiser providers. The reimbursement mandate applies to expenses dating back to October 12, 2023, and remains in effect until Kaiser completes implementation of corrective actions required under its 2023 settlement agreement with the Department of Managed Health Care.

Under the bill's provisions, Kaiser must process reimbursement requests within 60 days of receiving required documentation from enrollees, including receipts, provider recommendations, and statements confirming inability to obtain timely care through Kaiser's system. Covered expenses encompass copayments, deductibles, provider visits, telehealth consultations, prescription medications, and related transportation costs. Failure to provide timely reimbursement results in Kaiser owing the original amount plus 10% interest to the enrollee and a $5,000 fine per incident.

The legislation establishes oversight mechanisms requiring Kaiser to implement formal procedures for processing reimbursement requests and appeals. Monthly reports to the Department of Managed Health Care must detail the number of requests received, total amounts reimbursed, average processing times, and reasons for any denials. The department maintains authority to review Kaiser's compliance with these procedural requirements and certify completion of the corrective action plan that would end the reimbursement mandate.