Despite the passage of federal and state parity laws, Tennesseans living with mental health and addiction challenges continue to face barriers in finding affordable, quality care. This is, in part, attributable to insurance companies’ continued practice of denying coverage and limiting treatment options.
In Tennessee, more than 1 in 5 adults—over 1 million people—have a mental illness, compared to 1 in 6 nationally. 1 in 4 adults with mental illness in Tennessee are uninsured, compared to 1 in 7 nationally. Rates of suicides and overdoses are higher than the national averages and continue to climb in Tennessee.
According to a recent report, “Evaluating State Mental Health and Addiction Parity Statutes,” (Kennedy Forum, 2018) Tennessee ranks 2nd in the country for state statutes designed to ensure equal access to mental health and addiction treatment. Unfortunately, with a score of 79, our ranking says more about the failure of state-level parity enforcement efforts nationally than it does about what’s happened in Tennessee.
In 2017 Tennessee passed legislation that mandated parity in all TennCare insurance plans (link to bill); and the following year passed a mirror bill to provide the same thing for private insurance companies (link to bill).
The Division of TennCare and the Department of Commerce and Insurance, the regulatory authorities responsible for enforcing parity in the state’s Medicaid managed care organizations and individual and small group health plans, are required to strengthen their enforcement of Federal Parity Law by collect information from health plans to ensure that they are applying similar processes and restrictions for treatment and coverage of mental health and addiction as they would for medical and surgical benefits.
The Tennessee Parity Act of 2018 (SB2165/HB2355) helps consumers and employers get the coverage they paid for, and gives specific guidance to help health plans comply with parity. The law aligns Tennessee statute with federal parity law and strengthens enforcement.
Now, the Department of Commerce and Insurance is required to collect information from health plans showing that they comply with parity: that their standards and procedures are designed and applied fairly. And parity questions must be included in the Department’s regular audits of health plans. The Department must also report to the legislature by January 31, 2020. Part of the report will cover consumer complaints.
With these two bills, Tennessee has passed comprehensive model parity legislation that addresses insurer reporting requirements and commissioner implementation requirements. There is model parity legislation that eliminates some managed care barriers to medication-assisted treatment for substance use disorders that has yet to be introduced (See the American Psychiatric Association’s model parity-implementation legislation guide).
Despite these recent legislative advances, there is still room for improvement in Tennessee, particularly around how compliance with parity laws are monitored and enforced.
The Federal Parity Law requires health insurers to cover mental health substance use disorders no more restrictively than other medical conditions. Health insurance plans CANNOT limit frequency of treatment, number of visits, or days of coverage for mental health care more so than for other types of medical care. Parity laws protect parity in several types of care:
- Inpatient or hospital care must be covered equally in or outside the health plan network;
- Outpatient care in and out of network;
- Residential treatment
- Emergency care, and
- Prescription drugs.
Parity also applies to cost sharing such as co-pays, co-insurance, deductibles and out-of-pocket cost limits. Health insurance plans CANNOT require higher deductibles, co-payments or out-of-pocket expenses for mental health benefits that they do for other medical care. Health plans are required to have enough mental health and substance use outpatient providers and mental health hospitals to serve members close to home. And, provider payment rates for mental health must be on the same level as other types of care.
Finally, standards used to approve or deny treatment requests CANNOT be more strict for mental health and addiction care than for other medical care.