Tennessee State-Regulated Insurance Coverage

Tennessee requires meaningful coverage for autism under state-regulated plans. 

In, 2006, Tennessee passed a mandate for the treatment of autism for children under the age of twelve. However, this coverage did not extend to evidence-based therapies like applied behavior analysis. On August 1, 2019, the Tennessee Department of Commerce and Insurance issued a bulletin requiring insurance companies to cover medically necessary care for autism, including applied behavior analysis.  

 Health benefit plans were given till March 1, 2020 to come into compliance with the new requirements.

To which plan types does the state autism insurance law apply?

  • Fully Insured Individual Plans - Yes
  • Fully Insured Large Group Plans -Yes
  • Fully Insured Small Group Plans - Yes

What services are covered by the bulletin?

“Any treatment that is medically necessary and appropriate and is not experimental... must be covered at parity as outlined by MHPAEA.” This may include:

  • Assessment, screening and diagnosis
  • Psychological care
  • Psychiatric care
  • Speech, occupational and physical therapy
  • Applied behavior analysis and other therapies deemed medically necessary

Does Tennessee have caps on ABA coverage?

The bulletin effectively prohibits plans from imposing restrictions on the number of treatment hours that historically have existed in some Tennessee plans.

Where can I find more details about the Tennessee insurance bulletin?

A copy of the Tennessee Department of Commerce and Insurance bulletin can be found here.

If you have additional questions, please email advocacy@autismspeaks.org.

 

Last Updated: December 2019

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