Amends TCA Title 8 and Title 56.

REQUIRED COVERAGE FOR HEALTH BENEFIT PLANS This bill requires a health benefit plan to include coverage for cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy and rehabilitation, neurobehavioral, neurophysiological, neuropsychological, psychophysiological testing and treatment, neurofeedback therapy, remediation, post-acute transition services, community reintegration services, including outpatient day treatment services, and other post-acute care treatment services required for and related to treatment of an acquired brain injury. PROHIBITED ACTIONS This bill prohibits a health benefit plan from (i) including, in any annual or lifetime limitation on the number of days of acute care treatment covered under the plan, any post-acute care treatment covered under the plan; or (ii) limiting the number of days of: (1) Covered post-acute care, including a therapy, treatment, rehabilitation, testing, remediation, or other service as described above under the heading "Required Coverage for Health Benefit Plans;" or (2) Covered inpatient care, to the extent that the treatment or care is determined to be medically necessary as a result of and related to an acquired brain injury; for purposes of this provision, the insured's or enrollee's treating physician determines whether treatment or care is medically necessary in consultation with the treatment or care provider, the insured or enrollee, and, if appropriate, members of the insured's or enrollee's family; the determination may be subject to review as described below under the heading "Responding to Requests and Appeals." EQUAL COVERAGE Except as described above under the heading "Prohibited Actions," a health benefit plan must include the same amount of limitations, deductibles, copayments, and coinsurance factors for coverage required under this bill as applicable to other medical conditions for which coverage is provided under the health benefit plan. COVERAGE FOR PERIODIC REEVALUATION In addition to the required coverage described above under the heading "Required Coverage for Health Benefit Plans," a health benefit plan must include coverage for reasonable expenses related to periodic reevaluation of the care of an insured or enrollee who (i) has incurred an acquired brain injury, (ii) has become unresponsive to treatment, and (iii) becomes responsive to treatment at a later date. For purposes of determining whether an expense incurred is reasonable, factors to be considered include (i) the cost, (ii) the time that has expired since the insured's or enrollee's previous evaluation, (iii) any difference in the expertise of the physician or practitioner performing the evaluation, (iv) changes in technology, and (v) advances in medicine. RESPONDING TO REQUESTS AND APPEALS This bill requires an issuer of a health benefit plan to respond to a person requesting utilization review or appealing for an extension of coverage based on an allegation of medical necessity not later than three business days after the date on which the person makes the request or submits the appeal. The person must make the request or submit the appeal in the manner prescribed by the terms of the health benefit plan's insurance policy or agreement, contract, evidence of coverage, or similar coverage document. CONTRACTING WITH SERVICE PROVIDERS This bill prohibits the issuer of a health benefit plan that contracts with or approves admission to a service provider refusing to contract with or approve admission to the facility to provide services solely because a facility is licensed by this state as an inpatient rehabilitation facility, if the services are as follows: (1) Required by this bill; (2) Within the scope of the license of the inpatient rehabilitation facility; and (3) Within the scope of the services provided under a rehabilitation program for brain injury that is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) or another nationally recognized accredited rehabilitation program. DESIGNATED HEALTHCARE PROVIDERS This bill requires the issuer of a health benefit plan that requires or encourages an insured or enrollee to use healthcare providers that are designated by the plan to ensure that the services required by this bill that are within the scope of the license of an inpatient rehabilitation facility and that may be provided under a program described above in (3) under the heading "Contracting with Service Providers," are made available and accessible to the insured or enrollee at an adequate number of inpatient rehabilitation facilities. PROHIBITION ON CUSTODIAL CARE CLASSIFICATION This bill prohibits a health benefit plan from treating care provided in accordance with this bill as custodial care solely because it is provided by an inpatient rehabilitation facility if the facility holds a CARF accreditation or another nationally recognized accreditation for a rehabilitation program for brain injury. REQUIRING CARF ACCREDITATION This bill authorizes the commissioner of commerce and insurance to require that a licensed inpatient rehabilitation facility that provides covered post-acute care other than custodial care under this bill to an insured or enrollee with an acquired brain injury hold a CARF accreditation or another nationally recognized accreditation for a rehabilitation program for brain injury.