A New York state official says he is involved in an ongoing effort to enforce the state's mental health parity law.
The official, state Attorney General Eric Schneiderman, has announced a settlement with MVP Health Care, a nonprofit carrier with about 500,000 enrollees.
A New York state parity law enacted in 2006 requires insurers to provide mental health coverage that is at least equal to the coverage provided for other health conditions, officials in Schneiderman's office said in the settlement announcement.
The settlement agreement calls for MVP to change its behavioral health claims review process; cover residential treatment for conditions such as anorexia nervosa and substance abuse disorders; and charge a co-payment equal to the primary care co-payment for outpatient visits to most mental health and substance abuse treatment providers.
The agreement also calls for MVP to pay a $300,000 civil penalty.
Officials said that, before 2014, MVP did not cover residential treatment for behavioral health conditions but did cover skilled nursing care for health problems classified as medical problems.
MVP was about twice as likely to deny claims for behavioral health services as it was to deny other types of claims, officials said.
The settlement with MVP is the second Schneiderman's office has negotiated with a health insurer "so far this year," officials said.
Denise Gonick, MVP's president said in a statement that the company is taking steps to improve the way it communicates decisions about behavioral health claims to its enrollees.
Any enrollees who received behavioral health claim denials based on medical necessity from Jan. 1, 2011, through March 10, 2014, can submit those claims to an independent review process, Gonick said.
MVP cooperated with the attorney general's investigation of the behavioral health benefits concerns, Gonick said.
"We at MVP care deeply about the communities we serve, and will continue to strive to offer high quality services that promote the health and well-being of all our members," Gonick said.