ON APRIL 8, 2021, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 151, AS AMENDED.
AMENDMENT #1 rewrites this bill and revises the present law requirement for the department of commerce and insurance to report on coverage for mental health, alcoholism, and drug dependency.
PRESENT LAW
Present law (TCA 56-7-2360) requires that individual and group health benefit plans issued by a health insurance carrier provide coverage for mental health or alcoholism or drug dependency services in compliance with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Generally, that Act prohibits group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. This provision is in addition to two other provisions of present law requiring coverage for mental illness (TCA 56-7-2601) and coverage for alcohol and drug dependency (TCA 56-7-2602).
Under present law, the department of commerce and insurance was required to issue, by January 31, 2020, a report to the general assembly and provide an educational presentation to the general assembly. Present law set out in detail requirements for the report and presentation, which included the following:
(1) Discuss the methodology the department is using to check for compliance with the MHPAEA and TCA sections 56-7-2601, 56-7-2602, 56-7-2360;
(2) Identify market conduct examinations conducted or completed during the preceding 12-month period regarding compliance with parity in mental health or alcoholism or drug dependency benefits under state and federal laws and summarize the results of such market conduct examinations; and
(3) Describe how the department examines any provider or consumer complaints related to denials or restrictions for possible violations of the MHPAEA and TCA sections 56-7-2601, 56-7-2602, 56-7-2360, including complaints regarding actions such as denials of claims for residential treatment or other inpatient treatment on the grounds that such a level of care is not medically necessary.
THIS AMENDMENT
This amendment reestablishes a requirement for the department to report and present and revises the requirements for the report and presentation.
Under this amendment, by January 31, 2022, and each year thereafter, the department must issue a report to the general assembly and provide an educational presentation to the general assembly. This bill requires the department to request from the United States department of labor and the United States department of health and human services certain analyses submitted to those entities the previous year in compliance with the federal Consolidated Appropriations Act of 2021 and incorporate these analyses into the report. This bill requires that the department's report and presentation:
(1) List health plans sold in this state and over which of these plans the department has jurisdiction;
(2) Discuss the methodology the department is using to check for compliance with the MHPAEA and TCA sections 56-7-2601, 56-7-2602, 56-7-2360;
(3) Identify market conduct examinations and full scope examinations conducted or completed during the preceding 12-month period and summarize the results of the examinations. This amendment sets out in detail what must be included in this discussion;
(4) Detail educational or corrective actions the department of commerce and insurance has taken to ensure health benefit plan compliance with the MHPAEA and TCA sections 56-7-2601, 56-7-2602, 56-7-2360;
(5) Detail the department's educational approaches relating to informing the public about mental health or alcoholism or drug dependence parity protections under state and federal law; and
(7) Describe how the department examines any provider or consumer complaints related to denials or restrictions for possible violations of the MHPAEA and TCA sections 56-7-2601, 56-7-2602, 56-7-2360, including complaints regarding, but not limited to:
(A) Denials of claims for residential treatment or other inpatient treatment on the grounds that such a level of care is not medically necessary;
(B) Claims for residential treatment or other inpatient treatment that were approved but for a fewer number of days than requested;
(C) Denials of requests, authorizations, pre-authorizations, prior authorizations, concurrent reviews, or claims for residential treatment or other inpatient treatment because the beneficiary had not first attempted outpatient treatment, medication, or a combination of outpatient treatment and medication;
(D) Denials of claims for medications such as buprenorphine or naltrexone on the grounds that they are not medically necessary;
(E) Step therapy requirements imposed before buprenorphine or naltrexone are approved;
(F) Prior authorization requirements imposed on claims for buprenorphine or naltrexone, including those imposed because of safety risks associated with buprenorphine; and
(G) Denial of in-network authorization or denials of out-of-network services or claims where there is not an in-network provider within 75 miles of the insured patient's home.

Statutes affected:
Current Version: 56-7-2360(e), 56-7-2360