Minnesota fines HealthPartners $150K over alleged mental health parity violations

Minnesota has fined HealthPartners $150,000 for business practices it believes violated mental health parity laws, including paying less to mental health care providers and engaging in more stringent reviews of patient requests for behavioral health care.

The Bloomington-based health insurer neither admitted nor denied the allegations, according to a May 1 consent order with the Minnesota Department of Commerce.

HealthPartners has committed to a corrective action plan, the state said, and the department will monitor the health insurer for compliance for at least one year.

Parity laws prohibit health insurers from making it more difficult for patients to obtain mental health care than services for physical ailments. While the laws have been around for decades in Minnesota and across the country, regulators say they've struggled with enforcement due to the complexity of comparing benefits for mental and physical health care.

"We are committed to ensuring Minnesotans get mental health and substance abuse care when they need it," Commerce Commissioner Grace Arnold said in a statement. "That means holding insurers accountable and targeting obstacles that may make mental health care more difficult to access than other medical care."

HealthPartners said it shared the Commerce Department's goal of mental health parity and had "agreed on a collaborative path forward to address the department's concerns."

"We look forward to continuing our efforts to make meaningful improvements to mental health care and coverage for our members and the community," the health insurer said.

In the consent order, Commerce maintained that HealthPartners violated state law by reimbursing medical/surgical providers at higher rates for certain billing codes — and without sufficient analysis or justification — compared with payments to mental health and substance use disorder providers.

The health insurer failed to maintain accurate and complete directories of its health care provider network, Commerce claimed, and conducted certain utilization reviews disproportionately on behavioral health benefits.

The department alleged that HealthPartners reviewed appeals more stringently with behavioral benefits and reconsidered denied medical and surgical claims more frequently.

Through 2018, the health insurer excluded some coverage for behavioral residential treatment care services while providing coverage for medical skilled nursing services, Commerce claimed. Other allegations addressed documentation of internal coverage reviews and meeting required timelines.

Arnold said the department could not release more details beyond the consent order — such as a timeline of the alleged violations.

"Today's consent order benefits Minnesotans because it compels a large insurer to make major changes," said Jacqueline Olson, assistant commissioner for enforcement, in a statement. "Those changes will expand access to mental health care in our state. We will not permit insurers to jeopardize access to treatment for Minnesotans who need it."

In an interview, Arnold said health care providers across Minnesota are voicing concern over the mental health needs of patients. The Commerce commissioner pointed to a recent Minnesota Department of Health report showing that residents responding to a 2021 survey reported an increase in the average number of mentally unhealthy days per month.

"It's a really timely and important issue to make sure that Minnesotans are getting access to mental health care," Arnold said. "Parity is not sufficient to making sure that people get access to care, but it's important to make sure that we can have accountability and systemic change where we can."

HealthPartners is one of the state's largest nonprofit health insurers. It also owns a prominent network of hospitals and clinics.

The U.S. Department of Labor, which regulates health plans offered by the nation's largest employers, has stepped up enforcement of parity violations in recent years. It also has added new requirements for health insurers to document compliance through comparative analyses.

The Commerce Department regulates fully insured health plans in Minnesota purchased by smaller businesses and individuals.

In the May 1 consent order, the department said HealthPartners provided comparative analysis reviews that were "noncomprehensive and did not fully comply with the [required] guidance and timeframes."

The health insurer waived its rights to a hearing and appeal, agreeing to "informal disposition of this matter," according to the consent order.

HealthPartners "shall pay a civil penalty in the amount of $150,000 to the State of Minnesota," the consent order states. "In determining this penalty, the commissioner considered ... [HealthPartners'] significant cooperation during the examination process, commitment to certain claims repayments and dedication of resources to implement the corrective action plan."