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TASER recommends adjusting Tennessee’s ACA benchmark to expand speech therapy coverage
Summary
After studying proposed changes to speech‑therapy coverage for stuttering, TASER recommended that Tennessee update its Essential Health Benefits benchmark plan to increase the minimum number of speech‑therapy visits covered by ACA plans rather than eliminating utilization review, a step that would trigger federal defray obligations.
TASER approved a final report on speech therapy services on June 22 that analyzes proposed changes to insurance coverage for stuttering and recommends updating the state’s Essential Health Benefits (EHB) benchmark for Affordable Care Act (ACA) plans rather than eliminating utilization review or visit limits.
Senior Research Associate Jennifer Arzate said the study examined Senate Bill 231/House Bill 296 language that would have required state plans, ACA plans, TennCare and CoverKids to cover habilitative and rehabilitative stuttering therapy without age or visit caps or utilization review. The report concluded removing utilization review raises cost and oversight concerns and could trigger defray obligations under the ACA if the mandated benefits exceed federal minimums.
Arzate said Tennessee’s current EHB benchmark requires ACA plans to cover a minimum of 20 visits per year for habilitative and rehabilitative services; most insurers follow that minimum. The report recommends the Tennessee Department of Commerce and Insurance update the state’s EHB benchmark to increase the minimum number of speech‑therapy visits required for ACA plans, which would improve coverage without triggering state defray costs or eliminating utilization review practices used by insurers.
Representative Love, sponsor of the original bill language, praised the staff work and said improving coverage could benefit children and families. The commission approved the report by voice vote (motion moved by Rep. Love; seconded by Rep. Parkinson).
Why it matters: Increasing the EHB minimum could expand equitable access to speech therapy for children with stuttering while avoiding federal fiscal penalties for the state.
What’s next: Staff and the Department of Commerce and Insurance would need to consider the effects of changing the benchmark, since adopting a new EHB plan adopts all coverage requirements in that benchmark plan, not just the speech‑therapy changes.
