This bill requires a TennCare health benefit plan issued by a health insurance carrier to provide coverage and reimbursement for mental health services and treatment to the same extent that the TennCare health benefit plan provides coverage and reimbursement for the treatment of alcoholism and drug dependence.
This bill applies to policies, plans, and contracts entered into, renewed, amended, or modified on or after July 1, 2024.
ON APRIL 18, 2024, THE SENATE ADOPTED AMENDMENT #2 AND PASSED SENATE BILL 2801, AS AMENDED.
AMENDMENT #2 makes the following changes:
(1) Requires an individual or group health benefit plan issued by a health insurance carrier regulated pursuant to this bill 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 of 2008;
(2) Adds to the present law providing that present law 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 benefits, as long as that for an 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. Additional criteria must not be used during utilization review or benefit determination for treatment of substance use disorders. This amendment adds to the present law by providing that for purposes of a TennCare health benefit plan, additional criteria used must ensure that benefit determination, including coverage and reimbursement for the treatment of alcoholism or drug dependence, remain in parity with benefit determination for the treatment of mental health disorders;
(3) Revises the present law that requires the department of commerce and insurance to issue a report to the general assembly and provide an educational presentation to the general assembly. The report and presentation must, among other things, 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 discussion must include any examination regarding compliance with parity in mental health or alcoholism or drug dependency benefits under state and federal laws. This amendment revises the present law by, instead, requiring the discussion to include a detailed explanation regarding parity in coverage and rates of reimbursement for mental health services and alcoholism and drug dependency services;
(4) Revises the present law requiring any individual, franchise, blanket or group policy of insurance that provides hospital expense and surgical expense insurance and that is entered into, delivered, issued for delivery, or renewed, excepting individual insurance policy renewal, by agreement or otherwise, commencing on July 1, 1974, to provide benefits for expense of residents of this state covered under the policy or plan, arising from psychiatric disorders, mental or nervous conditions, alcoholism, drug dependence, or the medical complication of mental illness or intellectual disability, unless the policy or plan of insurance specifically excludes or reduces these benefits. This amendment excludes a TennCare health benefit plan from the exception in the above provisions for policy or plans of insurance that specifically excludes or reduces these benefits;
(5) Adds to the present law providing that when benefits are made available for treatment received at the community mental health center, the benefits that cover services rendered by a physician in accordance with the policy or service plan contract must also be made available when services are rendered by a member of the clinical staff, so long as the community mental health center has in effect a plan for quality assurance approved by the department of mental health and substance abuse services and the treatment is supervised by a licensed physician or a licensed psychologist designated as a health service provider. However, nothing in this present law affects the license of a physician or psychologist designated as a health service provider providing the service or supervision. The benefits must be provided at the usual and customary rates established by the community mental health center for the services rendered. However, the benefits provided must be subject to deductibles and coinsurance factors that are not less favorable than for physical illness generally, and in no event must coverage be required to be made available for more than 30 outpatient visits per year. This amendment adds to the present law by providing that with respect to benefits provided under the present law above by a TennCare health benefit plan, 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 and reimbursement are not required to be made available for more than the number of visits per year offered for the treatment of alcoholism or substance abuse; and
(6) Requires all group hospital and major medical policies delivered or issued for delivery in this state after July 1, 1980, and all group hospital, medical and major medical service plans commencing in this state after July 1, 1980, that provide benefits for expenses of residents of the state arising from psychiatric disorders, mental or nervous conditions, alcoholism, drug dependence or medical complication of mental illness or intellectual disability, to reimburse for these benefits, if any, when the benefits are provided at a facility that is for persons covered under a TennCare health benefit plan, a residential or other mental health treatment facility licensed under existing law.