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AB 1429

Behavioral health reimbursement.

2025-2026 Regular Session Introduced by Jasmeet Bains and 3 co-sponsors

Kaiser must fully reimburse enrollees for out-of-pocket behavioral health costs when timely care from Kaiser was not available, until DMHC certifies corrective actions are complete

In committee: Held under submission.
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Bill Summary · AB 1429

AB 1429 (Bains) — Behavioral health reimbursement

Status: Introduced Feb 21, 2025. In committee; held under submission (last action: 05/23/2025).
Subject: Behavioral health reimbursement; targets Kaiser Foundation Health Plan and its California subsidiaries.

Purpose / Intent

AB 1429 seeks to require Kaiser Foundation Health Plan (referred to in the bill as “Kaiser” or “the plan”) to reimburse enrollees for out‑of‑pocket behavioral health expenses they incurred when they obtained care or medications from non‑Kaiser/non‑plan providers because they could not obtain timely or appropriate care through Kaiser. The requirement is temporary and remains in effect until the Department of Managed Health Care (DMHC) certifies that the plan has completed implementation of required corrective actions identified in recent DMHC enforcement matters and non‑routine survey(s).

Key provisions

  • Eligible costs and timeframe

    • Reimbursement available for out‑of‑pocket costs incurred on or after May 1, 2022.
    • “Behavioral health care” includes behavioral health services, psychiatric and psychological services, counseling, addiction services, and related prescription medications offered by the plan.
    • “Out‑of‑pocket costs” explicitly includes copayments, deductibles, prescription costs, provider visit fees, telehealth fees, and transportation costs directly related to obtaining behavioral health care.

  • Reimbursement requirements

    • Kaiser/the plan must fully reimburse enrollees who paid for behavioral health services from non‑plan providers/facilities and for mental‑health prescription medication purchased from non‑plan pharmacies/providers.
    • Enrollees must submit: (1) receipts/invoices showing actual costs; (2) documentation that the service/medication was prescribed or recommended by a licensed mental health provider; and (3) a signed statement that the expense was incurred due to inability to obtain timely/appropriate care through the plan.
    • Reimbursements must be paid within 60 calendar days of the enrollee’s submission of documented expenses.

  • Oversight, procedures and reporting

    • The plan must establish procedures for online/paper submission, processing, appeals of denied requests, and statistical monitoring.
    • The plan must submit monthly reports to DMHC showing number of requests, total amount reimbursed, average processing time, and number/ reasons for denials.
    • DMHC will review whether the plan has met procedural requirements and must report findings to the Legislature.

  • Enforcement and penalties

    • If the plan fails to reimburse as required, it must pay the original amount plus 10% per annum interest and is subject to a $5,000 fine per incident, in addition to other sanctions authorized under existing law.
    • The bill is framed as a special statute specific to Kaiser/the identified plan(s) tied to DMHC Enforcement Matter No. 22‑469/22‑496 and Non‑Routine Survey 933‑0055 (both enforcement/survey references appear in the text).

Who is affected

  • Primary effect: enrollees of Kaiser Foundation Health Plan in California who paid out‑of‑pocket to non‑plan providers or pharmacies for behavioral health services or mental‑health medications since May 1, 2022.
  • Regulator: Department of Managed Health Care (oversight, certification, and reporting).
  • The bill is narrowly targeted as a special statute for Kaiser and its California subsidiaries.

Duration / Sunset

  • The reimbursement mandate remains in effect only until DMHC certifies to the Legislature (via a detailed publicly available report) that the plan has successfully completed the required corrective action work plan; at that point the new Article 3.6 is repealed.

Fiscal / Legal notes

  • The bill refers to enforcement under the Knox‑Keene Act; willful violations carry criminal penalties under existing law. The bill states it imposes a state‑mandated local program but also declares no state reimbursement to local agencies is required under Art. XIII B, Sec. 6, for specified reasons.

Legislative progress

  • Introduced Feb 21, 2025. Referred to Assembly Health; amended and re‑referred to Assembly Appropriations. As of May 23, 2025, AB 1429 is in committee and held under submission.

Compiled from official sources — confirm details with the bill’s official record.

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