Mental Health Assurance Settlement reached in Massachusetts

Massachusetts Attorney General Maura Healey announced last week her office had reached agreements with health insurance companies and insurance coverage managers to improve access to behavioral health services for that state’s residents.

Healey worked with Harvard Pilgrim Health Care and United Behavioral Health d/b/a Optum; Fallon Community Health Plan and Beacon Health Strategies; AllWays Health Partners; Blue Cross Blue Shield of Massachusetts (BCBS); and Tufts Health Plan to reach a settlement after her office’s investigation found that the companies were not in compliance with state laws regarding behavioral health parity.

“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,” said AG Healey 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.”

Massachusetts’ Mental Health Parity and Addiction Equity Act (the Parity Act) requires that health insurance providers apply the same rules to mental health benefits, as it does to medical and surgical benefits, and applies to a range of treatment limitations like provider reimbursement rates, and requirements that patients obtain authorization from their health plan before receiving certain health care services.

Three of the companies – Harvard Pilgrim, Fallon, and AllWays – have changed how they determine outpatient behavioral health reimbursement rates, as well as changing the requirement for prior authorization for some behavioral health care.

The National Council for Behavioral Health applauded the announcement.

“The settlement in Massachusetts between insurance companies and companies that manage behavioral health coverage could represent a dramatic improvement in access to mental health and addiction services the state’s residents receive,” said Chuck Ingoglia, President and CEO of the NCBH. “More than one million Massachusetts residents rely on behavioral health coverage, but residents in the state have long faced obstacles to coverage. This agreement can eliminate those obstacles once and for all by allowing consumers to identify and reach behavioral health providers more easily and increasing reimbursement rates for in-network behavioral health outpatient services to make them comparable to the rates paid to general medical providers.”

All of the companies have said they will make changes to their directories to make accessing behavioral health care providers less difficult.