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Bill > A5052

NJ A5052

NJ A5052
Requires health insurance and Medicaid coverage for screening, prevention, and treatment services of behavioral health issues affecting children.

summary

Introduced
12/09/2024
In Committee
12/18/2025
Crossed Over
12/22/2025
Passed
01/20/2026
Dead
Signed/Enacted/Adopted
01/20/2026

Introduced Session

2024-2025 Regular Session

Bill Summary

This bill requires health insurers (health, hospital and medical service corporations, commercial individual and group health 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) and the State Medicaid program to provide benefits to any covered person for medical expenses incurred relating to screening, prevention, and treatment of behavioral health issues in children. Carriers and the State Medicaid program are required to accept and reimburse claims for screening, prevention, and treatment using an at-risk diagnosis. As used in the bill, an "at-risk diagnosis" is a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood when billing for services, without a formal mental health diagnosis for children who are 18 years of age or younger.

AI Summary

This bill requires health insurance carriers, state health benefit programs, and the NJ FamilyCare Medicaid program to provide coverage for screening, prevention, and treatment of behavioral health issues in children under 18 years old, with a unique approach that allows for "at-risk diagnoses." An at-risk diagnosis is a preventive assessment that considers factors like family circumstances or life challenges without requiring a formal mental health diagnosis, enabling healthcare providers to use alternative billing codes such as Social Determinants of Health Z-codes. The bill mandates that these services be covered to the same extent as other medical services and includes various types of preventive care like screenings, individual, group, and family psychotherapy for children who may have potential mental health concerns but have not yet received a formal diagnosis. By broadening the definition of billable services and removing traditional diagnostic barriers, the legislation aims to encourage early intervention and proactive mental health support for children. The act will take effect 90 days after enactment and will apply to health insurance policies, plans, and contracts delivered, executed, issued, or renewed on or after that date.

Committee Categories

Budget and Finance, Business and Industry

Sponsors (21)

Last Action

Approved P.L.2025, c.369. (on 01/20/2026)
(1 Companion Bills)

bill text

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bill summary

Document Type Source Location
State Bill Page https://www.njleg.state.nj.us/bill-search/2024/A5052
Analysis - Statement AAP 12/18/25 https://pub.njleg.gov/Bills/2024/A5500/5052_S2.PDF
Fiscal Note - Fiscal Estimate 12/19/25; as introduced https://pub.njleg.gov/Bills/2024/A5500/5052_E1.PDF
Analysis - Statement AFI 12/11/25 https://pub.njleg.gov/Bills/2024/A5500/5052_S1.PDF
BillText https://pub.njleg.gov/Bills/2024/A5500/5052_I1.HTM
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