SB 1248

COVERAGE FOR MENTAL HEALTH SERVICES Present law requires an individual or group health benefit plan to provide coverage for mental health or alcoholism or drug dependency services in compliance with the federal " Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 ."" However, this requirement does not apply with respect to a group health plan if it would result in an increase in the cost under the plan of more than 1%. This bill deletes the provision that exempts plans from the mandate if the mandate increases the plan's cost by m ore than 1% and requires, instead, that coverage for mental health treatment must remain in parity with coverage for alcoholism and drug dependence coverage . Present law prohibit s alcoholism and drug dependence coverage from being less favorable than for physical illness generally, subject to the same durational limits, dollar limits, deductibles and coinsurance factors. The offer of benefits must be subject to the right of the group policy or contract holder to reject the coverage or to select any alter n ative level of benefits if the right is offered by or negotiated with the insurer, service plan corporation or health maintenance organization. Present law defines a health benefit plan as a hospital or medical expense policy; health, hospital, or medi cal service corporation contract; a policy or agreement entered into by a health insurer or a health maintenance organization contract offered by an employer; other plans administered by the state government; or a certificate issued under the policies, co n tracts, or plans . This bill adds that a health benefit plan includes a plan of coverage under TennCare or a successor program . REPORTING Present law requires the department of commerce and insurance to issue a n annual report and provide an educational presentation to the general assembly. The report and presentation must, among other things, i dentify market conduct examinations and full scope examinations conducted or completed during the preceding 12 -month period and summarize the results of the exami nations. This discussion must also include a detailed explanation regarding parity in coverage and rates of reimbursement for mental health services and alcoholism and drug dependency services in compliance with state laws on insurance and the mandatory m ental health services under welfare. This bill changes what is required in the report to the extent that the report no longer must include information on compliance with welfare, and it must, instead, include a detailed explanation regarding parity in cov erage and rates of reimbursement for mental health services and alcoholism and drug dependency services in compliance with this bill. INCLUDED MENTAL HEALTH TREATMENT FACILIT IES Present law requires a ll group hospital and major medical policies and all group hospital, medical and major medical service plans, that provide benefits for expenses arising from psychiatric disorders, mental or nervous conditions, alcoholism, drug dependence or medical complication of mental illness or intellectual disability, to reimburse for these benefits, if any, when the benefits are provided at a facility that is:  With respect to outpatient benefit, a community mental health center .  With respect to inpatient benefits, a community mental health center that has facilities for inpatient care and that has received a certificate of need from the Tennessee health facilities commission certifying the necessity of the facility if required by law .  For persons covered under a TennCare health benefit plan, a residential or other mental health treatment facility licensed in this state . This bill adds to this list any residential or other mental health treatment facility licensed in this state."