AN ACT to amend Tennessee Code Annotated, Title 8; Title 56 and Title 71, relative to coverage of behavioral health services.
Impact
The enactment of SB7097 is expected to transform how behavioral health services are covered under TennCare, thereby improving the quality of care available to enrollees. Specifically, the bill mandates that MCOs reimburse contract providers for covered services at a rate no less than 180% of the Medicare allowable charge at the time services are provided. Additionally, should enrollees choose to access out-of-network or non-contract providers, they are guaranteed reimbursement at 100% of the Medicare rate. This change aims to support those in need of behavioral health services who may be unable to find an in-network provider.
Summary
Senate Bill 7097 aims to amend the Tennessee Code Annotated regarding the coverage of behavioral health services. The bill specifies that managed care organizations (MCOs) must not impose quantitative treatment limitations on behavioral health services. This means that there cannot be restrictions such as limiting the number of visits or the duration of treatment, which has been a significant barrier for enrollees seeking mental health care. The intent of this legislation is to enhance accessibility and ensure a more equitable approach to behavioral health service delivery under TennCare, especially as awareness of mental health issues continues to grow.
Contention
Notable points of contention surrounding SB7097 stem from concerns regarding the financial implications of these mandated coverage expansions on MCOs. Critics argue that without such limitations, there may be an increased burden on insurance systems, potentially resulting in higher costs for both providers and enrollees. Proponents of the bill counter this concern by emphasizing the necessity of removing barriers to care and the importance of adequately funding mental health services, particularly in a time when mental health issues are prevalent in communities.