HB 654

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."