TN Insurance Bulletin (1988-09-01): Coverage of Mental Illness, Community Mental Health Centers, Clinical Staff, T.C.A. 56-7-1003

NED McWHERTER GOVERNOR TO: STATE OF TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE 500 JAMES ROBERTSON PARKWAY NASHVILLE, TENNESSEE 37219 B U L L E T I N All Heal th Insurers FR: Elai ne A. McReynolds, Commissioner ~~~ Depa rtme nt of Commerce and Insuranc~'1 RE: Cove rage of Mental Illness, Community Menta l Heal th Centers, Clinical Staff, T.C.A. 56-7 -1003 DA: Sept embe r 1, 1988 ELAINE A. McREYNOLDS COMMISSIONER A re cent inquiry has lead the Department t o believe that there may b e some confusion as to the re quirements for coverage of community mental health center treatment and coverage of clinical staff working at community mental h ealth centers. Subs ecti on (a) of T.C.A. Section 56-7-1003 provides that policies iss ued in Tennessee must provide cove rage of mental illness u nle ss the policy specifically exclud es or re duces such benefit s. Subsection (e) provides that all pol icies which do provide benefits for mental i llness s hall reimburse for such be nefits when such benefits are provided at a community me ntal health center, whether wit h respect to outpatien t or inpatient benefits. Subs ecti on (b)(1)(2) provide that any pol icy must cover treatment at a community mental health cent er unless the policyholder specifically rejects in writing suc h coverage . Subse cti on (b)(3) provides that when benefits are provided for treatment at a community mental health center, such bene fits shall include coverage of ''clinica l staff" which is define d as an individual who holds at lea st a mast er's degree in ei ther psychology, nursing, or socia l work and any required lice nsed. In s hor t, the policy may exclude or reduc e benefits for coverage of mental health but must provide fu ll coverag e in the absenc e of an exclusion. Any policy provid ing covera ge of mental il lne ss must cover treatment at a co mmunity mental health ce nter in the absence of a written rejec tion signe d by the appl ican t. Any policy so covering tr eatment a t a community me ntal health center must "cover cli nical staf f at the commun ity mental health center.