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This page lists some of the action toward parity compliance undertaken by New Jersey regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org.

Action in the Regulatory Arena

6/2017

Primary Focus:  SUD
Agency: Department of Human Services / Division of Medical Assistance and Health Services Home
Title/Description:  Substance use disorder treatment services
Citation: N.J. Admin. Code §  10:66-2.3
Summary:  Enumerates substance use disorder treatment services provided by independent clinics.  Independent clinics include substance use disorder outpatient rehabilitative services; substance use disorder intensive outpatient (IOP) services; substance use disorder partial care services; non-hospital based withdrawal management services; ambulatory outpatient withdrawal management services; short-term residential services; and opioid treatment and maintenance services.
Effective Date: Original effective date December 7, 1998
Notes: Amended June 7, 2004 and June 5, 2017

3/2017

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.

9/2013

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.

1/2010

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

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)

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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