Tennessee Regulations

The Insurance Division of the Tennessee Department of Commerce and Insurance issued an interpretive opinion, (pdf | Get Adobe® Reader®) as a letter, in response to a request to clarify standards for utilization review for outpatient mental health and chemical dependency care under Tennessee Code § 56-6-705. The interpretive opinion clarifies that generally a patient is entitled to 12 visits to a provider for outpatient mental health and chemical dependency care followed by twelve additional visits, pending utilization review. This standard is permissible if it is no more restrictive than the standard applied for medical benefits.

The opinion goes on to apply this standard to three scenarios:

• Intensive outpatient care for chemical dependency treatment from an out of network provider
• Neuropsychological testing for Alzheimer’s disease diagnosis and follow up
• Autism spectrum disorder services on a “per hour” basis rather than a “per visit” basis.

The Insurance Division of the Tennessee Department of Commerce and Insurance issued an interpretive opinion (pdf | Get Adobe® Reader®), as a letter, in response to a request to clarify the term “at risk population” used in a section of the Tennessee Code § 56-6-705(a)(10)©. Under this law, follow-up utilization review for outpatient mental health and chemical dependency services can only make up 18% of the total number of outpatient mental health and chemical dependency services. There is an exception to this for at risk populations, making it so the 18% utilization review limit does not apply. Under this law, at risk populations can be subject to more follow-up review.

The Insurance Division stated that at risk populations are patients that are being seen for more than two visits a week or patients with reported or suspected substance abuse .

The opinion specifically states that this is the opinion of the Insurance Division, and not of the Department of Commerce and Insurance as a whole.

Please be aware that it is not possible to provide a direct link to Section 56-6-705(a)(10)© of the law. To find this section, go to this link and click on the plus sign next to Title 56. Then click on the plus sign next to Chapter 6.

The Tennessee Attorney General’s Office released an opinion (pdf | Get Adobe® Reader®) on the Federal Parity Law , and three Tennessee statutes that address insurance coverage of behavioral health conditions: Sections 56-7-2360, 56-7-2601, and 56-7-2602. The opinion was requested by State Senator Douglas Henry.

The opinion states that the Commissioner of the Tennessee Department of Commerce and Insurance is responsible for enforcing Tenn. Code Ann. § 56-7-2602.

The opinion also states that there is not a private cause of action under Tenn. Code Ann. § 56-7-2602. However, the opinion also states that Tenn. Code Ann. § 56-7-2602 allows administrative enforcement by the Commissioner and criminal penalties for violations of the law.

The opinion goes on to state that there is no statutory authority for a state agency to enforce the Internal Revenue Code or ERISA , therefore, no state agency can enforce the parts of the Federal Parity Law that amend those statutes. However, the Commissioner may enforce the Federal Parity Law and regulations that apply to group health insurance policies offered and sold in Tennessee.

The opinion also states that Tenn. Code Ann. § 56-7-2602 requires insurers selling group health insurance plans to offer coverage for substance use disorders on the same terms as physical health services. However, the entity purchasing the insurance (generally the employer), can reject this coverage. Under Tennessee law, the purchaser may reject behavioral health coverage or purchase less extensive coverage for behavioral health benefits.

The opinion states that the Federal Parity Law applies to group health plans with more than fifty employees, and for nonfederal governmental plans, the Federal Parity Law applies to group health plans with more than one hundred employees.