TN Insurance Bulletin (1988-09-01): Coverage of Mental Illness, Community Mental Health Centers, Clinical Staff, T.C.A. 56-7-1003

NED McWHERTER

GOVERNOR

TO:

STATE OF TENNESSEE

DEPARTMENT OF COMMERCE AND INSURANCE

500 JAMES ROBERTSON PARKWAY

NASHVILLE, TENNESSEE 37219

B U L L E T I N

All Heal th Insurers

FR:

Elai ne A. McReynolds, Commissioner

~~~

Depa rtme nt of Commerce and Insuranc~'1

RE:

Cove rage of Mental Illness, Community Menta l

Heal th Centers, Clinical Staff, T.C.A. 56-7 -1003

DA:

Sept embe r 1, 1988

ELAINE A. McREYNOLDS

COMMISSIONER

A re cent inquiry has lead the Department t o believe that

there

may

b e

some

confusion

as

to

the

re quirements

for

coverage

of

community

mental

health

center

treatment

and

coverage of clinical staff working at community mental h ealth

centers.

Subs ecti on (a) of T.C.A. Section 56-7-1003 provides that

policies iss ued in Tennessee must provide cove rage of mental

illness

u nle ss

the policy specifically exclud es

or

re duces

such

benefit s.

Subsection

(e)

provides

that all pol icies

which do provide benefits for mental i llness s hall reimburse

for

such

be nefits

when

such

benefits

are

provided

at

a

community

me ntal

health

center,

whether

wit h

respect

to

outpatien t or inpatient benefits.

Subs ecti on (b)(1)(2) provide that any pol icy must cover

treatment

at

a

community

mental

health

cent er

unless

the

policyholder specifically rejects in writing suc h coverage .

Subse cti on

(b)(3)

provides

that

when

benefits

are

provided for treatment at

a

community mental health center,

such bene fits shall include coverage of ''clinica l staff" which

is define d

as

an individual who

holds at lea st

a

mast er's

degree in ei ther psychology, nursing, or socia l

work and any

required lice nsed.

In s hor t, the policy may exclude or reduc e benefits for

coverage of mental health but must provide fu ll coverag e

in

the absenc e of an exclusion

nity mental health center,

such bene fits shall include coverage of ''clinica l staff" which

is define d

as

an individual who

holds at lea st

a

mast er's

degree in ei ther psychology, nursing, or socia l

work and any

required lice nsed.

In s hor t, the policy may exclude or reduc e benefits for

coverage of mental health but must provide fu ll coverag e

in

the absenc e of an exclusion.

Any policy provid ing covera ge of

mental il lne ss

must

cover

treatment at

a

co mmunity

mental

health ce nter in the absence of a written rejec tion signe d by

the

appl ican t.

Any

policy

so

covering

tr eatment

a t

a

community me ntal health center must "cover cli nical staf f

at

the commun ity mental health center.