Mass. Attorney General Announces Settlement with Insurers Over Suspected Parity Violations

The office of Massachusetts attorney general Maura Healey this week announced that the state has reached agreements with five health insurers and two companies that manage behavioral health coverage for insurers in a move to increase access to behavioral health services for more than 1 million residents in the state.

Harvard Pilgrim, Fallon and AllWays Health Partners were accused of violating the Mental Health Parity and Addiction Treatment Act. Practices by Beacon Health Strategies, Blue Cross Blue Shield of Massachusetts, Optum and Tufts Health Plan drew scrutiny from the attorney general’s office over potential issues around reimbursement, prior authorization and provider directories.

As part of the settlement, Harvard Pilgrim, Fallon and AllWays have agreed to:

• Change, or in some cases already have changed, processes for determining reimbursement rates for outpatient behavioral health services.
• Limit prior authorization for certain behavioral health services. Fallon, through its administrator Beacon, will no longer require prior authorization for routine behavioral health visits or inpatient mental health admissions after treatment in an emergency department. Harvard Pilgrim and AllWays, through their administrator Optum, have agreed to generally not overrule providers’ decisions on what constitutes appropriate care.
• Make changes to their respective provider directories so that plan members can more easily reach providers. Optum, Beacon, Tufts and BCBS are also revising their respective directories.

The companies involved in the settlement also have agreed to pay a combined nearly $1 million to a fund to be used by the attorney general’s office to promote a variety of behavioral health and addiction treatment initiatives.

Former U.S. Rep. Patrick Kennedy, lead author of the federal parity law, lauded Healey’s work.

“For far too long, insurers have been able to make their own rules about covering mental health and addiction treatment without recourse,” Kennedy said in a statement. “Such illegal practices of conspiring to deny care have undoubtedly contributed to historic rates of overdoses and suicides that continue to devastate families nationwide.

“Other states and the federal government must follow Massachusetts’ lead in demanding that insurers end discriminatory practices against those with mental health and substance use disorders. When they do, we will finally be able to stop the insufficient reimbursement rates that are making it nearly impossible for people to find providers in-network.”