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Legislation Signed Into Law

2017-2018

Primary Focus: Mandated Benefit: Provider
Title/Description: Coverage for mental health, alcoholism, or drug dependency services
Citation110th General Assembly, Public Chapter 1012

Summary:
Aligns definitions in state’s parity law with the Federal Parity Act; defines conditions covered by state’s parity law as any mental health of substance use disorder that falls under the diagnostic categories in the current edition of the International Classification of Disease or the Diagnostic and Statistical Manual of Mental Disorders; for substance use disorders, requires that insurers use American Society of Addiction Medicine clinical review criteria or other evidence-based clinical guidelines; requires the Department of Commerce and Insurance to implement and enforce provisions of the Federal Parity Act, and to issue a report on its parity enforcement activities to the General Assembly; requires the Department of Commerce and Insurance to request detailed analyses of plans’ parity compliance, particularly with respect to non-quantitative treatment limitations whenever the Department is conducting market conduct examinations; and notes that the mandate to provide coverage for mental health services shall not apply with respect to a group health plan if the application of the mandate to the plan results in an increase in the cost under the plan of more than one percent (1%).
Effective Date: 1/1/19
Notes: Amended by Tenn. SB 2165.

HB 480/SB 837
Introduced: 2/2017
Sponsor: Rep. Clemmons and Sen. Briggs
Status: Signed into law 4/2017
Summary:
This bill requires all Medicaid managed care organizations providing coverage through TennCare to submit annual reports that demonstrate their compliance with the Federal Parity Law, including information that shows that NQTLs for behavioral health services are applied no more restrictively than those used for other medical services.

2013-2014

HB 2257/SB 2538
Introduced: 2/2014
Sponsor: Rep. McManus & Sen. Tracy
Status: Signed into law 5/2014
Summary: This bill created an autism spectrum disorder task force to study and make recommendations on ways to improve access to programs and services for screening, diagnosis, and treatment. Among other things, the bill required the task force to assess and develop recommendations on the availability of health insurance coverage for autism spectrum disorders.

2011-2012

Primary Focus: Mandated Benefit: SUD
Title/Description: Alcoholism and drug dependence – Coverage for treatment
Citation: Tenn. Code Ann. § 56-7-2602
Summary: Insurers, nonprofit hospitals and medical service plan corporations and health maintenance organizations transacting health insurance in this state shall offer and make available under group policies, contracts and plans providing hospital and medical coverage on an expense-incurred, service or prepaid basis, benefits for the necessary care and treatment of alcohol and other drug dependency that are not less favorable than for physical illness generally, subject to the same durational limits, dollar limits, deductibles and coinsurance factors, and that offer of benefits shall be subject to the right of the group policy or contract holder to reject the coverage or to select any alternative level of benefits if the right is offered by or negotiated with the insurer, service plan corporation or health maintenance organization.
Effective Date: July 1, 2012
Notes: Amended by Tenn. SB 2229.

Primary Focus: Mandated Benefit: Provider
Title/Description: Health insurance — Coverage of mental illness
Citation: Tenn. Code Ann. § 56-7-2601
Summary: This law was amended to delete the language “mental retardation” and substitute it with “intellectual disability” Additionally, The Department of Mental Health was substituted for the Department of Mental Health and Developmental Disabilities.
Effective Date: May 5, 2011 and June 23, 2010, respectively.
Notes: Amended by Tenn. SB 1533 and Tenn. HB 3526, respectively.

HB 1754/SB 1988
Introduced: 2/2011
Sponsor: Rep. Turner and Sen. Stewart
Status: Signed into law 5/2011
Summary: This bill changed the section of the state insurance law about utilization review agents. It made clear that this section, relating to the percentage of reviews an agent is allowed to perform, applies to reviews of outpatient services for behavioral health conditions. It also changed the law so that agents that have Utilization Review Accreditation Commission (URAC) accreditation are no longer exempt from this section of the law if they are performing outpatient behavioral health reviews.

2009-2010

HB 2289/SB 2239
Introduced: 2/2009
Sponsor: Rep. C. Cobb and Sen. Kyle
Status: Signed into Law 7/2009
Summary: This bill changed the section of the state insurance law about utilization review agents. It added that utilization review methods have to comply with the national standards set by either the Utilization Review Accreditation Commission (URAC) or the National Committee for Quality Assurance (NCQA) for reviews of behavioral health services.

Tennessee Parity Law

The sections of Tennessee law relevant to parity can be found in the state’s Insurance Law:

Please be aware that it is not possible to provide direct links to any of these sections of the law. To find these sections, go to this link and click on the plus sign next to Title 56. Then click on the plus sign next to the appropriate chapter. Then click on the plus sign next to the appropriate part (2360 and 2367 are part 23. 2601 and 2602 are part 26.)

Large Employer Fully-Insured Plans

This section of the law states that for large employer fully-insured plans , annual maximums and lifetime maximums for mental health services must be determined similarly to how they are for other medical services. Small employer plans and individual plans are specifically exempted from this.

This section of the law requires 20 days of inpatient mental healthcare and 25 outpatient visits. The law also allows the days of inpatient days to be used instead for residential care or partial hospitalization with the day limit doubled so that a person could have up to 40 days of coverage.

This section of the law makes it clear that office visits for medication management do not count as outpatient visits.

This section of the law specifically says that it does not apply to treatment of substance use disorders .

Small Employer Fully-Insured Plans and Individual Plans

Insurance companies must offer small employer fully-insured plans and individuals plans that meet the requirements listed here for behavioral health coverage. However, the small employers or individual can choose different plans that do not meet these requirements:

Substance Use Disorders

For substance use disorder services, insurance companies must offer large employer fully-insured and small employer fully-insured plans that have annual maximums , lifetime maximums , deductibles , coinsurance , inpatient day limits, and outpatient visit limits that are the same as those for other medical services. However the employer can decide not to accept it and choose a plan with less coverage or no coverage for substance use disorder services.

Autism

All insurance plans are required to cover autism services for children through age 11 that are “at least as comprehensive as those provided for other neurological disorders” (like epilepsy or cerebral palsy).

Insurance plans must cover autism services with the same financial requirements and treatment limitations used for services of other neurological disorders.

There is nothing in this section about annual maximums or lifetime maximums, unlike most other state laws about autism.

Utilization Review Agents

Within the sections of state law about utilization review agents there are several things that are relevant to parity :

  • Utilization review methods for behavioral health services must follow national criteria from either URAC or NCQA
  • Utilization review programs for behavioral health must give patient’s provider written copy of the criteria used
  • Medical necessity reviews must be made by a behavioral health professional in the same discipline as the patient’s provider
  • Patients must always be approved for at least 12 outpatient behavioral health visits
  • Agents are required to limit their review reports to 1 page and must send it to the patient using the internet
  • Agents are only allowed to have follow-up utilization reviews make up 18% of how many total reviews they conducted the previous year

Get Support

Tennessee Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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