Insurance, Health, Accident - As introduced, revises requirements for mental health parity with medical health insurance statutes to require certain demonstrations of parity and reports from insurers. - Amends TCA Title 56 and Title 71.
  • Bill History
  • Amendments
  • Video
  • Summary
  • Fiscal Note
  • Votes
  • Actions For HB1244Date
    Meeting Canceled: Taken off notice for cal in s/c Insurance and Banking Subcommittee of Insurance and Banking Committee01/31/2018
    Placed on s/c cal Insurance and Banking Subcommittee for 1/31/201801/24/2018
    Placed on s/c cal Insurance and Banking Subcommittee for 1/24/201801/17/2018
    Action Def. in s/c Insurance and Banking Subcommittee to 1/24/201801/10/2018
    Placed on s/c cal Insurance and Banking Subcommittee for 1/10/201801/03/2018
    Action Def. in s/c Insurance and Banking Subcommittee to 1st Calendar of 201804/05/2017
    Placed on s/c cal Insurance and Banking Subcommittee for 4/5/201703/29/2017
    Action Def. in s/c Insurance and Banking Subcommittee to 4/5/201703/29/2017
    Sponsor(s) Added.03/28/2017
    Placed on s/c cal Insurance and Banking Subcommittee for 3/29/201703/22/2017
    Sponsor(s) Added.03/08/2017
    Assigned to s/c Insurance and Banking Subcommittee02/15/2017
    P2C, ref. to Insurance and Banking Committee02/15/2017
    P1C.02/13/2017
    Intro.02/09/2017
    Filed for intro.02/09/2017
    Actions For SB0839Date
    Assigned to General Subcommittee of Senate Commerce and Labor Committee04/04/2017
    Placed on Senate Commerce and Labor Committee calendar for 4/4/201704/03/2017
    Action deferred in Senate Commerce and Labor Committee to 4/4/201704/03/2017
    Placed on Senate Commerce and Labor Committee calendar for 4/3/201703/28/2017
    Action deferred in Senate Commerce and Labor Committee to 4/4/201703/28/2017
    Placed on Senate Commerce and Labor Committee calendar for 3/28/201703/22/2017
    Passed on Second Consideration, refer to Senate Commerce and Labor Committee02/13/2017
    Introduced, Passed on First Consideration02/09/2017
    Filed for introduction02/09/2017
  • No amendments for HB1244.
    AmendmentsFiscal Memos
    SA0302Amendment 1-1 to SB0839Fiscal Memo for SA0302 (6014)  
    SA0303Amendment 2-2 to SB0839 

    NOTE: Each fiscal memorandum applies only to the amendment(s) identified in the memorandum. The fiscal memorandum must be matched to any amendments that have been adopted.

  • Videos containing keyword: HB1244

  • Fiscal Summary

    Increase State Expenditures - $116,800/FY17-18 $214,300/FY18-19 and Subsequent Years


    Bill Summary

    This bill revises requirements regarding coverage for mental health, mental illness, and alcohol or drug dependency, and requires certain reports, as discussed below.

    COVERAGE

    Present Law:

    Under present law, in addition to any other requirement of law concerning coverage of mental health or mental illness benefits, any group health plan issued by any entity regulated pursuant to insurance law must provide coverage for mental health services as follows:

    (1) As to either aggregate lifetime limits or annual limits, or both, for a group health plan providing both medical and surgical benefits and mental health benefits: if the plan does not have a limit on substantially all medical and surgical benefits, the plan may not impose the limit on mental health benefits; if the plan has a limit on substantially all medical and surgical benefits, the plan must either include mental health benefits under the limit applied to medical and surgical benefits, or apply a separate limit to mental health benefits that is no less than the one applied to medical and surgical benefits; and if the plan has varying limits on different medical or surgical benefits, the plan must apply an average limit to mental health benefits with the average to be computed based on the weighted average of the varying limits;
    (2) Any annual visit limits by a plan must be equal to or greater than 20 hospital inpatient days and 25 outpatient or doctor visits. As an alternative to hospital inpatient days, if less costly residential treatment, partial hospitalization, or crisis respite care for the patient is appropriate, the plan must provide for this care at the rate of two alternate care days to one day of inpatient hospital treatment. An issuer of a plan may not count toward the number of outpatient visits required to be covered an outpatient visit for the purpose of medication management, and must cover that outpatient visit under the same terms and conditions as it covers outpatient visits for the treatment of physical illness. Medication management does not include services that could be billed as a therapy or consultation visit.

    A plan may not establish a separate limitation for mental health services for out-of-pocket cost sharing that is more costly than the limitation applied to medical and surgical benefits.

    The mandate to provide coverage for mental health services at the same rates and terms as coverage provided for all medical and surgical conditions under present law is not applicable to services for the abuse of or dependency on alcohol or drugs, and the requirements do not apply to any individual policy issued. Also, the above present law provisions do not apply to group health plans issued to employers with from two to 25 employees. Also, the mandate to provide coverage for mental health services does not apply with respect to a group health plan if the application of the mandate to the plan results in an increase in the cost under the plan of more than 1 percent. The provisions also do not apply to accident-only, specified disease, hospital indemnity, medicare supplement, long-term care or other limited benefit hospital insurance policies.

    Present law specifies that the benefits may not be denied for care for confinement provided in a hospital owned or operated by this state that is especially intended for use in the diagnosis, care, and treatment of psychiatric, mental, or nervous disorders.

    This bill rewrites the above provisions to, among other things, include individual policies and drug and alcohol dependency treatment.

    Under this bill, in addition to any other requirement of law concerning coverage of mental health or mental illness benefits or alcoholism or drug dependency benefits, an individual or group health benefit plan must provide coverage for mental health or alcoholism or drug dependency services as required by this bill. This bill specifies that it does not require benefits that exceed the essential health benefits requirements of federal law.

    This bill specifies, as to either aggregate lifetime limits or annual limits, or both, for a health benefit plan providing both medical and surgical benefits and mental health or alcoholism or drug dependency benefits:

    (1) If the plan does not have a limit on substantially all medical and surgical benefits, the plan may not impose the limit on mental health or alcoholism or drug dependency benefits;
    (2) If the plan has a limit on substantially all medical and surgical benefits, the plan must either include mental health or alcoholism or drug dependency benefits under the limit applied to medical and surgical benefits, or apply a separate limit to mental health or alcoholism or drug dependency benefits that is no less than the one applied to medical and surgical benefits; and
    (3) If the plan has varying limits on different medical or surgical benefits, the plan must apply an average limit to mental health or alcoholism or drug dependency benefits with the average to be computed based on the weighted average of the varying limits.

    In the case of a health benefit plan that provides both medical and surgical benefits and mental health or alcoholism or drug dependency benefits, the plan must ensure certain things, such as that the financial requirements applicable to the mental health or alcoholism or drug dependency benefits in any classification of benefits are no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits in the same classification of benefits covered by the plan.

    This bill provides that a health benefit plan may not impose a NQTL with respect to a mental health condition or alcoholism or drug dependency in any classification of benefits unless, under the terms of the plan, as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to mental health or alcoholism or drug dependency benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the NQTL with respect to medical and surgical benefits in the same classification. With respect to opioid use disorders, an insurer must use policies and procedures for the election and placement of opioid use disorder treatment drugs on their formulary that are no less favorable to the insured as those policies and procedures the insurer uses for the selection and placement of other drugs.

    An issuer of a plan may not count toward the number of outpatient visits required to be covered an outpatient visit for the purpose of medication management, and must cover that outpatient visit under the same terms and conditions as it covers outpatient visits for the treatment of physical illness. Medication management shall not include services that could be billed as a therapy or consultation visit.

    A plan may not establish a separate limitation for mental health services for out-of-pocket cost sharing that is more costly than the limitation applied to medical and surgical benefits.

    This bill specifies that the mandate to provide coverage for mental health services will not apply with respect to a group health plan if the application of the mandate to the plan results in an increase in the cost under the plan of more than 1 percent.

    This bill requires the department of commerce and insurance to implement and enforce applicable provisions of: the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; this bill; and present law provisions governing coverage for mental health and drug and alcohol dependency. This bill details what is included in such requirement.

    This bill requires the department, no later than June 1 of each year, to report to the general assembly and provide an educational presentation to the general assembly. The report and presentation must include, among other things, the methodology the department is using to check for compliance with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and market conduct examinations conducted or completed during the preceding 12-month period regarding compliance with parity in mental health or alcoholism or drug dependency benefits under state and federal laws and summarize the results of such market conduct examinations.

    This bill specifies that benefits may not be denied for care for confinement provided in a hospital owned or operated by this state that is especially intended for use in the diagnosis, care, and treatment of psychiatric, mental, or nervous disorders.

    The above provisions regarding coverage under this bill will not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or other limited benefit hospital insurance policies.

    This bill requires the commissioner to monitor health benefit plan claims denials for mental health or alcoholism or drug dependence benefits on the grounds of medical necessity. The commissioner must examine denial rates for these benefits among inpatient in-network benefits, inpatient out-of-network benefits, outpatient in-network benefits, outpatient out-of-network benefits, prescription drugs, and emergency care. The commissioner must also study and compare denial rates among the health benefit plans and request additional data if significant discrepancies in denial rates are found.

    REPORT FROM CARRIERS

    This bill requires every health insurance carrier that issues a health benefit plan under the jurisdiction of the department of commerce and insurance to submit an annual report to the department on or before March 1 that contains the following information, and prohibits the commissioner from certifying any health benefit plan of a health insurance carrier that fails to submit the required data:

    (1) The frequency with which the health insurance carrier required prior authorization for all prescribed procedures, services, or medications for mental health and alcoholism or drug dependence benefits during the previous calendar year and the frequency with which the health insurance carrier required prior authorization for all prescribed procedures, services, or medications for medical and surgical benefits during the previous calendar year;
    (2) A description of the process used to develop or select the medical necessity criteria for mental health and alcoholism or drug dependence benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits;
    (3) Identification of all non-quantitative treatment limitations (NQTLs) that are applied to both mental health and alcoholism or drug dependence benefits and medical and surgical benefits;
    (4) The results of an analysis that demonstrates that for the medical necessity criteria described in (2) and for each NQTL identified in (3), as written and in operation, the processes, strategies, evidentiary standards, or other factors used to apply the medical necessity criteria and each NQTL to mental health and alcoholism or drug dependence benefits are comparable to, and are applied no more stringently than the processes, strategies, evidentiary standards, or other factors used to apply the medical necessity criteria and each NQTL, as written and in operation, to medical and surgical benefits. This bill sets out specific requirements for analysis;
    (5) The rates of and reasons for denial of claims for inpatient in-network, inpatient out-of-network, outpatient in-network, outpatient out-of-network, prescription drugs, and emergency care mental health and alcoholism or drug dependence services during the previous calendar year compared to the rates of and reasons for denial of claims in those same classifications of benefits for medical and surgical services during the previous calendar year;
    (6) A certification signed by the health insurance carrier's chief executive officer and chief medical officer that affirms that the health insurance carrier has completed a comprehensive review of its administrative practices for the prior calendar year for compliance with the necessary provisions of: this bill; present law governing coverage of mental illness, alcoholism, and drug dependence; and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; and
    (7) Any other information necessary to clarify data provided in accordance with this section requested by the commissioner, including information that may be "proprietary" or have "commercial value." Any information submitted that is proprietary will not be made a public record.

    REPORT FROM MANAGED CARE ORGANIZATIONS

    This bill requires every managed care organization that participates in the TennCare program to submit an annual report to the bureau of TennCare on or before March 1 of each year that contains the following information for enrollees in the TennCare program:

    (1) The frequency with which the managed care organization required prior authorization for all prescribed procedures, services, or medications for mental health and alcoholism or drug dependence benefits during the previous calendar year and the frequency with which the managed care organization required prior authorization for all prescribed procedures, services, or medications for medical and surgical benefits during the previous calendar year;
    (2) A description of the process used to develop or select the medical necessity criteria for mental health and alcoholism or drug dependence benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits;
    (3) Identification of all non-quantitative treatment limitations (NQTLs) that are applied to both mental health and alcoholism or drug dependence benefits and medical and surgical benefits. There may be no separate NQTLs that apply to mental health and alcohol or drug dependence benefits but do not apply to medical and surgical benefits within any classification of benefits;
    (4) The results of an analysis that demonstrates that for the medical necessity criteria described in (2) and for each NQTL identified in (3), as written and in operation, the processes, strategies, evidentiary standards, or other factors used to apply the medical necessity criteria and each NQTL to mental health and alcoholism or drug dependence benefits are comparable to, and are applied no more stringently than the processes, strategies, evidentiary standards, or other factors used to apply the medical necessity criteria and each NQTL, as written and in operation, to medical and surgical benefits. This bill sets out specific requirements for the analysis;
    (5) The rates of and reasons for denial of claims for inpatient, outpatient, prescription drugs, and emergency mental health and alcoholism or drug dependence services during the previous calendar year compared to the rates of, and reasons for, denial of claims in those same classifications of benefits for medical and surgical services during the previous calendar year; and
    (6) A certification signed by the managed care organization's chief executive officer and chief medical officer that affirms that the managed care organization has completed a comprehensive review of its administrative practices for the prior calendar year for compliance with this bill and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

    This bill requires the bureau of TennCare to monitor managed care organization claims denials for mental health and alcoholism or drug dependence benefits on the grounds of medical necessity within each classification of benefits among inpatient benefits, outpatient benefits, prescription drugs, and emergency care. This bill also requires the bureau to study and compare denial rates among each managed care organization and request additional data if significant discrepancies in denial rates are found.

    This bill specifies that separate NQTLs that apply to mental health and alcohol or drug dependence benefits but do not apply to medical and surgical benefits within any classification of benefits are not permitted.

    This bill will take effect January 1, 2018, and apply to policies and contracts entered into or renewed on and after January 1, 2018.

  • FiscalNote for HB1244/SB0839 filed under SB0839
  • House Floor and Committee Votes

    Votes for Bill HB1244 by the House are not available.

    Senate Floor and Committee Votes

    Votes for Bill SB0839 by the Senate are not available.