TN Insurance Bulletin (2019-08-01): Coverage for Mental Health Services

The Department has received specific inquiries regarding autism treatment. In 2006, the Tennessee legislature passed a coverage mandate for treatment of autism spectrum disorders for people under twelve years of age. (Tenn. Code Ann. § 56-7-2367). At the time the Tennessee mandate became effective, the federal mental health parity regulations defined "mental health benefits" as" ... benefits for mental health services, as defined under the terms of the plan or group health insurance coverage ... " ( 45 C.F.R. § 146.136). The federal regulation at the time did not incorporate an independent standard of current medical practice like the ICD and DSM. Tenn. Code Ann. § 56-7-2360 now requires treatment of mental disorders listed in the ICD and DSM to be covered at parity. Autism is included among the conditions listed in both independent standards of current medical practice. Therefore, any treatment that is medically necessary and appropriate and is not experimental, such as Applied Behavioral Analysis therapy, must be covered at parity as outlined by MHPAEA. How: Tenn. Code Ann. § 56-7-1007(b) requires the chief executive officers and chief medical officers of health insurance carriers to sign a certification that the carrier has completed a comprehensive review of its compliance with Tennessee mental health coverage laws and MHP AEA. This certification may bt: an attestation confirming compliance during the previous calendar year and should be submitted to the Department annually on or before March 1st beginning in 2020. Carriers should submit the notifications electronically to mhp.certification@tn.gov. Any questions about this Bulletin should be directed to the Director of Insurance, I 0th Floor, Davy Crockett Tower, 500 James Robertson Parkway, Nashville, Tennessee, 37243, and/or (615) 741-1670.