Generally, present law requires an individual or group health benefit plan issued by a health insurance carrier to 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. This bill makes such requirement applicable to TennCare.
Present law specifies that the coverage mandate for mental health or alcoholism or drug dependency services does not prohibit an employee health benefit plan, or a plan issuer offering an individual or group health plan from utilizing managed care practices for the delivery of such services, as long as that for a utilization review or benefit determination for the treatment of alcoholism or drug dependence the clinical review criteria is the most recent Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions established by the American Society of Addiction Medicine or other evidence-based clinical guidelines, such as those referenced by the federal substance abuse and mental health services administration. Present law prohibits the use of other criteria during utilization review or benefit determination for treatment of substance use disorders. This bill adds that additional criteria used must ensure that benefit determination for the treatment of alcoholism or drug dependence remain in parity with benefit determination for the treatment of mental health disorders.
Present law provides that the mandate to provide coverage for mental health services does 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. This bill replaces such exception with a requirement that a health benefit plan issued by a health insurance carrier must provide coverage for mental health services and treatment to the same extent that the health benefit plan provides coverage for the treatment of alcoholism and drug dependence. This bill makes some changes to the department of commerce and insurance's reporting and educational requirements to reflect the requirement for parity in coverage for mental health services and alcoholism and drug dependency services.
This bill removes a provision of present law that authorizes certain health insurance policies and plans to exclude coverage for psychiatric disorders, mental or nervous conditions, alcoholism, drug dependence, or the medical complication of mental illness or intellectual disability.
Present law generally requires that every insurer that proposes to issue a group hospital policy or a group major medical policy in this state and every nonprofit hospital and medical service plan corporation that proposes to issue group hospital, medical or major medical service plan contracts that provide coverage for the insured or the subscriber, in the case of outpatient expenses at a community mental health center, make available certain benefits for the care and treatment of mental, emotional or nervous disorders, alcoholism, drug dependence or the medical complication of mental illness or intellectual disability. Present law requires that the benefits provided be subject to deductibles and coinsurance factors that are not less favorable than for physical illness generally, and in no event shall coverage be required to be made available for more than 30 outpatient visits per year. This bill instead requires that the benefits provided are subject to deductibles and coinsurance factors that are not less favorable than for physical illness or the treatment of alcoholism or substance abuse generally, and coverage is not required to be made available for more than the number of visits per year offered for the treatment of alcoholism or substance abuse.
Present law requires that all group hospital and major medical policies, and all group hospital, medical and major medical service plans, that provide benefits for expenses of state residents arising from psychiatric disorders, mental or nervous conditions, alcoholism, drug dependence or medical complication of mental illness or intellectual disability, reimburse for these benefits, if any, when the benefits are provided at a facility that is:
(1) With respect to outpatient benefit, a community mental health center, or
(2) With respect to inpatient benefits, a community mental health center that has facilities for inpatient care and that has received a certificate of need from the Tennessee health facilities commission certifying the necessity of the facility if required by law.
This bill adds a third category of facility, which is residential or other mental health treatment facility licensed under the Mental Health, Alcohol and Drug Abuse Prevention and/or Treatment, Intellectual and Developmental Disabilities, and Personal Support Services Licensure Law.
This bill specifies that a group health plan issued by an entity regulated under the insurance laws of Tennessee does not have to provide mental health benefits unless the plan provides coverage for alcoholism and drug dependence.
This bill specifies that a group health plan issued to a small employer (an employer having two-50 employees) by an entity regulated under the insurance laws of Tennessee, and which plan provides coverage for alcoholism and drug dependence, will not be exempt from providing mental health coverage in parity with coverage for alcoholism and drug dependence.
ON AUGUST 28, 2023, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 7032, AS AMENDED.
AMENDMENT #1 makes the following clarifications to this bill:
(1) Clarifies that "benefit determination," as used in this bill when talking about the additional criteria used to ensure that the benefit determination for the treatment of alcoholism or drug dependence remain in parity with the benefit determination for the treatment of mental health disorders, includes coverage and reimbursement;
(2) Clarifies that the provision of the bill that requires a health benefit plan issued by a health insurance carrier to provide coverage for mental health services and treatment to the same extent that the health benefit plan provides coverage for the treatment of alcoholism and drug dependence also includes the provision of reimbursement;
(3) Clarifies that the provision of this bill that makes changes to the department of commerce and insurance's reporting and educational requirements to reflect the requirement for parity in coverage for mental health services and alcoholism and drug dependency services must also reflect parity in the rates of reimbursement;
(4) Clarifies that the provision of this bill that provides that coverage is not required to be made available for more than the number of visits per year offered for the treatment of alcoholism or substance abuse also applies to reimbursement;
(5) Clarifies that the provision of this bill that specifies that a group health plan issued by a regulated entity does not have to provide mental health benefits unless the plan provides coverage for alcoholism and drug dependence, also requires the plan to provide reimbursement for alcoholism and drug dependence; and
(6) Clarifies that the provision of this bill that specifies that a group health plan issued to a small employer (an employer having two-50 employees) by a regulated entity, and which plan provides coverage for alcoholism and drug dependence, will not be exempt from providing mental health coverage in parity with coverage for alcoholism and drug dependence, also requires reimbursement to remain in parity.

Statutes affected:
Introduced: 56-7-2360, 56-7-2360(a)(2), 56-7-2360(b), 56-7-2360(c), 56-7-2360(e)(4)(E), 56-7-2601(b), 56-7-2601, 56-7-2601(c)(3), 56-7-2601(e), 56-7-2601(g), 56-7-2601(g)(5)