ABA Therapy Coverage in Tennessee: Private Insurance, TennCare and How to Check Your Benefits

Tennessee's rules on autism and insurance changed in 2019, and many families, and some older websites, still describe the law as it was before. The details that matter now are what kind of plan your child has, whether your employer's plan is regulated by the state at all, and, for TennCare members, which health plan is on the card.

This guide walks through what Tennessee law requires of private insurance, how ABA works under TennCare, what to look for on your card, and how BH Field verifies your benefits before your child's assessment is requested.

Key takeaway: Since 2019, Tennessee's mental health parity law has required health plans issued in the state to cover medically necessary treatment of autism, including ABA, on the same terms as other medical care. TennCare covers medically necessary care, including ABA, for members under 21. Whether your plan covers ABA, and on what terms, is confirmed during benefits verification, which we handle for you.

What Tennessee law requires of private insurance

Tennessee has two laws that matter here.

• The 2006 autism law. Tenn. Code Ann. § 56-7-2367 created a coverage requirement for autism spectrum disorders for people under 12. When it took effect, it did not reach evidence-based therapies like ABA, which is why you may read that "Tennessee has no ABA mandate."
• The mental health parity law, since 2019. Public Chapter 1012, effective January 1, 2019, amended Tenn. Code Ann. § 56-7-2360 so that plans must cover treatment of any condition listed in the mental disorders sections of the ICD or the DSM, at parity with medical and surgical benefits, as the federal Mental Health Parity and Addiction Equity Act requires.

In Bulletin 19-01, the Tennessee Department of Commerce and Insurance told every licensed health insurer what that means for autism: because autism is listed in both the ICD and the DSM, "any treatment that is medically necessary and appropriate and is not experimental, such as Applied Behavioral Analysis therapy, must be covered at parity."

In plain language:

• ABA has to be covered when it is medically necessary. Your plan decides medical necessity, usually through prior authorization, based on your child's diagnosis and their BCBA's assessment.
• No separate, tighter limits. Parity means the plan cannot put stricter limits on ABA than it puts on comparable medical care, such as lower visit caps or extra hurdles that do not apply elsewhere.
• Normal cost sharing applies. Deductibles, copays and coinsurance can apply in the same way as for other benefits in your plan.

Which plans the law reaches

According to the bulletin, the parity law applies to individual, small group and large group policies issued in Tennessee, including short-term plans, grandfathered plans that include mental health benefits, and Multiple Employer Welfare Arrangements. It does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care or other limited benefit policies.

The biggest exception is self-funded employer plans. Many large employers pay claims themselves and use an insurance company only to administer the plan. Those plans are regulated under federal law (ERISA), so state mandates generally do not apply. The federal parity law still applies to most of them, and many self-funded plans cover ABA, but their rules can differ. Your HR department can tell you whether your plan is fully insured or self-funded.

ABA under TennCare

TennCare is Tennessee's Medicaid program. For members under 21, it covers medically necessary care through TennCare Kids, Tennessee's version of the federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit (TennCare Rule 1200-13-13-.04).

ABA is a covered TennCare benefit for children with autism when it is medically necessary. TennCare members get their care through a managed care health plan, and the plan reviews ABA through prior authorization: an assessment is authorized first, and then treatment hours, based on the assessment and treatment plan (Amerigroup Community Care TennCare ABA guideline).

TennCare's three health plans are BlueCare Tennessee, UnitedHealthcare Community Plan and Wellpoint (formerly Amerigroup). Each one handles its own authorizations and has its own provider network, so the plan named on your child's card is the one that matters.

If your income is too high for TennCare

Tennessee's Katie Beckett program serves children under 18 with disabilities or complex medical needs who do not qualify for TennCare because of their parents' income or assets. It has two parts with different benefits and premiums, and some parts have limited slots, so contact TennCare to ask whether your child may qualify.

If your child has CoverKids, Tennessee's Children's Health Insurance Program (CHIP), send us that card too and we will check the plan.

Whether BH Field can serve your child under your specific TennCare or CoverKids plan is something we confirm during benefits verification. We will tell you plainly what we find.

What to check on your insurance card

Have your child's insurance card in hand (front and back) and look for:

• The plan name and logo. For TennCare members, this shows which health plan your child is in: BlueCare, UnitedHealthcare Community Plan or Wellpoint.
• The member ID and group number. We need both.
• The policyholder. If your child is on a parent's employer plan, we need that parent's name and date of birth.
• Phone numbers on the back. Look for member services and, if listed, behavioral health. ABA is often managed by a plan's behavioral health team.
• Words like "administered by." On an employer plan, this can be a sign that the plan is self-funded. It is not proof, so check with HR if you are unsure.
• A second card. If your child has two plans, send both. Which one pays first matters.

How BH Field verifies your benefits

Benefits verification is built into our intake, before the assessment is requested. Our intake has nine stages:

1. You complete the questionnaire on our site.
2. We contact you within 24 hours and tell you exactly which documents to send.
3. You send your documents, including both sides of your insurance card and your child's diagnosis report. This stage sets the pace of everything after it.
4. We build your intake package in 1 to 3 business days. We verify your insurance benefits and coverage, confirm your diagnosis paperwork will be accepted, and prepare the authorization request.
5. Insurance approves the assessment, in 1 day to 4 weeks depending on your plan.
6. Your BCBA assesses your child and writes the report, usually in 1 to 2 weeks.
7. Clinical review of the report, in 2 to 4 business days.
8. Insurance approves treatment and sets your child's hours, in 1 day to 4 weeks.
9. We match your team, in 1 business day to 4 weeks.

From first contact to first session usually takes 2 to 16 weeks. Where you land depends mostly on your insurer, which can approve an authorization in a day or take up to a month, and on your schedule flexibility, any language or therapist-gender preference, and your location.

After the benefits check, we explain what we found: whether ABA is covered, whether authorization is needed, and what cost sharing may apply. We never tell a family a plan covers something before we have confirmed it.

How BH Field serves families in Tennessee

BH Field is now open in Tennessee, with an office at 103 Continental Pl, Suite 204, Brentwood, TN 37027, and we serve families across the state. We do not have a clinic in Tennessee yet, so direct ABA therapy is delivered in person by a Registered Behavior Technician (RBT) at home or at school. Telehealth is used for assessments, BCBA supervision and parent training. Our team is bilingual in English and Spanish.

Behavior analysts in Tennessee are licensed by the Applied Behavior Analyst Licensing Committee of the Tennessee Department of Health.

Questions? Call (877) 438-1265 or email info@bhfield.com.

Next steps

• Learn how we serve families statewide on our Tennessee page.
• Ready to begin? Start ABA therapy and we will contact you within 24 hours.
• Gather your documents with the ABA intake checklist.
• See how we check your plan on our insurance verification page.