New Jersey Legislation

This bill prohibits the Commissioner of Banking and Insurance from issuing conditional approval of provider network adequacy. The bill provides that in the case of a carrier seeking approval for a tiered network, the preferred tier of the network must separately meet all requirements for provider network adequacy. Each health care provider that is used to meet provider network adequacy requirements shall be in the carrier’s network or, in the case of a tiered network, in the same tier of the tiered network, for all covered services provided by that provider.

This bill requires health insurers to provide coverage for buprenorphine and buprenorphine/naloxone used to treat opioid addiction and remove prior authorization requirements, dollar limits, and cost-sharing (deductible, copayment, co-insurance) for such medications.

A1228 amends the NJRS to require insurers to cover behavioral health services provided at licensed inpatient and outpatient health care facilities; state licensed detoxification facilities; residential treatment facility or behavioral health care facility, including a minimum of 90 days per year for inpatient residential care; and at office visits with a qualified provider when such treatment is determined medically necessary by a qualifying provider. Treatment or participation at any facility shall not preclude additional treatment at other eligible facility. Additionally, A1228 provides the only authorization or prerequisite allowed for such treatment to be the determination of medical necessity and prescription for treatment by a qualified physician. A1228 further amends NJRS C.17:48-6a, C.17:48A-7a, C.17:48E-34, C.17B:26-2.1, C.17B:27-46.1, and adds new sections to require the above of every group or individual contract, plan, or policy providing hospital or medical expense benefits; small employer health benefits plan; plan offered by a health maintenance organization; contract purchased by the State Health Benefits Commission; and contracts purchased by the School Employees’ Health Benefits Commission.

The bills amend NJRS to require plans to provide coverage for  medically necessary behavioral health care services and autism services and to comply with the Federal Parity law. A2031/S1339 amends NJRS C.17:48-6v, C.17:48A-7u, C.17:48E-35.20, C.17B:26-2.1s, C.17B:27-46.1v, C.17B:27A-7.5, C.17B:27A-19.7, C.26:2J-4.20, C.52:14-17.29e respectively, to require the above of individual and group hospital service corporation contracts; individual and group medical service corporation contracts; individual and group health service corporation contracts; individual health insurance policies; group health insurance policies; individual health benefit plans; small employer health benefit plans; every enrollee agreement delivered, issued, executed, or renewed in this approved for issuance or renewal by the Commissioner of Banking and Insurance; and every contract purchased by the State Health Benefits Commission.
Lastly, A2031/S1339 amends NJRS by adding a new section to create reporting requirements for the above listed insurers to submit detailed retrospective rates and NQTL parity compliance analyses using specific guidelines and processes to certify the plan is in compliance with parity requirements. The Department of Banking and Insurance must implement and enforce parity requirement, post on their website analysis of the plan’s reports, and submit to the legislature a report detailing enforcement, oversight, correctional, and educational efforts and actions taken to ensure compliance with MHPAEA and state statutes.

A3276 amends 2017 NJRS C26:2S-1 to establish the Behavioral Health Insurance Claims Advocacy Program within the Department of Banking and Insurance to assist and advocate for covered individuals with issues concerning behavioral health services, claims, denials, and appeals. A website and toll-free phone number must be maintained and made accessible for consumers.

A2932 amends 2017 NJRS to require insurers to provide mental health benefits for posttraumatic stress disorder under the same terms and conditions provided for any other disorder.
A 2932 amends C.17:48-6v, C.17:48A-7u, C.17:48E-35.20, C.17B26-2.1s, C.17B:27-46.1v, C.17B:27A-7.5, C. 17B:27A-19.7, C. 26:2J-4.20, C.34:11A-15, and C.52:14-17.29d respectively to require the above of individual and group hospital service corporation contracts; individual and group medical service corporation contracts; individual and group health service corporation contracts; individual health insurance policies; group health insurance policies; individual health benefits plans; small employer health benefit plans; and enrollee agreements delivered, issued, executed or renewed in New Jersey or approved by the Commissioner of Health and Senior Services. Section 11 amends the NJRS to define Posttraumatic Stress Disorder as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. Section 12 amends the NJRS to require the above of every contract purchased by the State Health Benefits Commission.

A3006 amends 2017 NJRS C.30:4D-6 to add a paragraph requiring, pending federal approval, Medicaid reimbursement for mental health services provided via telepsychiatry at a rate commensurate with the cost of providing such services traditionally.

A3056 amends 2017 NJRS to require insurers to provide mental health benefits for eating disorders under the same terms and conditions provided for any other disorder. It also amends NJRS C.17:48-6v, C.17:48A-7u, C.17:48E-35.20, C.17B:26-2.1s, C.17B:27-46.1v, C.17B:27A-7.5, C. 17B:27A-19.7, and C. 26:2J-4.20 respectively to require the above of individual and group hospital service corporation contracts; individual and group medical service corporation contracts; individual and group health service corporation contracts; individual health insurance policies; group health insurance policies; individual health benefits plans; small employer health benefit plans; and enrollee agreements delivered, issued, executed or renewed in New Jersey or approved by the Commissioner of Banking and Insurance. Section 9 amends NJRS C.52:14-17.29d to define eating disorders as “all eating disorders, including but not limited to, anorexia, bulimia, and binge-eating disorder.”

S1000 amends 2017 NJRS to require insurers to provide coverage for depression screenings of individuals under 18 years of age, including a screening performed by a pediatrician using a nationally-recognized depression screening tool. This coverage must be provided under the same terms and conditions afforded to other conditions under the contract. Section 1 amends NJRS C.17:48-1 et seq., C.17:48A-1 et seq., NJRS C.17:48E-1 et seq., NJRS C.17B:26, C.17B:27, C.17B:27A-2, C. 17B:27A-17, and C. 26:2J-1 et seq. to require the above of hospital service corporation contracts, medical service corporation contracts, health service corporation contracts, individual health insurance policies, group health insurance policies, individual health benefits plans, small employer health benefit plans, and any enrollee agreements delivered, issued, executed or renewed in New Jersey or approved by the Commissioner of Banking and Insurance. Section 9 amends NJRS to require the State Health Benefit Commission to provide such benefit in every contract purchased by the commission and Section 10 requires the School Employees’ Health Benefit Commission to provide such benefit in every contract purchased by the commission.

A1593 amends NJRS by requiring insurers to cover treatment for substance use disorders or dependency provided at licensed inpatient and outpatient health care facilities, residential facilities, or state licensed detoxification facilities when determined medically necessary by a qualifying provider. Treatment or participation at any facility shall not preclude additional treatment at other eligible facility. Additionally, A1593 provides the only authorization or prerequisite allowed for such treatment to be the determination of medical necessity and prescription for treatment by a qualified physician. A1593 further amends NJRS C.17:48-6a, C.17:48A-7a, C.17:48E-34, C.17B:26-2.1, C.17B:27-46.1 respectively and adds new sections to require the above of group or individual contract providing hospital or medical expense benefits, insurance policies, or plans; small employer health benefits plan; plans offered by health maintenance organization; contracts purchased by the State Health Benefits Commission; and contracts purchased by the School Employees’ Health Benefits Commission.

A1724 amends NJRS by requiring insurers to cover treatment for behavioral health disorder services provided at outpatient health care facilities, outpatient treatment at state licensed detoxification or residential facilities, office visits, and treatment at home and community-based service facilities when determined medically necessary by a qualifying provider. Treatment or participation at any facility, hospital or office may not preclude additional treatment at other eligible facilities. Additionally, A1724 prohibits the use of utilization management review for such benefits, and provides the only authorization or prerequisite allowed for such treatment to be the determination of medical necessity and prescription for treatment by a qualified physician. A1593 amends NJRS C.17:48-6a, C.17:48A-7a, C.17:48E-34, C.17B:26-2.1, C.17B:27-46.1 respectively and adds new sections to require the above of group or individual contract providing hospital or medical expense benefits, insurance policies, or plans; small employer health benefits plan; plans offered by health maintenance organization; contracts purchased by the State Health Benefits Commission; and contracts purchased by the School Employees’ Health Benefits Commission.

 This bill would change the sections of the state insurance law about behavioral health coverage by doing the following:

• Specifies that plans must comply with all sections of federal law about parity and their implementing regulations
• Defines non-quantitative treatment limitations (NQTLs) identically to how they are defined the the final regulations of the Federal Parity Law
• Requires plans to allow people access to out-of-network providers if no in-network providers are available
• Requires plans to use the criteria of the American Society of Addiction Medicine when making medical necessity determinations for substance use disorders
• Requires all insurance plans subject to state jurisdiction to submit annual reports that demonstrate their compliance with the Federal Parity Law, including information that shows that NQTLs for behavioral health services are applied no more restrictively than those used for other medical services
• Requires the Department of Banking and Insurance to submit annual reports showing how they are implementing the Federal Parity Law and relevant sections of state law

This bill tried to change the sections of the state insurance law about mental health coverage to include eating disorders as covered conditions, with anorexia, bulimia, and binge eating disorders specifically mentioned.

This bill tried to change state law so that Medicaid would reimburse for “evidence-based” outpatient behavioral health services at the same rate that Medicare reimburses for those services. What constitutes “evidence-based” would be determined by criteria provided by the Commissioner of Human Services, in consultation with the Commissioner of Children and Families.

This bill tried to change the sections of the state insurance law about autism coverage in the following ways:

• Specifically lists autistic disorder, Asperger’s disorder, childhood disintegrative disorder, rett’s disorder, fragile X syndrome, pervasive developmental disorder not otherwise specified, central auditory processing disorder, childhood apraxia of speech, sensory processing disorder, and social communication disorder as covered conditions
• Specifies that diagnoses should be based on criteria in the DSM or ICD
• Specifies that attorney fees should be included in any award for a successful lawsuit brought against an insurance plan for failing to comply with these sections of the insurance law

This bill tried to change the sections of the state insurance law about mental health coverage to include eating disorders as covered conditions, with anorexia, bulimia, and binge eating disorders specifically mentioned.

This bill tried to change the sections of the insurance law about coverage for alcohol use disorders so that they would also apply to other substance use disorders. It also would require plans to cover at least 30 days of inpatient care.

This bill tried to change the sections of the state insurance law about autism coverage in the following ways:

• Specifically lists autistic disorder, Asperger’s disorder, childhood disintegrative disorder, rett’s disorder, fragile X syndrome, pervasive developmental disorder not otherwise specified, central auditory processing disorder, childhood apraxia of speech, sensory processing disorder, and social communication disorder as covered conditions
• Specifies that diagnoses should be based on criteria in the DSM or ICD
• Specifies that attorney fees should be included in any award for a successful lawsuit brought against an insurance plan for failing to comply with these sections of the insurance law

This bill tried to change the sections of the state insurance law about mental health coverage to include all mental health conditions in the DSM. The bill would have required the section of the state insurance law about alcohol use disorder coverage so that it would have applied to all substance use disorders. The bill also would have expanded the definition of “same terms and conditions” to include the following:

• Annual limits on inpatient days and outpatient visits
• Lifetime limits on inpatient days and outpatient visits
• Annual maximums on inpatient and outpatient care
• Lifetime maximums on inpatient and outpatient care

This bill tried to change the sections of the state insurance law about autism coverage in the following ways:

• Specifically lists autistic disorder, Asperger’s disorder, childhood disintegrative disorder, rett’s disorder, fragile X syndrome, pervasive developmental disorder not otherwise specified, central auditory processing disorder, childhood apraxia of speech, sensory processing disorder, and social communication disorder as covered conditions
• Specifies that diagnoses should be based on criteria in the DSM or ICD
• Specifies that attorney fees should be included in any award for a successful lawsuit brought against an insurance plan for failing to comply with these sections of the insurance law

This bill tried to change the sections of the state law about mental health coverage in the following ways:

• Includes substance use disorders
• Includes dysthymic disorder, post-traumatic stress disorder, borderline personality disorder, anorexia, bulimia, other eating disorders, and any other condition in the DSM included by the Commissioner of Banking and Insurance (with consultation from the Commissioner of Health and Senior Services)
• Financial requirements, annual maximums, lifetime maximums and treatment limitations must be “no more restrictive” for behavioral health services and other medical services

This bill tried to change the sections of the state insurance law about mental health coverage to include eating disorders as covered conditions, with anorexia, bulimia, and binge eating disorders specifically mentioned.

This bill tried to change the sections of the state law about mental health coverage in the following ways:

• Includes substance use disorders
• Includes dysthymic disorder, post-traumatic stress disorder, borderline personality disorder, anorexia, bulimia, other eating disorders, and any other condition in the DSM included by the Commissioner of Banking and Insurance (with consultation from the Commissioner of Health and Senior Services)
• Financial requirements, annual maximums, lifetime maximums and treatment limitations must be “no more restrictive” for behavioral health services and other medical services