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  • NJ A3743
  • Requires certain health benefits plans to provide coverage for behavioral health care services determined to be medically necessary, including 90 days per year of inpatient residential care.
Introduced
(5/19/2016)
In Committee
(5/19/2016)
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. 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, including a minimum of 90 days per year for inpatient residential care 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. 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 that shall be needed 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. The determination and prescription shall control both the nature and duration of treatment. 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
Reviewed by the Pension and Health Benefits Commission Recommend to not enact  (on 7/29/2016)
 
 

Date Chamber Action Description
7/29/2016 A Reviewed by the Pension and Health Benefits Commission Recommend to not enact
5/19/2016 A Introduced, Referred to Assembly Financial Institutions and Insurance Committee
Date Motion Yea Nay Other
None specified