Bill Text: NJ A2847 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires certain health insurers to provide coverage for counseling and behavioral therapies for any person receiving medication-assisted treatment.
Spectrum: Bipartisan Bill
Status: (Introduced) 2024-01-09 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A2847 Detail]
Download: New_Jersey-2024-A2847-Introduced.html
STATE OF NEW JERSEY
221st LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2024 SESSION
Sponsored by:
Assemblyman ANTHONY S. VERRELLI
District 15 (Hunterdon and Mercer)
Co-Sponsored by:
Assemblywoman Dunn
SYNOPSIS
Requires certain health insurers to provide coverage for counseling and behavioral therapies for any person receiving medication-assisted treatment.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning health insurance coverage for certain treatment of substance use disorders and amending P.L.1999, c.106 and P.L.1999, c.441.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1999, c.106 (C.17:48-6v) is amended to read as follows:
1. a. (1) Every individual and group hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act shall provide coverage for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness under the contract and shall meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. s.18031(j), and any amendments to, and federal guidance or regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45 C.F.R. s.156.115(a)(3). Coverage provided pursuant to this section shall include, but not be limited to, medication-assisted treatment for opioid addiction for any subscriber or other person covered under the contract.
(2) As used in this section:
"Medication-assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Same terms and conditions" means that the hospital service corporation cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
b. (Deleted by amendment, P.L.2019, c.58)
c. The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.
d. Nothing in this section shall reduce the requirement for a hospital service corporation to provide benefits pursuant to section 1 of P.L.2017, c.28 (C.17:48-6nn).
(cf: P.L.2019, c.58, s.1)
2. Section 2 of P.L.1999, c.106 (C.17:48A-7u) is amended to read as follows:
2. a. (1) Every individual and group medical service corporation contract that provides hospital or medical expense benefits that is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act shall provide coverage for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness under the contract and shall meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. s.18031(j), and any amendments to, and federal guidance or regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45 C.F.R. s.156.115(a)(3). Coverage provided pursuant to this section shall include, but not be limited to, medication-assisted treatment for opioid addiction for any subscriber or other person covered under the contract.
(2) As used in this section:
"Medication-assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Same terms and conditions" means that the medical service corporation cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
b. (Deleted by amendment, P.L.2019, c.58)
c. The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.
d. Nothing in this section shall reduce the requirement for a medical service corporation to provide benefits pursuant to section 2 of P.L.2017, c.28 (C.17:48A-7kk).
(cf: P.L.2019, c.58, s.2)
3. Section 2 of P.L.1999, c.106 (C.17:48E-35.20) is amended to read as follows:
2. a. (1) Every individual and group health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act shall provide coverage for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness under the contract and shall meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. s.18031(j), and any amendments to, and federal guidance or regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45 C.F.R. s.156.115(a)(3). Coverage provided pursuant to this section shall include, but not be limited to, medication-assisted treatment for opioid addiction for any subscriber or other person covered under the contract.
(2) As used in this section:
"Medication-assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Same terms and conditions" means that the health service corporation cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
b. (Deleted by amendment, P.L.2019, c.58)
c. The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.
d. Nothing in this section shall reduce the requirement for a health service corporation to provide benefits pursuant to section 3 of P.L.2017, c.28 (C.17:48E-35.38).
(cf: P.L.2019, c.58, s.3)
4. Section 4 of P.L.1999, c.106 (C.17B:26-2.1s) is amended to read as follows:
4. a. (1) Every individual health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act shall provide coverage for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness under the contract and shall meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. s.18031(j), and any amendments to, and federal guidance or regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45 C.F.R. s.156.115(a)(3). Coverage provided pursuant to this section shall include, but not be limited to, medication-assisted treatment for opioid addiction for any covered person.
(2) As used in this section:
"Medication-assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Same terms and conditions" means that the insurer cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
b. (Deleted by amendment, P.L.2019, c.58)
c. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
d. Nothing in this section shall reduce the requirement for an insurer to provide benefits pursuant to section 4 of P.L.2017, c.28 (C.17B:26-2.1hh).
(cf: P.L.2019, c.58, s.4)
5. Section 5 of P.L.1999, c.106 (C.17B:27-46.1v) is amended to read as follows:
5. a. (1) Every group health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to chapter 27 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act shall provide benefits for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness under the policy and shall meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. s.18031(j), and any amendments to, and federal guidance or regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45 C.F.R. s.156.115(a)(3). Coverage provided pursuant to this section shall include, but not be limited to, medication-assisted treatment for opioid addiction for any covered person.
(2) As used in this section:
"Medication-assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Same terms and conditions" means that the insurer cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
b. (Deleted by amendment, P.L.2019, c.59)
c. The provisions of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
d. Nothing in this section shall reduce the requirement for an insurer to provide benefits pursuant to section 5 of P.L.2017, c.28 (C.17B:27-46.1nn).
(cf: P.L.2019, c.58, s.5)
6. Section 6 of P.L.1999, c.106 (C.17B:27A-7.5) is amended to read as follows:
6. a. (1) Every 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 benefits for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness under the health benefits plan and shall meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. s.18031(j), and any amendments to, and federal guidance or regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45 C.F.R. s.156.115(a)(3). Coverage provided pursuant to this section shall include, but not be limited to, medication-assisted treatment for opioid addiction for any covered person.
(2) As used in this section:
"Medication-assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Same terms and conditions" means that the plan cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
b. (Deleted by amendment, P.L.2019, c.58)
c. The provisions of this
section shall apply to all health benefits plans in which the carrier has
reserved the right to change the premium.
d. Nothing in this section shall reduce the requirement for a plan to provide benefits pursuant to section 6 of P.L.2017, c.28 (C.17B:27A-7.21).
(cf: P.L.2019, c.58, s.6)
7. Section 7 of P.L.1999, c.106 (C.17B:27A-19.7) is amended to read as follows:
7. a. (1) Every 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 benefits
for mental health conditions and substance use disorders under the same terms
and conditions as provided for any other sickness under the health benefits
plan and shall meet the requirements of the federal Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act of 2008,
42 U.S.C. s.18031(j), and any amendments to, and federal guidance or
regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45
C.F.R. s.156.115(a)(3). Coverage provided pursuant to this section shall
include, but not be limited to, medication-assisted treatment for opioid
addiction for any covered person.
(2) As used in this section:
"Medication-assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Same terms and conditions" means that the plan cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
b. (Deleted by amendment, P.L.2019, c.58)
c. The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium.
d. Nothing in this section shall reduce the requirement for a plan to provide benefits pursuant to section 7 of P.L.2017, c.28 (C.17B:27A-19.25).
(cf: P.L.2019, c.58, s.7)
8. Section 8 of P.L.1999, c.106 (C.26:2J-4.20) is amended to read as follows:
8. a. (1) Every enrollee
agreement delivered, issued, executed, or renewed in this State pursuant to
P.L.1973, c.337
(C.26:2J-1 et seq.) or approved for issuance or renewal in this
State by the Commissioner of Banking and Insurance, on or after the effective
date of this act shall provide health care services for mental health
conditions and substance use disorders under the same terms and conditions as
provided for any other sickness under the agreement and shall meet the
requirements of the federal Paul Wellstone and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008, 42 U.S.C. s.18031(j), and any
amendments to, and federal guidance or regulations issued under that act,
including 45 C.F.R. Parts 146 and 147 and 45 C.F.R. s.156.115(a)(3). Coverage
provided pursuant to this section shall include, but not be limited to,
medication-assisted treatment for opioid addiction for any enrollee.
(2) As used in this section:
"Medication-assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Same terms and conditions" means that the health maintenance organization cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles,, aggregate or annual limits or health care services limits to mental health condition and substance use disorder services than those applied to substantially all other medical or surgical health care services.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
b. (Deleted by amendment, P.L.2019, c.58)
c. The provisions of this section shall apply to enrollee agreements in which the health maintenance organization has reserved the right to change the premium.
d. Nothing in this section shall reduce the requirement for a
health maintenance organization to provide benefits pursuant to section 8 of P.L.2017, c.28 (C.26:2J-4.39).
(cf: P.L.2019, c.58, s.8)
9. Section 1 of P.L.1999, c.441 (C.52:14-17.29d) is amended to read as follows:
1. As used in this act:
"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.
"Medication-assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Same terms and conditions" means that a carrier cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
(cf: P.L.2019, c.58, s.9)
10. Section 2 of P.L.1999, c.441 (C.52:14-17.29e) is amended to read as follows:
2. a. The State Health
Benefits Commission shall ensure that every contract purchased by the
commission on or after the effective date of this act that provides hospital or
medical expense benefits shall provide coverage for mental health conditions
and substance use disorders under the same terms and conditions as provided for
any other sickness under the contract and shall meet the requirements of the
federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
Equity Act of 2008,
42 U.S.C. s.18031(j), and any amendments to, and federal guidance or
regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45
C.F.R. s.156.115(a)(3). Coverage provided pursuant to this section shall include,
but not be limited to, medication-assisted treatment for opioid addiction for
any covered person.
b. The commission shall provide notice to employees regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the employee; (2) the yearly informational packet sent to the employee; or (3) July 1, 2000. The commission shall also ensure that the carrier under contract with the commission, upon receipt of information that a covered person is receiving treatment for a mental health condition or substance use disorder, shall promptly notify that person of the coverage required by this section.
c. Nothing in this section shall reduce the requirement for a carrier to provide benefits pursuant to section 9 of P.L.2017, c.28 (C.52:14-17.29u).
(cf: P.L.2019, c.58, s.10)
11. This act shall take effect on the 90th day after the date of enactment and shall apply to all health benefits plans currently in effect in the State, or that are delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act.
STATEMENT
This bill amends existing law concerning health insurance coverage of mental health conditions and substance use disorders to add a requirement that 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, and the State Health Benefits Program) provide coverage for medication-assisted treatment for opioid addiction for any covered person. Under the bill, "medication-assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders.
