Healey settles with insurers over behavioral health access

Photo | SHNS Attorney General Maura Healey

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By State House News Service

More than a million Massachusetts residents stand to benefit from greater access to behavioral health care as a result of settlements with five insurers, Attorney General Maura Healey said as she announced the agreements Thursday.

Healey said the deals — reached with Harvard Pilgrim Health Care and United Behavioral Health, which does business as Optum; Fallon Community Health Plan and Beacon Health Strategies; AllWays Health Partners; Blue Cross Blue Shield of Massachusetts; and Tufts Health Plan — will lead to "critical and unprecedented changes that will make it easier for our patients to get access to the care that they need."

The attorney general announced the settlements at a press conference at Boston Medical Center.

"So the big picture is that we know, and we've known for far too long, that we've got to treat behavioral health in the same way that we prioritize and treat physical health," Healey said. "We wouldn't expect a person with cancer or diabetes to wait months for an appointment, and somebody needing to see a mental health provider shouldn't have to wait, either. Patients who need mental health care should also not have to jump through unnecessary hurdles or overcome onerous barriers."

The settlements came after a years-long investigation by Healey into compliance with state and federal behavioral health parity laws.

Resolving claims that they violated the Mental Health Parity and Addiction Equity Act, Harvard Pilgrim, Fallon and AllWays agreed to change how they determine reimbursement rates for outpatient behavioral health and to limit prior authorization for certain behavioral health care.

Some of the plans have already changed how they determine their rates, Healey's office said.

All the companies involved have also "agreed to make extensive changes to their provider directories" so members can more easily reach behavioral health providers, Healey's office said.

The companies will pay nearly $1 million, in total, into a new fund Healey's office will use to support initiatives aimed at assisting behavioral health patients, such as efforts to prevent or treat substance use disorder.

A 2019 state law required health plans to ensure the accuracy of their provider directories by October 2020, and the Massachusetts Association of Health Plans said the provider directories agreement is "consistent" with that law.

MAHP President and CEO Lora Pellegrini said that health plans in the state are "committed to providing comprehensive behavioral health benefits for their members in compliance with state and federal mental health parity laws."

Pellegrini called on Healey and other state officials to "establish a uniform interpretation" of the federal parity law so insurers, providers, employers and consumers have a clear understanding of their rights and responsibilities. She has pushed in the past, unsuccessfully, to convince the Legislature to create a inter-agency task force to establish clear guidelines for insurers.

"Despite best efforts by health plans and state regulators to interpret the federal mental health parity law, the federal government has failed to provide clear and comprehensive guidance, resulting in an uneven application of the law and ambiguity as to the meaning of certain provisions among state agencies and regulators," she said.

Harvard Pilgrim officials said in a statement that they "do not agree with the Attorney General's allegations and feel the law does not support their assertions." They said they "voluntarily raised" reimbursement rates for Massachusetts behavioral health providers in 2019 and "will continue to work proactively" with regulators.

"For many years, Harvard Pilgrim, along with its behavioral health vendor, Optum, have devoted significant time, resources and efforts to enhancing coverage for behavioral health care services, including network expansion, engagement and retention efforts, and providing programs, initiatives and plan designs aimed at increasing access to behavioral health services," the statement said.

Speakers at the press conference shared several stories of challenges accessing behavioral health care.

Healey said her office heard from a patient with chronic depression whose insurance company stopped paying for her weekly therapy because it said she wasn't making measurable progress. Health and Human Services Secretary Marylou Sudders said she's paid out-of-pocket for a relative's behavioral health care after being unable to work through the insurer.

MetroWest Health Foundation President and CEO Marty Cohen, a member of the state's Health Policy Commission, said that in Framingham, where he works, the average wait time for an outpatient mental health appointment is eight to 14 weeks.

Eva Stahl, a patient advocate, said she has two children with behavioral health challenges and accessing care for her kids has been an "emotionally exhausting and scary" process.

Healey said the settlements mark one of the first times a state attorney general has enforced the provisions of the federal mental health parity law. Massachusetts also has a state-level parity law.

Earlier this month, the Senate unanimously passed a bill that seeks to build on the 2000 state law. Among other measures, it creates new enforcement mechanisms, calls for an expanded and more diverse practitioner workforce, seeks a rate floor to pay mental health clinicians the same as primary care providers for similar services, and bars insurers from requiring prior authorization for acute psychiatric inpatient care.

Sen. Cindy Friedman, the Senate chair of the Health Care Financing Committee, said Healey's actions "present an even more compelling case for Massachusetts to pass the Senate's Mental Health ABC Act that would provide our state with better tools to enforce our parity laws so that insurance coverage for mental health is equal to and no more restrictive than insurance coverage for any other medical conditions."

A separate bill proposed by Gov. Charlie Baker would require health plans and providers to boost their spending on behavioral and primary care. The Health Care Financing Committee faces a March 25 deadline to make its report on that bill.

"It's not lost on me that the state's first parity law will be 20 years old this May, and perhaps we can finally say that we will have achieved parity in Massachusetts," Secretary Sudders said.

"Between the efforts of the attorney general, the governor's health care bill, the commitment of the House to address behavioral health and the Senate's recently released bill on behavioral health -- which is extraordinary -- we stand together in our state once again and for all that behavioral health is health care and that long-standing barriers to care must come down. The time is now, and I really do feel that the time has come," Sudders said.