New Jersey Regulations

The Department of Banking and Insurance (DOBI) issued a bulletin to insurers explaining some of the requirements of the recently-passed A3/S3 (A3/S3 is summarized on our NJ legislative page under “Legislation Signed into Law” for 2016-2017). The bulletin explicitly noted the requirement that if inpatient substance use disorder is denied for not being medically necessary after the first 28 days of coverage, insurers must notify the beneficiary and her provider within 24 hours and make them aware that they can file an expedited appeal.

This is not a regulatory action but rather a general executive branch action.

The State Health Benefits Program Plan Design Committee reached an agreement to provide behavioral health coverage at parity with coverage for other medical care for state employee plans, county employee plans, and municipal employee plans. The design committee for teachers coverage reached a similar acted similarly shortly before this deal was reached.

The New Jersey Department of Banking and Insurance (DBOI) issued a bulletin (pdf | Get Adobe® Reader®) to plans detailing requirements of the then recently-passed sections of the state insurance law about autism coverage (those sections are summarized at the bottom of this page under “New Jersey Parity Law,” “Autism Coverage”). In addition to listing some of the requirements written into the law, the bulletin explained some issues in further detail, such as:

• Cites another section of the state law to define “developmental disabilities”
• Clarifies that the DBOI considers the definition of autism to be “pervasive developmental disorders” in the DSM or ICD except for rett’s disorder and childhood disintegrative disorder
• Listed the services the DBOI considers “based on” applied behavior analysis
• Listed the services the DBOI considers “related structural behavioral programs”
• Directs plans to cover services by Board Certified Behavior Analyst – Doctoral and a Board Certified Behavior Analyst
• Specified that large employer fully-insured plans cannot use the $36,000 annual maximum because of the Federal Parity Law and the sections of the state law about mental health coverage, which include autism and pervasive developmental disorders as “biologically-based mental illness” (these sections are summarized at the bottom of this page under “New Jersey Parity Law”, “Mental Health Coverage”)
• Requires plans to cover certain services required by the “Family Cost Share” expense provided through the New Jersey Early Intervention System