Bill Text: NJ A2298 | 2016-2017 | Regular Session | Introduced
Bill Title: Requires certain health benefits plans to provide treatment for behavioral health care services when determined medically necessary.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2016-02-04 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A2298 Detail]
Download: New_Jersey-2016-A2298-Introduced.html
Sponsored by:
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
SYNOPSIS
Requires certain health benefits plans to provide treatment for behavioral health care services when determined medically necessary.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health insurance coverage for behavioral health care services and revising and supplementing various parts of statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1977, c.115 (C.17:48-6a) is amended to read as follows:
1. a. No group or individual contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, after the effective date of [this act] P.L. , c. (pending before the Legislature as this bill), unless [such] that act provides benefits to any subscriber or other covered person [covered thereunder] for [expenses incurred in connection with the treatment of alcoholism] behavioral health care services when [such treatment is] those services are prescribed by a [doctor of medicine] physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. [Such] Except as provided in subsections c. and d. of this section, benefits shall be provided to the same extent as for any other sickness under the contract.
b. Every contract shall include [such] benefits for [the treatment of alcoholism] behavioral health care services as [are hereinafter set forth] follows:
[a.] (1) Inpatient or outpatient care in a [licensed hospital] health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
[b.] (2) Treatment at a State-licensed detoxification facility [licensed pursuant to P.L.1975, c.305];
[c. Confinement] (3) Participation as an inpatient or outpatient at a licensed, certified, or [state approved] State-approved residential treatment facility or behavioral health care facility, under a program which meets minimum standards of care equivalent to those prescribed by [the] The Joint Commission [on Hospital Accreditation]; and
(4) Office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
Treatment or [confinement] participation at any facility or office shall not preclude further or additional treatment at any other eligible facility [; provided, however, that the benefit days used do not exceed the total number of benefit days provided for any other sickness under the contract] or office.
c. Notwithstanding any law or regulation to the contrary, the benefits provided pursuant to this section shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain those benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
d. The determination and prescription specified pursuant to subsection c. of this section shall control both the nature and duration of treatment; except that the coverage under this section may be subject to limits relating to the use of participating providers and facilities as provided in the contract.
e. For the purposes of this section, "behavioral health care services" means 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.
f. The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.
(cf: P.L.1977, c.115, s.1)
2. Section 1 of P.L.1977, c.117 (C.17:48A-7a) is amended to read as follows:
1. a. No group or individual contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, after the effective date of [this act] P.L. , c. (pending before the Legislature as this bill), unless [such] that contract provides benefits to any subscriber or other covered person [covered thereunder] for [expenses incurred in connection with the treatment of alcoholism] behavioral health care services when [such treatment is] those services are prescribed by a [doctor of medicine] physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. [Such] Except as provided in subsections c. and d. of this section, benefits shall be provided to the same extent as for any other sickness under the contract.
b. Every contract shall include [such] benefits for [the treatment of alcoholism] behavioral health care services as [are hereinafter set forth] follows:
[a.] (1) Inpatient or outpatient care in a [licensed hospital] health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
[b.] (2) Treatment at a State-licensed detoxification facility [licensed pursuant to P.L.1975, c.305];
[c. Confinement] (3) Participation as an inpatient or outpatient at a licensed, certified, or [state approved] State-approved residential treatment facility or behavioral health care facility, under a program which meets minimum standards of care equivalent to those prescribed by [the] The Joint Commission [on Hospital Accreditation] ; and
(4) Office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
Treatment or [confinement] participation at any facility or office shall not preclude further or additional treatment at any other eligible facility[; provided, however, that the benefit days used do not exceed the total number of benefit days provided for any other sickness under the contract] or office.
c. Notwithstanding any law or regulation to the contrary, the benefits provided pursuant to this section shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain those benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
d. The determination and prescription as specified pursuant to subsection c. of this section shall control both the nature and duration of treatment; except that the coverage under this section may be subject to limits relating to the use of participating providers and facilities as provided in the contract.
e. For the purposes of this section, "behavioral health care services" means 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.
f. The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.
(cf: P.L.1977, c.117, s.1)
3. Section 34 of P.L.1985, c.236 (C.17:48E-34) is amended to read as follows:
34. a. No group or individual contract providing [health service coverage] hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State, or approved for issuance or renewal in this State by the commissioner, on or after the effective date of P.L. , c. (pending before the Legislature as this bill), unless the contract provides benefits to any [subscriber] insured or other covered person [covered thereunder] for [expenses incurred in connection with the treatment of alcoholism] behavioral health care services when the [treatment is] services are prescribed by a [doctor of medicine] physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. [Benefits] Except as provided in subsections c. and d. of this section, benefits shall be provided to the same extent as for any other sickness under the contract.
b. Every contract shall include benefits for [the treatment of alcoholism] behavioral health care services as follows:
[a.] (1) Inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
[b.] (2) Treatment at a State-licensed detoxification facility [licensed pursuant to section 8 of P.L.1975, c.305 (C.26:2B-14)];
[c. Confinement] (3) Participation as an inpatient or outpatient at a licensed, certified, or [State approved] State-approved residential treatment facility or behavioral health care facility, under a program which meets minimum standards of care equivalent to those prescribed by [the] The Joint Commission[on Hospital Accreditation] ; and
(4) Office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
Treatment or [confinement] participation at any facility or office shall not preclude further or additional treatment at any other eligible facility[, if the benefit days used do not exceed the total number of benefit days provided for any other sickness under the contract] or office.
c. Notwithstanding any law or regulation to the contrary, the benefits provided pursuant to this section shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain those benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
d. The determination and prescription as specified pursuant to subsection c. of this section shall control both the nature and duration of treatment; except that the coverage under this section may be subject to limits relating to the use of participating providers and facilities as provided in the contract.
e. For the purposes of this section, "behavioral health care services" means 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.
f. The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.
(cf: P.L.1985, c.236, s.34)
4. Section 1 of P.L.1977, c.118 (C.17B:26-2.1) is amended to read as follows:
1. a. No individual health insurance [contract] policy providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, after the effective date of [this act] P.L. , c. (pending before the Legislature as this bill), unless [such contract] that policy provides benefits to any [subscriber] insured or other covered person [covered thereunder] for [expenses incurred in connection with the treatment of alcoholism] behavioral health care services when [such treatment is] those services are prescribed by a [doctor of medicine] physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. [Such] Except as provided in subsections c. and d. of this section, benefits shall be provided to the same extent as for any other sickness under the [contract] policy.
b. Every [contract] policy shall include [such] benefits for [the treatment of alcoholism] behavioral health care services as [are hereinafter set forth] follows:
[a.] (1) Inpatient or outpatient care in a [licensed hospital] health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
[b.] (2) Treatment at a State-licensed detoxification facility [licensed pursuant to P.L1975, c.305];
[c. Confinement] (3) Participation as an inpatient or outpatient at a licensed, certified, or [state approved] State-approved residential treatment facility or behavioral health care facility, under a program which meets minimum standards of care equivalent to those prescribed by [the] The Joint Commission [on Hospital Accreditation] ; and
(4) Office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
Treatment or [confinement] participation at any facility or office shall not preclude further or additional treatment at any other eligible facility[; provided, however, that the benefit days used do not exceed the total number of benefit days provided for any other sickness under the contract] or office.
c. Notwithstanding any law or regulation to the contrary, the benefits provided pursuant to this section shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain those benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
d. The determination and prescription as specified pursuant to subsection c. of this section shall control both the nature and duration of treatment; except that the coverage under this section may be subject to limits relating to the use of participating providers and facilities as provided in the policy.
e. For the purposes of this section, "behavioral health care services" means 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.
f. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
(cf: P.L.1977, c.118, s.1)
5. Section 1 of P.L.1977, c.116 (C.17B:27-46.1) is amended to read as follows:
1. a. No group health insurance [contract] policy providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State, by the Commissioner of Banking and Insurance, after the effective date of [this act] P.L. , c. (pending before the Legislature as this bill), unless [such contract] that policy provides benefits to any [subscriber] insured or other covered person [covered thereunder] for [expenses incurred in connection with the treatment of alcoholism] behavioral health care services when [such treatment is] those services are prescribed by a [doctor of medicine] physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. [Such] Except as provided in subsections c. and d. of this section, benefits shall be provided to the same extent as for any other sickness under the [contract] policy.
b. Every [contract] policy shall include [such] benefits for [the treatment of alcoholism] behavioral health care services as [are hereinafter set forth] follows:
[a.] (1) Inpatient or outpatient care in a [licensed hospital] health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
[b.] (2) Treatment at a State-licensed detoxification facility [licensed pursuant to P.L.1975, c.305] ;
[c. Confinement] (3) Participation as an inpatient or outpatient at a licensed, certified, or [state approved] State-approved residential treatment facility or behavioral health care facility, under a program which meets minimum standards of care equivalent to those prescribed by [the] The Joint Commission [on Hospital Accreditation]; and
(4) Office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
Treatment or [confinement] participation at any facility or office shall not preclude further or additional treatment at any other eligible facility[; provided, however, that the benefit days used do not exceed the total number of benefit days provided for any other sickness under the contract] or office.
c. Notwithstanding any law or regulation to the contrary, the benefits provided pursuant to this section shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain those benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
d. The determination and prescription as specified pursuant to subsection c. of this section shall control both the nature and duration of treatment; except that the coverage under this section may be subject to limits relating to the use of participating providers and facilities as provided in the policy.
e. For the purposes of this section, "behavioral health care services" means 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.
f. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
(cf: P.L.1977, c.116, s.1)
6. (New section) a. An individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for issuance or renewal in this State, on or after the effective date of this act, shall provide coverage for behavioral health care services when the services are prescribed by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. Except as provided in subsections c. and d. of this section, the benefits shall be provided to the same extent as for any other sickness under the health benefits plan.
b. Every health benefits plan shall include benefits for behavioral health care services as follows:
(1) Inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
(2) Treatment at a State-licensed detoxification facility;
(3) Participation as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility or behavioral health care facility, under a program which meets minimum standards of care equivalent to those prescribed by The Joint Commission; and
(4) Office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
Treatment or participation at any facility or office shall not preclude further or additional treatment at any other eligible facility or office.
c. Notwithstanding any law or regulation to the contrary, the benefits provided pursuant to this section shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain those benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
d. The determination and prescription as specified pursuant to subsection c. of this section shall control both the nature and duration of treatment; except that the coverage under this section may be subject to limits relating to the use of participating providers and facilities as provided in the contract.
e. For the purposes of this section, "behavioral health care services" means 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.
f. The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium.
7. (New section) a. A small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for issuance or renewal in this State, on or after the effective date of this act, shall provide coverage for behavioral health care services when the services are prescribed by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. Except as provided in subsections c. and d. of this section, the benefits shall be provided to the same extent as for any other sickness under the health benefits plan.
b. Every health benefits plan shall include benefits for behavioral health care services as follows:
(1) Inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
(2) Treatment at a State-licensed detoxification facility;
(3) Participation as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility or behavioral health care facility, under a program which meets minimum standards of care equivalent to those prescribed by The Joint Commission; and
(4) office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
Treatment or participation at any facility or office shall not preclude further or additional treatment at any other eligible facility or office.
c. Notwithstanding any law or regulation to the contrary, the benefits provided pursuant to this section shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain those benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
d. The determination and prescription as specified pursuant to subsection c. of this section shall control both the nature and duration of treatment; except that the coverage under this section may be subject to limits relating to the use of participating providers and facilities as provided in the contract.
e. For the purposes of this section, "behavioral health care services" means 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.
f. The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium.
8. (New section) a. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this act unless the health maintenance organization provides health care services to any enrollee or other covered person for behavioral health care services when the services are prescribed by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. Except as provided in subsections c. and d. of this section, the health care services shall be provided to the same extent as for any other sickness under the contract.
b. Every contract shall include health care services for behavioral health care services as follows:
(1) Inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
(2) Treatment at a State-licensed detoxification facility;
(3) Participation as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility or behavioral health care facility, under a program which meets minimum standards of care equivalent to those prescribed by The Joint Commission; and
(4) Office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice
Treatment or participation at any facility or office shall not preclude further or additional treatment at any other eligible facility or office.
c. Notwithstanding any law or regulation to the contrary, the benefits provided pursuant to this section shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain those benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
d. The determination and prescription as specified pursuant to subsection c. of this section shall control both the nature and duration of treatment; except that the coverage under this section may be subject to limits relating to the use of participating providers and facilities as provided in the contract.
e. For the purposes of this section, "behavioral health care services" means 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.
f. The provisions of this section shall apply to all contracts for health care services in which the health maintenance organization has reserved the right to change the schedule of charges.
9. (New section) a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act provides hospital or medical expense benefits for behavioral health care services when the services are prescribed by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. Except as provided in subsections c. and d. of this section, the benefits shall be provided to the same extent as for any other sickness under the contract.
b. Every contract shall include benefits for behavioral health care services as follows:
(1) Inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
(2) Treatment at a State-licensed detoxification facility;
(3) Participation as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility or behavioral health care facility, under a program which meets minimum standards of care equivalent to those prescribed by The Joint Commission; and
(4) Office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
Treatment or participation at any facility or office shall not preclude further or additional treatment at any other eligible facility or office.
c. Notwithstanding any law or regulation to the contrary, the benefits provided pursuant to this section shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain those benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
d. The determination and prescription as specified pursuant to subsection c. of this section shall control both the nature and duration of treatment; except that the coverage under this section may be subject to limits relating to the use of participating providers and facilities as provided in the contract.
e. For the purposes of this section, "behavioral health care services" means 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.
10. (New section) a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act provides hospital or medical expense benefits for behavioral health care services when the services are prescribed by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice. Except as provided in subsections c. and d. of this section, the benefits shall be provided to the same extent as for any other sickness under the contract.
b. Every contract shall include benefits for behavioral health care services as follows:
(1) Inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
(2) Treatment at a State-licensed detoxification facility;
(3) Participation as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility or behavioral health care facility, under a program which meets minimum standards of care equivalent to those prescribed by The Joint Commission; and
(4) Office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
Treatment or confinement at any facility or office shall not preclude further or additional treatment at any other eligible facility or office.
c. Notwithstanding any law or regulation to the contrary, the benefits provided pursuant to this section shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain those benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
d. The determination and prescription as specified pursuant to subsection c. of this section shall control both the nature and duration of treatment; except that the coverage under this section may be subject to limits relating to the use of participating providers and facilities as provided in the contract.
e. For the purposes of this section, "behavioral health care services" means 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.
11. P.L.1999, c.106 (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 and C.34:11A-15) is repealed.
12. This act shall take effect on the 60th day after enactment and shall apply to all contracts and policies delivered, issued, executed or renewed on or after that date.
STATEMENT
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, without utilization management review, for behavioral health care services when the treatment is prescribed by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
The bill amends several statutes, initially enacted in 1977 and 1985, which require hospital, medical and health service corporations, and individual and group health insurers to provide coverage for the treatment of alcoholism. The bill expands that coverage to include mental illness, emotional disorders, other types of substance abuse, including drug abuse, and updates terminology in those statutes.
The bill also extends the required behavioral health coverage to health maintenance organizations, the individual and small employer insurance programs, the State Health Benefits Program, and the School Employees' Health Benefits Program, which were not included in the 1977 and 1985 statutes.
Specifically, the bill requires that the coverage for behavioral health care services include:
· inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
· treatment at a State-licensed detoxification facility;
· participation as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility or behavioral health care facility under a program which meets minimum standards of care equivalent to those prescribed by The Joint Commission; and
· office visits with a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
Treatment or participation at any facility or office shall not preclude further or additional treatment at any other eligible facility or office.
The bill further provides that, notwithstanding any law or regulation to the contrary, the benefits provided pursuant to the bill shall not be subject to utilization management review and the only prerequisite or authorization necessary for a covered person to obtain the benefits shall be a determination of medical necessity and a prescription for treatment by a physician licensed to practice medicine and surgery, a licensed psychologist, a licensed clinical social worker, a certified advanced practice nurse, or a licensed physician assistant, acting within their lawful scope of practice.
The determination and prescription as specified shall control both the nature and duration of treatment. However, the bill also provides that this coverage may be subject to limits relating to the use of participating providers and facilities as provided in the contract.
The bill also repeals P.L.1999, c.106, which requires mental health parity, meaning coverage under the same terms and conditions as provided for any other sickness, for "biologically-based mental illnesses." As the bill requires coverage, without utilization management review, for behavioral health care services, including for all mental health and emotional disorders, P.L.1999, c.106 is superseded by the provisions of this bill.
