Tufts Health Plan will revise its coverage policies and pay a $90,000 fine after settling allegations from the attorney general’s office that the health insurer restricted treatment for autism services.
Attorney General Maura Healey said Tufts violated autism insurance, mental health parity, and consumer protection laws when it restricted access to applied behavioral analysis (ABA) therapy, a treatment for autism spectrum disorders.
“We can’t treat patients with behavioral health issues, including autism, differently from those with physical conditions,” Healey said in a statement. “Together, we need to break down the barriers that for too long have made the treatment of behavioral health secondary in our health care system.”
According to a settlement filed in Suffolk Superior Court, Tufts has agreed to revise its policies and reimburse members who paid out-of-pocket for therapy that should have been covered by insurance.
Watertown-based Tufts, the state’s third-largest commercial health insurer, will pay $90,000 to the state, including $5,000 in civil penalties, $20,000 in legal fees, and $65,000 toward programs aimed at improving autism treatment.
In a statement, Tufts said it drafted policies that it believed met the requirements of a 2010 law requiring Massachusetts health insurers to provide coverage for autism.
“At the time the law was passed there was very little guidance upon which to develop new policies,” the company said. “We did our best to interpret the law, recognizing the responsibility we have to manage the benefit in a way that provides access to necessary services while carefully balancing costs.”
Since then, Tufts said it has revised polices to make ABA therapy more accessible, by allowing treatment at daycares and preschools, and by removing a restriction that required a parent to be present at every appointment.