HB7104113th GA (Historical)Introduced

Amends TCA Title 8; Title 56 and Title 71.

This bill requires the bureau of TennCare to do the following: (1) Require that each group health insurance contract, or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, amended, or renewed in this state by an MCO on or after the date that this bill becomes a law not include limits on the scope or duration of a benefit that are expressed numerically ("quantitative treatment limitations") for behavioral health services; (2) Reimburse an in-network or contract provider for covered behavioral health services provided to an enrollee at a rate not less than 180 percent of the federal centers for medicare and medicaid services (CMS) medicare program's allowable charge for participating providers that is in effect at the time the service is provided; and (3) Allow an enrollee to access an out-of-network or non-contract provider for covered behavioral health services and reimburse such provider at a rate not less than 100 percent of the CMS medicare program's allowable charge for participating providers that is in effect at the time the service is provided. A provider reimbursed pursuant to this (3) is prohibited from billing an enrollee for an amount above the allowed amount.

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Overview

This bill requires the bureau of TennCare to do the following: (1) Require that each group health insurance contract, or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, amended, or renewed in this state by an MCO on or after the date that this bill becomes a law not include limits on the scope or duration of a benefit that are expressed numerically ("quantitative treatment limitations") for behavioral health services; (2) Reimburse an in-network or contract provider for covered behavioral health services provided to an enrollee at a rate not less than 180 percent of the federal centers for medicare and medicaid services (CMS) medicare program's allowable charge for participating providers that is in effect at the time the service is provided; and (3) Allow an enrollee to access an out-of-network or non-contract provider for covered behavioral health services and reimburse such provider at a rate not less than 100 percent of the CMS medicare program's allowable charge for participating providers that is in effect at the time the service is provided. A provider reimbursed pursuant to this (3) is prohibited from billing an enrollee for an amount above the allowed amount.

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Sponsor

Unknown

Details
Session

113th General Assembly

Introduced

August 21, 2023

Subjects
2170

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