This bill requires every state healthcare entity to provide coverage for the treatment of mental health or substance use disorders in accordance with the federal Mental Health Parity and Addiction Equity Act of 2008, which must be at least as extensive and provide at least the same degree of coverage as that provided by the entity for the treatment of other types of physical illnesses. As used in this bill, "state healthcare entity" means an entity that provides or arranges health care on a prepaid, capitated, or fee for service basis to enrollees or recipients of the state health plan, the TennCare program, or CoverKids program, including any insurer, managed care organization, administrative services organization, utilization management organization, or other entity.
This bill requires the coverage described above to also cover the spouse and the dependents of the insured if the insured's spouse and dependents are covered under the benefit plan, policy, or contract. Additionally, the coverage must not contain any exclusions, reductions, or other limitations as to coverages, deductibles, or coinsurance provisions which apply to the treatment of mental health or substance use disorders unless such provisions apply generally to other similar benefits provided or paid for under the state health plan.
REQUIREMENTS OF STATE HEALTHCARE ENTITIES
This bill requires every state healthcare entity to do the following:
(1) Provide such coverage for children, adolescents, and adults;
(2) Apply the definitions of generally accepted standards of mental health or substance use disorder care, medically necessary, and mental health or substance use disorder in making any medical necessity, prior authorization, or utilization review determinations under such coverage;
(3) Ensure that any subcontractor or affiliate responsible for management of mental health and substance use disorder care on behalf of the state healthcare entity complies with this bill;
(4) Process hospital claims for emergency healthcare services for mental health or substance use disorders in accordance with this section regardless of whether a member is treated in an emergency department; and
(5) No later than January 1, 2024, and annually thereafter, submit a report to the commissioner of commerce and insurance (the "commissioner") that contains the comparative analysis and other information required of insurers under the federal Mental Health Parity and Addiction Equity Act of 2008 and which delineates the comparative analysis and written processes and strategies used to apply benefits for children, adolescents, and adults.
PUBLICATION OF REPORTS
No later than January 1, 2025, and annually thereafter, this bill requires the commissioner to publish on the department's website in a prominent location the reports submitted to the commissioner.
This bill authorizes the department of commerce and insurance to promulgate rules to effectuate this bill.
This bill applies to policies entered into, amended, or renewed on or after October 1, 2023.