Bill

Bill > A1655


NJ A1655

Requires health benefits plan and carriers to meet certain requirements concerning network adequacy and mental health care.


summary

Introduced
01/09/2024
In Committee
01/09/2024
Crossed Over
Passed
Dead

Introduced Session

2024-2025 Regular Session

Bill Summary

This bill requires carriers to take certain action to ensure that health benefits plans meet certain network adequacy requirements and mental health care. Under the bill, "carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, and includes the State Health Benefits Program, the School Employees' Health Benefits Program, the Medicaid program, and a Medicaid managed care organization. The bill requires the Commissioner of Banking and Insurance or the Commissioner of Human Services, as appropriate, to approve a network for a health benefits plan only if the plan meets certain requirements concerning access to mental health providers. Under the bill a plan is required to have a sufficient number of mental health providers to ensure that 100 percent of the covered persons have access to either in-network mental health providers that can provide services delivered in person and within certain geographic and temporal requirements, or access to in-network or out-of-network mental health providers that can provide services delivered through telemedicine or telehealth. A plan that provides access to in-network or out-of-network mental health providers that can provide services delivered through telemedicine or telehealth is required to provide coverage for out-of-network mental health care services delivered through telemedicine or telehealth on the same basis as when the services are delivered through in-person contact and consultation in New Jersey and at a provider reimbursement rate of not less than the corresponding Medicaid provider reimbursement rate. Reimbursement payments are to be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate. In addition, a carrier is not to charge any deductible, copayment, or coinsurance for a mental health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person, in-network consultation.

AI Summary

This bill requires health carriers to ensure that their health benefits plans have a sufficient number of mental health providers to provide in-person or telehealth services to all covered persons within certain geographic and temporal requirements. The bill also mandates that carriers provide coverage for out-of-network mental health services delivered through telehealth at the same rate as in-person services and prohibits them from charging higher deductibles, copayments, or coinsurance for telehealth mental health services compared to in-person visits. The bill applies to various types of carriers, including insurance companies, health service corporations, and Medicaid managed care organizations, and allows self-funded plans subject to federal law to elect to meet the requirements. Carriers that violate the provisions of the bill are subject to penalties.

Committee Categories

Business and Industry

Sponsors (2)

Last Action

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 01/09/2024)

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