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Legislation Signed into Law

2019

Primary Focus: Parity: General; Enforcement: Reporting requirement; Compliance: Reporting requirement; Mandated Benefit: MAT; Mandated Benefit: Providers
Title/Description: Expands health insurance coverage for behavioral health services and autism and enhances enforcement and oversight of mental health parity laws
Citation: N/A
Summary: The Act amends 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. The Act 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, the Act 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.
Effective Date: Mid-July 2019
Notes: Enacted through A2031/S1339

2017-2018

Primary Focus: Mandated Benefit: Biologically-Based Mental Illness
Title/Description: SHBP to provide benefits for treatment of substance use disorder.
Citation: N.J. Stat. § 52:14-17.29u
Summary: The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date [May 16, 2017] of this act provides unlimited benefits for inpatient and outpatient treatment of substance use disorder at in-network facilities. The services for the treatment of substance use disorder shall be prescribed by a licensed physician, licensed psychologist, or licensed psychiatrist and provided by licensed health care professionals or licensed or certified substance use disorder providers in licensed or otherwise State-approved facilities, as required by the laws of the state in which the services are rendered.
Effective Date: May 16, 2017.
Notes: Enacted by N.J. S.B. 3.

2008-2009

A 2238/S 1651
Introduced: 2/2008
Sponsor: Assmbs. Roberts, Prieto, Voss, Evans and Sens. Vitale and Weinberg
Status: Signed into law 8/2009
Summary: This bill added the sections of the state insurance law about autism coverage. These sections are summarized at the bottom of the page under “New Jersey Parity Law,” “Autism Coverage.”

New Jersey Parity Law

There are many sections of the state insurance law related to parity. They are summarized in three parts. Here, we have listed the relevant sections. The summaries are below the listed sections.

Mental health coverage sections:

17:48-6v; 17:48A-7u; 17:48E-35.20; 17B:26-2.1s; 17B:27-46.1v; 17B:27A-7.5; 17B:27A-19.7; 26:2J-4.20; 52:14-17.29d and 52:14-17.29e) (all of these are identical except for language about to which plan they apply)

Alcohol use disorder coverage sections:

17:48-6a; 17:48A-7a; 17:48E-34; 17B:26-2.1; 17B:27-46.1 (all of these are identical except for language about to which plan they apply)

Autism coverage sections:

17:48-6ii; 17:48A-7ff; 17B:26-2.1cc; 17B:27-46.1ii; 17B:27A-7.16; 17B:27A-19.20; 26-2J-4.34; §52:14-17.29p; 52:14-17.46.6b (all of these are identical except for language about to which plan they apply)

It is not advisable for us to provide direct links to these sections on the website of the New Jersey Legislature because the links frequently change. Instead we will explain how you can find the relevant sections of the law on the New Jersey Legislature website.

Go to this link. Enter any section listed above in the search bar at the bottom of the linked page. Make sure to put quotation marks around the section. For example: “17:48-6v” for one of the mental health sections, or “17B:27A-7.16” for one of the autism sections. If you have any questions about how to access these laws, contact us at info@paritytrack.org

Mental Health Coverage

Instructions for how to find the relevant sections of the insurance law are listed above

These sections of the insurance law require individual plans, small employer fully-insured plans, large employer fully-insured plans and state employee plans to cover services for the following mental health conditions:

  • Schizophrenia
  • Schizoaffective disorder
  • Major depressive disorder
  • Bipolar disorder
  • Paranoia and other psychotic disorders
  • Obsessive-compulsive disorder
  • Panic disorder
  • Pervasive developmental disorder or autism

Plans cannot use different copayments, deductibles, and “benefit limits” for these conditions than what are in place for other medical conditions (“benefit limits” could mean treatment limitations or financial requirements, but it is not explicitly defined in these sections).

These sections specifically state that they have no impact on how plans make medical necessity determinations for mental health services and which providers plans decide to reimburse for mental health services.

Alcohol Use Disorder Coverage

Instructions for how to find the relevant sections of the insurance law are listed above

These sections require individual plans, small employer fully-insured plans, and large employer fully-insured plans to provide coverage for alcohol use disorder services “to the same extent” as coverage for other medical services. The following services are specifically listed:

Autism Coverage

Instructions for how to find the relevant sections of the insurance law are listed above

These sections require individual plans, small employer fully-insured plans, large employer fully-insured plans , state employee plans, and public school employee plans to cover autism services.

Plans must cover medically necessary occupational therapy, physical therapy, and speech therapy. For children and young adults through age 20, plans must cover applied behavior analysis.

Coverage for autism services must be “to the same extent” as coverage for other medical services, but there cannot be any visit limits for outpatient care.

Plans must cover an annual maximum of $36,000 that can be adjusted for inflation each year.

Plans can review a child’s treatment plan once every 6 months.

Get Support

New Jersey Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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