Rhode Island Enforcement

Rhode Island – State Requires BlueCross BlueShield of Rhode Island to Pay $5 Million in Support of Mental Health Care (September 2018)

BlueCross BlueShield of Rhode Island agreed to pay $5 million to expand mental health services following a state audit that found insurer to be out of compliance with state and federal laws.  The market conduct exam report can be found online here.

The state investigation found that the requirements for prior authorization of prescription drugs used to treat mental health conditions led to, or caused a potential to, impede or delay care. Specifically, the health plan reviewed in-patient care for MH/SUD more frequently than it did on the physical health side, and that there were times when a less costly drug was used to treat certain mental health conditions when the more expensive drug would be the preferred choice.  As a result, the health plan agreed to pay $5 million into a fund at the RI Foundation   used for prevention of mental health problems and intervention, in lieu of paying a traditional fine.

Additional background can be found in this U.S. News and World Report article.