ATTORNEY GENERAL JAMES SECURES SETTLEMENT WITH MVP HEALTH PLAN OVER MENTAL HEALTH GHOST NETWORK

The following information was released by the office of the New York Attorney General:

New York Attorney General Letitia James today announced an agreement with MVP Health Plan (MVP) to overhaul its mental health provider directory, ensure the accuracy of its mental health provider network, and provide restitution to plan members impacted by the directory's inaccurate listings. The settlement follows an investigation by the Office of the Attorney General (OAG) that uncovered systemic issues within MVP's network, including incorrect directory information, that may have left some members unable to access care or forced them to pay out-of-pocket for out-of-network treatment. The agreement, which is the first resolution resulting from Attorney General James' report, Inaccurate and Inadequate: Health Plans' Mental Health Provider Directories, requires MVP toadopt significant, industry-leading reforms to improve the accuracy of its online provider directory and pay restitution to impacted plan members.

"New Yorkers seeking mental health care deserve timely, accurate information," said Attorney General James. "When families turn to their health plans for help, they should be able to trust that the information they are given is reliable, and that they can access care without unnecessary obstacles. Today's agreement holds MVP accountable for its past failures and ensures that plan members can find and access the help they need."

The OAG launched its investigation in 2023 andconducted a secret shopper survey of mental health providers listed in MVP's online directory.TheOAG found that100 percent of the mental health providers it called, all of whom were listed as "accepting new patients," were either unreachable or not currently accepting new patients, and that MVP had no process in place to routinely verify providers' availability.

Under the agreement with OAG, MVP must provide financial restitution to eligible members who paid more than they should have for mental health care due to inaccurate provider listings or a lack of available in-network providers since January 1, 2020. An OAG-approved compliance administrator will oversee the restitution process, and MVP is required to notify eligible members and post claim submission information on its website. In addition, MVP will pay $250,000 in penalties, fees, and costs to the state of New York.

To address the root causes of these failures, MVP must overhaul its provider directory to ensure all listed mental health providers are actively in-network, accepting new patients, and reachable. The company must update listings within 15 days of receiving updated information and remove providers who fail to respond to verification requests or are not accepting new patients.

Attorney General James is also requiring MVP to implement a robust verification process. Every 90 days, the company must contact each provider in its network to confirm their participation and availability. MVP must also adopt protocols to ensure timely responses to member inquiries and create a complaint monitoring system to track issues with network access and directory accuracy.

An OAG-approved compliance administrator will monitor MVP's compliance with these reforms for at least two years. The administrator will conduct periodic audits of the directory's accuracy, review member access to care, and evaluate whether MVP is meeting network adequacy standards. They will also assess MVP's reimbursement rates and out-of-network utilization, with a focus on identifying disparities between mental health and medical or surgical services.

MVP has also committed to making new and meaningful investments in improving its mental health provider network. These investments could include recruiting additional psychiatrists and psychiatric nurse practitioners who treat children and adolescents, assisting providers with navigating MVP's systems, or conducting outreach to help members understand and access the mental health services available to them.

"NAMI New York State wholeheartedly supports the Attorney General's action to reform insurer provider networks, because there is no Health Care without Mental Health Care," said Nathan McLaughlin, Executive Director of the National Alliance on Mental Illness, New York State. "NAMI New York State has consistently called for all health plans to maintain accurate, up-to-date directories and expand access to mental health care in parity with physical health. These directory reforms are critical to preventing ghost networks and ensuring that all New Yorkersparticularly those most vulnerablecan securely and efficiently find in-network care when they need it most. We are grateful that both parties have come to an agreement that ensures access to mental health services. With one in five adults having a diagnosed mental health condition, and one in every ten in recovery from a process or substance use disorder, mental health services are needed now more than ever. The National Alliance on Mental Illness of New York State thanks Attorney General James and her staff for their diligent work ensuring equitable access to mental health services."

"This year is the 20th anniversary of New York's passage of mental health insurance parity Timothy's Law yet there are still insurers and plans that have not been compliant with the law," said Glenn Liebman, CEO of Mental Health Association in New York State. "As a result, individuals and their loved ones have not received needed services. Tough enforcement actions are needed, and we thank Attorney General James and her team for their leadership."

This matter was handled by Assistant Attorneys General Michael Reisman and Carol Hunt under the supervision of Health Care Bureau Chief Sudarsana Srinivasan, with critical assistance from Assistant Attorney General Gina Bull of the Executive Division. The Health Care Bureau is part of the Division for Social Justice, which is led by Chief Deputy Attorney General Meghan Faux. The Executive Division and the Division for Social Justice are overseen by First Deputy Attorney General Jennifer Levy.