To: Chiquita Brooks La-Sure, Administrator
Centers for Medicare and Medicaid Services
Re: Urgent Request for CMS Enforcement
We, the undersigned, strongly support the National Union of Healthcare Workers’ urgent request for CMS enforcement to protect the well-being of the many thousands of Californians covered by Medicare Advantage, Medicaid (“Medi-Cal”), and qualified health plans who have been and are being subjected to unlawful and dangerous behavioral healthcare delays by Kaiser Permanente.
Federal law requires Medicare Advantage plans operated by Kaiser Permanente to provide or arrange for necessary specialty care, including behavioral healthcare, and to arrange for out-of-network specialty care when network providers are “unavailable or inadequate” to meet members’ medical needs. Likewise, federal law requires Medicaid managed care organizations like Kaiser Permanente to provide behavioral healthcare in a timely manner, including on an out-of-network basis, when such services are not “adequately and timely” available to members. Federal law also requires qualified health plans operated by Kaiser Permanente to ensure that behavioral healthcare is “accessible without unreasonable delay.” The State of California imposes similar requirements.
Despite these standards, and years of state-level investigations which have resulted in multiple rounds of sanctions, Kaiser Permanente has failed to remedy its persistent behavioral health network inadequacy and resulting gaps in care, with the result that during the current strike of NUHW members, Kaiser Permanente has indefinitely cancelled many thousands of behavioral health appointments, and in one or more service areas has curtailed the availability of intensive outpatient treatment programs and partial hospitalization programs, and suspended and downgraded the availability of emergency psychiatric care for significant portions of each day.
We ask CMS to review this complaint and its supporting documents with all deliberate speed, and to take corrective action to protect Kaiser Permanente members who are being denied care.