• Views: in the last
  • 17Week
  • 12Month
  • 83Total


  • NJ A4498
  • Expands health insurance coverage for behavioral health services and autism and enhances enforcement and oversight of mental health parity laws. *
Introduced
(1/19/2017)
In Committee
(6/12/2017)
Crossed Over
(6/8/2017)
PassedSignedDead/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, for medically necessary behavioral health care services and to meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which prevents certain health insurers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical or surgical benefits, commonly referred to as mental health parity. The bill amends several statutes, initially enacted in 1999, which require hospital, medical and health service corporations, individual and group health insurers and the State Health Benefits Program to provide coverage for biologically-based mental illness under the same terms and conditions as provided for any other sickness. The bill expands that coverage to include coverage for "behavioral health care services," which is defined as procedures or services rendered by a health care provider or health care facility for the treatment of mental illness, emotional disorders, or drug or alcohol abuse. The bill also removes certain provisions of the statutes that provide that nothing in those statutes shall be construed to change the manner in which the insurer determines: (1) whether a mental health care service meets the medical necessity standard as established by the insurer; or (2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for mental health services under the policy or contract. The bill also supplements the "Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et al.) to place certain restrictions on carriers to ensure parity with respect to imposing a non-quantitative treatment limitations, the use of out-of-network providers, and in-plan exceptions for behavioral health care services. The bill further specifies that for any utilization review or benefit determination for the treatment of a substance use disorder, including but not limited to prior authorization and medical necessity determinations, the clinical review criteria shall be the most recent Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions established by the American Society of Addiction Medicine. No additional criteria shall be used during utilization review or benefit determination for treatment of substance use disorders. In addition, the bill prohibits a carrier that provides coverage for prescription drugs from excluding coverage for any FDA-approved forms of medication assisted treatment prescribed for the treatment of alcohol dependence or treatment of opioid dependence, if such treatment is medically necessary, according to most recent Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions established by the American Society of Addiction Medicine. The bill also requires carriers to submit an annual report to the Department of Banking and Insurance on or before March 1 that contains certain information concerning compliance with the bill's provisions. The bill also requires, not later than May 1 of each year, the Department of Banking and Insurance to issue a report to the Legislature pursuant to section of P.L.1991, c.164 (C.52:14-19.1) and to make that report available to the public. The report is to detail certain information relating to the department's oversight of the bill's provisions.
Commerce, 2nd Reading in the Assembly, Financial Institutions and Insurance, Passed Assembly
Senate Commerce Hearing (19:00 6/19/2017 )  (on 6/19/2017)
 
 

Date Chamber Action Description
6/19/2017 Senate Commerce Hearing (19:00 6/19/2017 )
6/12/2017 S Received in the Senate, Referred to Senate Commerce Committee
6/8/2017 A Passed by the Assembly (67-5-5)
5/22/2017 A Assembly Floor Amendment Passed (Tucker)
1/30/2017 Assembly Financial Institutions and Insurance Hearing (19:00 1/30/2017 )
1/30/2017 A Reported out of Assembly Comm. with Amendments, 2nd Reading
1/30/2017 Assembly Financial Institutions and Insurance Hearing (10:00 1/30/2017 Committee Room 16, Fourth Floor)
1/19/2017 A Introduced, Referred to Assembly Financial Institutions and Insurance Committee
Date Motion Yea Nay Other
Detail 6/8/2017 Assembly Floor: Third Reading - Final Passage 67 5 8
Detail 1/30/2017 Assembly Financial Institutions and Insurance Committee: Reported with Amendments 8 0 5