Insurers Settle in Major Parity, Consumer Protection Case in Mass.
APA and patient groups have long said that discriminatory reimbursement rates for mental health care result in diminished access, but the attorney general’s settlements are believed to be the first to establish this principle.
Five major health insurers and two managed care companies have agreed to reverse practices that discriminate against patients and mental health professionals and restrict access to mental health care following landmark settlements with the Massachusetts Office of the Attorney General.
The settlements are a result of Massachusetts Attorney General Maura Healey’s investigation into the companies’ compliance with mental health parity laws, as well as the accuracy of health insurers’ provider directories.
The five “assurances of discontinuance” filed last month in Suffolk Superior Court involve Harvard Pilgrim Health Care, United Behavioral Health/Optum, Fallon Community Health Plan, Beacon Health Strategies, AllWays Health Partners, Blue Cross Blue Shield of Massachusetts (BCBS), and Tufts Health Plan.
“Treatment for substance use disorder and access to therapy are vital to public health, but too many people are facing unlawful barriers to the care they need,” Healey said in a statement. “These companies are making substantial and unprecedented changes to help ensure patients don’t have to struggle to find behavioral health services in Massachusetts.”
Marilyn Price, M.D., president of the Massachusetts Psychiatric Society, hailed the settlements and the work of the attorney general. “The Massachusetts Psychiatric Society applauds Attorney General Healey for her admirable work to help the residents of the commonwealth gain access to treatment and knowledge and transparency about their mental health and substance use benefits,” she said in a statement. “The mental health parity investigation is a tremendous endeavor. Persons seeking mental health care should have the same access to timely care as they would with any other illness.”
APA leaders agreed the settlements are groundbreaking in terms of both parity enforcement and consumer protection.
“This is an enormous victory for patients in Massachusetts and sets an example for insurance companies elsewhere,” said APA President Bruce Schwartz, M.D. “Health plans have to be held accountable for their compliance with federal law.”
Schwartz said the attorney general’s office in Massachusetts is to be commended for taking up this challenge and scoring a huge victory for patients and psychiatrists. “APA and patient groups have always held that disparate reimbursement rates violate parity because they decrease access to care for mental health patients,” he said. “The attorney general’s investigation is the first that we are aware of to enforce this provision of the parity law.”
APA CEO and Medical Director Saul Levin, M.D., M.P.A., emphasized that the settlements address consumer protection concerns as well as violations of parity. “The settlements demonstrate that attorneys general can guard the public against misrepresentations about the availability of psychiatrists in their provider networks,” he said. “It further ensures that plans cannot pay psychiatrists less than other medical doctors to discourage their participation in networks.”
The settlements cover three essential areas: unnecessary authorization requirements that violate the parity law, reimbursement rate disparities that violate parity, and provider networks that diminish access and violate consumer protection provisions.
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Reimbursement rate disparities: The companies have agreed to change, or have already changed, the way they establish their minimum reimbursement rates for in-network behavioral health outpatient services at all levels—including psychiatrists, psychologists, and social workers—generally resulting in higher reimbursement rates for such services.
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Unnecessary authorization requirements: Under the terms of its settlement, Fallon, through its administrator Beacon Health Strategies, 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 administrator Optum, have agreed that for routine behavioral health visits, they will not overrule health care professionals’ decisions on what constitutes appropriate care, including appropriate type of treatment and frequency of visits, according to the attorney general.
The settlements reached with Harvard Pilgrim and BCBS also resolve allegations by the attorney general’s office that the companies unlawfully imposed prior authorization requirements on certain patients who sought substance use disorder (SUD) treatment out of network or outside Massachusetts. This is in violation of state laws requiring insurers to cover certain SUD treatments without prior authorization.
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Provider directories: Harvard Pilgrim, AllWays, Fallon, Optum, Beacon, Tufts, and BCBS will improve the accuracy of information in their provider directories and make changes to allow their members to more easily identify and make appointments with behavioral health care professionals. These changes include regular and robust provider directory audits, timely correction of inaccurate information in the directory, and the tracking and resolution of complaints concerning directory inaccuracies.
In addition to the assurances made in these settlements, the companies will pay a combined total of nearly $1 million to a fund that the attorney general’s office will use to promote initiatives designed to prevent or treat patients with SUDs, increase access to behavioral health care services, or otherwise assist Massachusetts behavioral health care patients. ■
The statement of the Massachusetts Office of the Attorney General and separate legal agreements with the insurers in the case are posted here.
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Published online: 13 March 2020
Published in print: March 7, 2020 - March 20, 2020
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