When a Tennessean is experiencing a mental health crisis, should insurance paperwork stand between that person and treatment?
The Tennessee Mental Health Access and Patient Protection Act serves an amendment to Tennessee Code-Title 56-Chapter 7- Part 37. “Prior Authorization Fairness Act” to modernize behavioral health coverage by reducing unnecessary prior authorization requirements, improving access to mental health and substance use disorder treatment, strengthening continuity of care protections, and ensuring health plan decisions are based on evidence-based clinical standards
Thousands of Tennesseans face delays in accessing mental health and substance use treatment due to prior authorization requirements and utilization review practices that can postpone medically necessary care. Delayed treatment may contribute to:
· Worsening psychiatric symptoms
· Increased risk of suicide and overdose
· Increased psychiatric boarding in emergency departments
· Higher hospitalization and crisis intervention costs
· Lost productivity and workforce participation
· Increased strain on law enforcement, schools, and healthcare systems
Behavioral health needs continue to grow across Tennessee:
· 1.44 million Tennessee adults experienced a mental illness in 2025. [mhstats.org]
· Approximately 4% of Tennessee adults live with a serious mental illness. [mhstats.org]
· 1 in 4 Tennessee high school students reported seriously considering suicide. [mhstats.org]
· 37% of Tennesseans with mental illness received no formal treatment during the previous year. [mhstats.org]
Suicide remains a major public health concern:
· 1,229 Tennesseans died by suicide in 2024. [USAfacts.org]
· From 2020-2023, the Tennessee Violent Death Reporting System documented 5,012 suicide deaths, representing 56.1% of all violent deaths in the state. [tn.gov]
Tennessee's behavioral health safety net is already under significant pressure.
In 2025:
· Tennessee Mobile Crisis Services responded to 112,897 crisis calls [tn.gov]
· 72,784 individuals required face-to-face crisis assessments [tn.gov]
· Desired response times remain 2 to 4 hours during active crises [tn.gov]
When treatment is delayed, more individuals ultimately require emergency and crisis services.
Behavioral health providers report significant administrative burdens associated with obtaining treatment authorizations, diverting resources away from patient care. The 2025 American Medical Association Prior Authorization Physician Survey showed
· 95% of physicians reported prior authorization delays negatively impacted access to necessary behavioral healthcare.
· 79% of physicians reported patients abandoned treatment due to authorization-related delays or disputes.
· Providers also reported missed therapy appointments, medication interruptions, and delayed crisis interventions.
Research further indicates that patients receiving psychiatric, behavioral health, and substance use disorder services experience disproportionately high rates of harm associated with prior authorization requirements. [www.ama-assn.org]
At what cost?
In Tennessee, a psychiatric crisis requiring ambulance transport, emergency department evaluation, and a 72-hour psychiatric hold can easily exceed $7,000 to $15,000 per occurrence, depending on acuity level, hospital charges, and transportation costs. [checkmyerbill.com], [labrumlawfirm.com], [ambulancecost.com]
By comparison, residential treatment programs generally range from $6,000 to $30,000 per month, often making a single residential placement cost-comparable to one or two psychiatric emergency episodes. [therapyexplained.com], [talktomira.com]
Even a modest reduction in psychiatric emergency department visits, ambulance transports, involuntary commitments, and inpatient hospital psychiatric admissions could generate substantial savings for Tennessee's healthcare system. Expanding access to residential behavioral health treatment provides an opportunity to shift resources from costly crisis response toward earlier, more effective intervention
Tennessee's Prior Authorization Fairness Act improved transparency and accountability but did not eliminate the underlying barriers that continue to delay behavioral healthcare.
Federal turnaround standards for prior authorization decisions, including:
· 7 days for standard requests
· 72 hours for expedited requests
still fail to adequately address the clinical realities of behavioral health treatment, where delays of even a few days can significantly worsen patient outcomes.
Mental illness is highly treatable when care is timely and accessible. The Tennessee Mental Health Access and Patient Protection Act removes unnecessary insurance barriers that delay treatment, disrupt care, and contribute to costly behavioral health crises. By improving access to early intervention and ongoing treatment, Tennessee can improve outcomes, reduce suicide risk, decrease emergency department utilization, and strengthen its behavioral health system for patients, families, and communities.
What this bill does
· Eliminates prior authorization requirements for mental health and substance use disorder services
· Protects access to psychiatric, psychological, counseling, substance use disorder, ABA, rehabilitative, and habilitative services
· Reduces administrative burden on providers
· Improves continuity of care
· Promotes evidence-based clinical decision-making
· Increases timely access to treatment before conditions escalate into emergencies
· Supports parity between physical health and mental health treatment
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