Blue Cross of Minnesota agrees to legal settlement for better mental health coverage

Blue Cross and Blue Shield of Minnesota has reached a settlement with the state attorney general over concerns the Eagan-based health insurer failed to comply with laws insisting that health plans cover mental health services the same as they cover treatments for physical health problems.

The Minnesota Blues plan denied any wrongdoing, but agreed to a series of new oversight provisions. In addition, the insurer will operate under new mental and behavioral health care rules that call for prompt decisions on prior authorization requests as well as applications by health care providers to join the health insurer’s network.

Blue Cross will be required to pay a $300,000 civil penalty if a court finds the insurer has violated terms of the settlement, which was announced Friday. In addition, Blue Cross is contributing $600,000 to a center for rural behavioral health at Minnesota State University, Mankato.

“Mental and behavioral health care is health care, period,” Minnesota Attorney General Keith Ellison said in a statement. “We expect someone with a broken leg to be able to get the care they need, and the same should be true of Minnesotans struggling with conditions like depression or substance use disorder.”

Blue Cross said in a statement that it shares Ellison’s commitment to ensuring patients have timely access to “high quality and affordable mental health care.”

“Blue Cross has enhanced our practices related to addressing mental health benefits and access to care to ensure we are meeting the high expectations of members and other stakeholders,” the insurer said. “Today, our strategy is focused on transforming all mental health solutions in ways that can set new industry standards for equitable access to optimal care.”

The settlement is the latest in a series of agreements over the past 18 months between the state and Minnesota health insurers for improved coverage of mental health.

The earlier agreements were prompted by alleged violations of mental health parity laws, which have been adopted over the past two decades to improve patient access to mental health and behavioral health treatments.

Patient advocates have argued that health insurers, while avoiding the most obvious offenses, have continued to violate parity laws amid a lack of enforcement by regulators. Health plans contend that violations are few and far between and point to staffing shortages as the key driver of access problems.

Concerns over diminished access to mental health care, particularly for children, spiked during the COVID-19 public health emergency.

The settlement announced Friday between Ellison’s office and Blue Cross, which is called an “assurance of discontinuance,” is filed in Ramsey County District Court.

The filing says the state Attorney General’s Office issued civil investigative demands to Blue Cross in June 2019 seeking information and documents on compliance with certain state mental health parity requirements. The attorney general also sought information on advertising, selling or provision of health plans.

“The MN-AGO made preliminary findings that certain of Blue Cross’s past conduct may not have complied with mental health parity requirements with respect to prior authorization for some behavioral health codes and reimbursement rates for some behavioral health providers,” the filing states.

It goes on to say that “Blue Cross’s website may have been inaccurate because the MN-AGO had received constituent complaints asserting that Blue Cross had denied coverage for medically necessary behavioral health services.”

According to the assurance of discontinuance, Blue Cross disputed and denied the attorney general’s preliminary findings and maintained it was in compliance at all times with applicable laws and regulations.

“The state and Blue Cross wish to resolve the investigation initiated by the [civil investigative demands] on the terms set forth herein,” the filing states.

For at least 95% of prior authorization requests for behavioral health services subject to standard review, Blue Cross agreed to process, make decisions and communicate decisions to health care providers and patients within five business days after the insurer receives all reasonably necessary information for a determination.

The insurer says it will approve or deny behavioral health providers’ requests to join Blue Cross’ network within 45 days of receiving a clean application from the provider — a provision that should make it easier for Blue Cross to scale up the provision of mental health services, according to the Attorney General’s Office.

Blue Cross has agreed to share information, including nonpublic data, that will allow the Attorney General’s Office to evaluate the success of the insurer’s behavioral health initiatives. The company will pay a consultant selected by the Attorney General’s Office to advise Ellison on whether Blue Cross is imposing more restrictive treatment limitations on mental health/substance use benefits than medical/surgical benefits in the same classification.

Finally, Blue Cross will respond within 30 days to any complaint about behavioral health parity submitted to the Attorney General’s Office. This requirement “will significantly improve transparency in the care many Minnesotans receive,” the office said in a news release.

Previous settlements by other health insurers were reached with the state Commerce Department, which called for reforms by the health plans as well as fines of $150,000 against HealthPartners and $300,000 against Medica.

UnitedHealthcare’s settlement with Commerce included a $450,000 fine, although the agreement stipulated that $300,000 would be collected only if the insurer didn’t complete a corrective action plan.

In all three previous settlements, the insurers neither admitted nor denied allegations.

The landmark federal legislation for mental health parity passed in 2008 and was named in part for the late U.S. Sen. Paul Wellstone, D-Minn., who helped champion the effort. The laws have been critical, patient advocates say, yet better access to mental health care remains elusive due to a complex mix of factors that goes beyond what the statutes explicitly address.