Official Summary Text
For a health benefit plan that is offered, delivered, or issued for delivery on or after July 1, 2025, and that
provides mental health and substance abuse services, this bill generally requires such plan to provide for coverage and reimbursement of such services through a psychiatric collaborative care model ("PCCM"). As used in this bill, a PCCM means an evidenc
e
-based, integrated behavioral healthcare model of treatment that meets all of the following criteria:
Is provided by a primary care provider and a care manager who work in collaboration with a psychiatric consultant, such as a psychiatrist.
Is overseen by the primary care provider and care manager and includes structured care management with regular assessments of a patient's clinical status using validated tools and modification of treatment as appropriate.
Requires the psychiatric consultant to provide regular consultations to the primary care provider and care manager to review the clinical status and care of a patient and make appropriate recommendations.
However, this bill authorizes a health benefit plan to deny coverage and reimbursement of serv
ices mandated above on the grounds of medical necessity only if the plan's coverage for mental health and substance abuse otherwise complies with state law and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 20
08, and its regulations, and with the Health Care Service Utilization Review Act.
This bill requires a managed care organization contracting with the state to provide insurance through the TennCare or CoverKids programs to provide coverage in accordance
with this bill if such coverage is determined to be medically necessary.
ON MARCH 20, 2025, THE SENATE ADOPTED AMENDMENT 1 AND PASSED SENATE BILL 437, AS AMENDED.
AMENDMENT #1 makes the following revisions:
Revises the provision requiring a
health benefit plan that is offered, delivered, or issued for delivery on or after Jul
y
1, 2025, and that provides mental health and substance abuse services
to
provide for coverage and reimbursement of such services through a PCCM
to, instead, apply to plans offered, delivered, or issued for delivery on or after January 1, 2026.
Revises the provision authorizing a plan to deny coverage and reimbursement of services
on the grounds of medical necessity only if the plan's coverage for mental health and substance abuse otherwise complies with state law and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, and its regulations, and with the Health Care Service Utilization Review Act
by removing the requirement that the coverage comply with such state and federal law.
Revises the provision
requir
ing
a managed care organization contracting with the state to provide insurance through the TennCare or CoverKids programs to provide coverage in accordance with th
e
bill if such coverage is determined to be medically necessary
to, instead authorize a
policy or contract for health insurance coverage provided under the TennCare medical assistance program
or the CoverKids program
to
provide coverage pursuant to
the bill
when determined to be medically necessary
.
Changes the effective date of the bill from July 1, 2025, to January 1, 2026.
Current Bill Text
Read the full stored bill text
HOUSE BILL 654
By Hicks T
SENATE BILL 437
By Reeves
SB0437
001223
- 1 -
AN ACT to amend Tennessee Code Annotated, Title 56
and Title 71, relative to health insurance.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 56, Chapter 7, Part 26, is amended by
adding the following as a new section:
(a) As used in this section:
(1) "Health benefit plan" means a plan of health insurance coverage as
that term is defined in § 56-7-109;
(2) "Mental health or substance abuse services" means care or services
for the treatment of a mental health condition or substance use disorder that falls
under a diagnostic category listed in the most recent version of the Diagnostic
and Statistical Manual of Mental Disorders; and
(3) "Psychiatric collaborative care model" or "PCCM" means an
evidence-based, integrated behavioral healthcare model of treatment that:
(A) Is provided by a primary care provider and a care manager
who work in collaboration with a psychiatric consultant, such as a
psychiatrist;
(B) Is overseen by the primary care provider and care manager
and includes structured care management with regular assessments of a
patient's clinical status using validated tools and modification of treatment
as appropriate; and
- 2 - 001223
(C) Requires the psychiatric consultant to provide regular
consultations to the primary care provider and care manager to review the
clinical status and care of a patient and make appropriate
recommendations.
(b)
(1) Except as provided in subdivision (b)(2), a health benefit plan that is
offered, delivered, or issued for delivery on or after July 1, 2025, and that
provides mental health and substance abuse services must provide for coverage
and reimbursement of such services through a PCCM.
(2) A health benefit plan may deny coverage and reimbursement of
services mandated under subdivision (b)(1) on the grounds of medical necessity
only if the health benefit plan's coverage for mental health and substance abuse
otherwise complies with state law and the federal Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) (42
U.S.C. § 300gg-26), and its regulations, and with the Health Care Service
Utilization Review Act, codified in chapter 6, part 7 of this title.
(3) A managed care organization contracting with the state to provide
insurance through the TennCare program, or a successor program, established
under title 71, chapter 5, or the CoverKids program, or a successor program,
established under title 71, chapter 3, must provide coverage in accordance with
this section if such coverage is determined to be medically necessary pursuant to
§ 71-5-144 if the patient is enrolled in the TennCare program, or determined to
be medically necessary by a healthcare provider if the patient is enrolled in the
CoverKids program, as applicable.
SECTION 2. This act takes effect July 1, 2025, the public welfare requiring it.