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MA Attorney General Announces Insurance Changes to Address Mental Health Parity Violations

Friday, February 28, 2020   (0 Comments)
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Attorney General Maura Healey announced in a press conference yesterday that her office had reached groundbreaking agreements with five health insurance companies and two companies that manage behavioral health coverage for other insurers (also referred to as carve-outs). This settlement will provide more than one million Massachusetts residents with improved access to behavioral health services! We were honored that the Massachusetts Psychological Association was invited to attend the press conference in recognition of the work that we have done to improve access to care and address deceitful business practices. MPA's Executive Director, Susan Wagner, attended the press conference at Boston Medical Center when these agreements were first announced to the public.
Members can read the full press release, but here are the highlights. These settlements have come about following an investigation by AG Healey's office into the companies' compliance with behavioral health parity laws, as well as the accuracy of health insurers' provider directories. The companies involved are: Harvard Pilgrim Health Care and their carve-out United Behavioral Health/Optum; Fallon Community Health Plan and their carve-out Beacon Health Strategies; AllWays Health Partners; Blue Cross Blue Shield of Massachusetts; and Tufts Health Plan.
The health plans have agreed to make specific changes, as outlined below. The companies will also pay a combined total of nearly $1 million to a fund that will be used by the AG's Office to promote initiatives designed to prevent or treat substance use disorders, increase access to behavioral health care services, or otherwise assist Massachusetts behavioral health care patients.
Reimbursement Rate Disparities - A recent study found that Primary Care Physicians are paid 60% more than behavioral health providers for comparable in-office services.  Many behavioral health providers will not contract with health plans due to these low reimbursement rates, which reduces access to care for insurance subscribers. 

In their settlements with the AG's Office, Harvard Pilgrim, Fallon and AllWays have resolved claims that they violated the Mental Health Parity and Addiction Equity Act by paying less for behavioral health care than physical health care. As a result, they have agreed to change how they establish their minimum reimbursement rates for in-network behavioral health outpatient services at all provider levels.
Unnecessary Authorization Requirements - This settlement also addresses unlawful barriers, like prior authorization requirements, to behavioral health services that are not required for comparable physical health services. Fallon, through it's carve-out Beacon, will no longer require prior authorization for routine behavioral health office visits or for inpatient mental health admissions after treatment in an emergency department. Harvard Pilgrim and AllWays, through their carve-out Optum, have agreed that for routine behavioral health visits, they generally will not overrule health providers' decisions on what constitutes appropriate care, including decisions about the appropriate type of treatment and frequency of visits.
Provider Directories - A number of recent studies have documented problems with inaccurate health insurance companies' provider directories. All of the health plans involved in this settlement have agreed to improve the accuracy of information in their provider directories and make changes to allow their members to more easily identify and reach behavioral health providers, including regular and robust provider directory audits, timely corrections of inaccurate information, and the tracking and resolution of complaints concerning inadequacy. MPA's Director of Professional Affairs, Dr. Jennifer Warkentin, has similarly been working on this issue as a member of the Provider Directory Task Force.

MPA will keep members updated as these changes go into effect.

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