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  • NJ A2298
  • Requires certain health benefits plans to provide treatment for behavioral health care services when determined medically necessary.
Introduced
(2/4/2016)
In Committee
(2/4/2016)
Crossed OverPassedSignedDead/Failed/Vetoed
2016-2017 Regular Session
This bill requires hospital, medical and health service corporations, commercial insurers, health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the School Employees' Health Benefits Program, to provide coverage, without utilization management review, for behavioral health care services when the treatment is prescribed by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. The bill amends several statutes, initially enacted in 1977 and 1985, which require hospital, medical and health service corporations, and individual and group health insurers to provide coverage for the treatment of alcoholism. The bill expands that coverage to include mental illness, emotional disorders, other types of substance abuse, including drug abuse, and updates terminology in those statutes. The bill also extends the required behavioral health coverage to health maintenance organizations, the individual and small employer insurance programs, the State Health Benefits Program, and the School Employees' Health Benefits Program, which were not included in the 1977 and 1985 statutes. Specifically, the bill requires that the coverage for behavioral health care services include: · inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.); · treatment at a State-licensed detoxification facility; · participation as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility or behavioral health care facility under a program which meets minimum standards of care equivalent to those prescribed by The Joint Commission; and · office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. Treatment or participation at any facility or office shall not preclude further or additional treatment at any other eligible facility or office. The bill further provides that, notwithstanding any law or regulation to the contrary, the benefits provided pursuant to the bill shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain the benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. The determination and prescription as specified shall control both the nature and duration of treatment. However, the bill also provides that this coverage may be subject to limits relating to the use of participating providers and facilities as provided in the contract. The bill also repeals P.L.1999, c.106, which requires mental health parity, meaning coverage under the same terms and conditions as provided for any other sickness, for "biologically-based mental illnesses." As the bill requires coverage, without utilization management review, for behavioral health care services, including for all mental health and emotional disorders, P.L.1999, c.106 is superseded by the provisions of this bill.
Financial Institutions and Insurance
Introduced, Referred to Assembly Financial Institutions and Insurance Committee  (on 2/4/2016)
 
 

Date Chamber Action Description
2/4/2016 A Introduced, Referred to Assembly Financial Institutions and Insurance Committee
Date Motion Yea Nay Other
None specified