Insurance, Health, Accident - As enacted, revises certain protocols for mental health and substance abuse services. - Amends TCA Title 56 and Title 71. Companion bill has been assigned Public Chapter Number 168 by the Se, the official text

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State efJennessee

PUBLIC CHAPTER NO. 168

                                                     SENATE BILL NO. 437

                                    By Reeves, Crowe, Campbell, Walley, Yarbro

                                             Substituted for: House Bill No. 654

                By Tim Hicks, Freeman, Clemmons, Alexander, Hardaway, Parkinson, Terry

AN ACT to amend Tennessee Code Annotated, Title 56 and Title 71, relative to health insurance.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:

          SECTION 1. Tennessee Code Annotated, Title 56, Chapter 7, Part 26, is amended by adding
the following as a new section:

                    (a) As used in this section:

                              (1) "Health benefit plan" means a plan of health insurance coverage as that
                    term is defined in § 56-7-109;

                              (2) "Mental health or substance abuse services" means care or services for the
                    treatment of a mental health condition or substance use disorder that falls under a
                    diagnostic category listed in the most recent version of the Diagnostic and Statistical
                    Manual of Mental Disorders; and

                              (3) "Psychiatric collaborative care model" or "PCCM" means an evidence-
                    based, integrated behavioral healthcare model of treatment that:

                                        (A) Is provided by a primary care provider and a care manager who work
                              in collaboration with a psychiatric consultant, such as a psychiatrist;

                                        (8) Is overseen by the primary care provider and care manager and
                              includes structured care management with regular assessments of a patient's
                              clinical status using validated tools and modification of treatment as
                              appropriate; and

                                        (C) Requires the psychiatric consultant to provide regular consultations
                              to the primary care provider and care manager to review the clinical status and
                              care of a patient and make appropriate recommendations.

                    (b)(1) Except as provided in subdivisions (b)(2) and (3), a health benefit plan that is
                    offered, delivered, or issued for delivery on or after January 1, 2026, and that provides
                    mental health and substance· abuse services must provide for •coverage and
                    reimbursement of such services through a PCCM.

                              (2) A health benefit plan may deny coverage and reimbursement of services
                    mandated under subdivision (b)(1) on the grounds of medical necessity.

                              (3) A policy or contract for health insurance coverage provided under the
                    TennCare medical assistance program, or a successor program established under title
                    71, chapter 5, or the CoverKids program, or a successor program established under
                    title 71, chapter 3, may provide coverage pursuant to this section when determined to
                    be medically necessary pursuant to§ 71-5-144.

          SECTION 2. This act takes effect January 1, 2026, the public welfare requiring it.
         SENATE BILL NO. 437

PASSED:  March 28, 2025

         ~                                                                                                                    ~~

                                             RANDY Mc,,
                               SPEAKER OF THE SENATE

                         c~---?' -z:

                         CAMERON SEXTON, SPEAKER
                         HOUSE OF REPRESENTATIVES

Apri APPROVED this ~ day of  I  2025

         • 'L

           ILL LEE, GOVERNOR