Parity is about fairness. Americans with behavioral health conditions often have more difficulty getting the treatment and services they need when compared to individuals seeking other medical care. Explore parity-related information regarding legislation, statutes, and regulatory actions since the Federal Parity Law was passed in 2008.
Tennessee Parity Law
The sections of Tennessee law relevant to parity can be found in the state’s Insurance Law:
- Title 56 Chapter 7 Part 2360 only applies to large employer fully-insured plans
- Title 56 Chapter 7 Part 2601 applies to all plans
- Title 56 Chapter 7 Part 2602 applies to substance use disorder services (but does not apply to individual plans)
- Title 56 Chapter 7 Part 2367 applies to services for autism for all plans
- Title 56 Chapter 6 Part 704 and 705 apply to utilization review agents and have some relevant information
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 Full-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.
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).
Utilization Review Agents
- 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