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���������� Note: For many of us who read news about investigations into insurance companies not complying with parity regulations, the events are alarming, discouraging, and largely unsurprising. However, it is encouraging that the NY Attorney General’s aggressive approach may promote a welcome change in the practices of insurers before they are newly required to understand and manage behavioral health services for ����������ers with Medicaid. Some of the largest plans in NY have care managers who provide utilization management and prior authorizations all over the country, and policies and practices can be difficult to integrate. The work of NYS’ OMH and OASAS agencies in developing strict standards for insurance protocols in HARP and non-specialty BH management will go a long way toward ensuring integrated procedures within plans. If they don’t, these settlements may encourage us that the insurers will be held accountable.

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NY Settles With Excellus For More Mental Health Coverage

AP; Michael Virtanen, 3/18/2015

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The ���������� attorney general has reached agreement with the largest upstate health insurer to cover more mental health and addictions treatment for its 1.5 million members.

The settlement with Rochester-based Excellus Health Plan cites recent state and federal laws requiring mental health coverage at the same level as medical treatment.

Excellus said it has made benefit and policy changes based on revised law and regulations.

“My office has taken an aggressive approach to enforcing mental health parity laws that I hope can serve as a national model,” Attorney General Eric Schneiderman said. “Mental health and addiction recovery treatments must be regarded as the same as other health insurance claims under the law.”

It’s the fifth settlement by his office since last year. Others were with Cigna Corp., MVP Health Care, Emblem Health and Beacon Health Options, formerly known as ValueOptions.

The latest investigation found Excellus denied inpatient treatment coverage for mental health and addictions at more than double the denial rate for medical surgical treatment, according to the settlement agreement, which was signed last week.

“Every year, almost one in four ����������ers has symptoms of a mental disorder,” the agreement said, citing state Health Department data. “Lack of access to treatment, which can be caused by health plans’ coverage denials, can have serious consequences for consumers, resulting in interrupted treatment, more serious illness and even death.”

It also cited data from the state Office of Alcoholism and Substance Abuse Services that in any given year, 1.8 million or 11 percent of ����������ers have a drug or alcohol disorder, and only about one in 10 get treatment. That’s compared with 70 percent of residents with high blood pressure or diabetes. The settlement noted 65 heroin-related deaths in 2013 in Monroe County, which includes Rochester.

Former Rhode Island Congressman Patrick Kennedy, who sponsored the 2008 federal law mandating parity in mental health treatment, said the federal rules for carrying it out were issued only last year. Now an advocate for treatment, he said historically it just wasn’t covered adequately by insurers.

“Half the battle is making people aware that there is this law not only in the state of ���������� but federally,” Kennedy said, adding that other attorney generals should step up. “You can bet these benefits are being denied residents in every other state in the country.”

The settlement requires Excellus to notify about 3,300 members whose requests for inpatient treatment for drug and alcohol addiction and eating disorders were denied from 2011 through June 2014, the attorney general’s office said. It also requires the insurer to pay $500,000 to cover the cost of the investigation.

Excellus spokesman Jim Redmond said they’ve worked cooperatively with the attorney general’s office for two years, responding to its industrywide inquiry into the complexities of administering behavioral health benefits. “We remain fully committed to providing our members with the information and resources to secure coverage for medically necessary behavioral health care,” he said.

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