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ABA Coverage in Tennessee

Friday, August 02, 2019 2:14 PM | Anonymous member

To determine how this information impacts your coverage, call the number on the back of your insurance card.
Insurance coverage benefits vary widely.

From our friends at Autism Resources of the Mid-South

The Tennessee Department of Commerce and Insurance issued a bulletin on 8-1-2019. 8-1-19-Bulletin.pdf

In short, the bulletin clarifies that all fully insured health benefit plans subject to regulation by TN DC&I (including all individual, small group and large group health benefit plans) must provide coverage for mental health conditions, including autism as defined by the DSM covered services must comply with federal mental health parity law (Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act; MHPAEA); which prohibits plans from imposing a financial requirement or treatment limit restriction that is more restrictive than the predominant financial requirement or treatment limit restriction that applies to substantially all medical/surgical benefits.

The bulletin also clarifies that ABA is NOT experimental and must be covered at parity as outlined by MHPAEA

In addition to clarifying that ABA must be a covered service in all fully insured plans, it is our opinion that this bulletin will prohibit plans from imposing restrictive hour limits (e.g., 20 hours ABA/month) that currently exist in some Tennessee plans.

There will be follow up meetings scheduled with Commerce and Insurance later this month to discuss the implications of the bulletin in further detail and ARMS will keep you posted with any additional information

Please note that self-funded plans are NOT regulated by the DC&I and therefore not subject to this bulletin.

To determine how this information impacts your coverage, call the number on the back of your insurance card. Insurance coverage limits vary widely. 

HelpLine: 
(615) 270-2077
Address:
PO Box 60345
Nashville, TN 37206

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