Definition


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Below is the relevant legislation related to parity that has been introduced during the current or recently adjourned legislative session. State parity legislation passed in any state since 2008 is usually designed to increase compliance with the federal law and to strengthen state laws.

Are we missing any passed or introduced legislation? Let us know at info@paritytrack.org.

Introduced Legislation

Regular Session Convened 1/8/2018
Will Adjourn 1/13/2020
Governor's Deadline 2/27/2020

2018-2019

Primary Focus Access to Services
Title/Description Requires health insurance carriers to comply with certain network adequacy requirements.
Citation A1714
Citation S554
Introduced 1/9/2019
Sponsor Assemblywoman Huttle (D), Sen. Gil (D)
Status Pending
Summary

This bill prohibits the Commissioner of Banking and Insurance from issuing conditional approval of provider network adequacy. The bill provides that in the case of a carrier seeking approval for a tiered network, the preferred tier of the network must separately meet all requirements for provider network adequacy. Each health care provider that is used to meet provider network adequacy requirements shall be in the carrier’s network or, in the case of a tiered network, in the same tier of the tiered network, for all covered services provided by that provider.

Primary Focus Mandated benefit: MAT; Medical Management Limitation
Title/Description Requires health benefits coverage for buprenorphine and buprenorphine/naloxone under certain conditions.
Citation S1756
Citation A4273
Introduced 2/5/2019; 6/27/2018
Sponsor Seb. Weinberg (D), Assemblyman Conaway (D)
Status Pending
Summary

This bill requires health insurers to provide coverage for buprenorphine and buprenorphine/naloxone used to treat opioid addiction and remove prior authorization requirements, dollar limits, and cost-sharing (deductible, copayment, co-insurance) for such medications.

Primary Focus Mandated Benefit
Title/Description Requires certain health benefits plans to provide coverage for behavioral health care services determined to be medically necessary, including 90 days per year of inpatient residential care
Citation A.1228
Introduced 1/2018
Sponsor Assemblyman McKeon (D); Kampitt (D); Huttle (D); Lagana (D); Benson (D)
Status Pending
Summary

A1228 amends the NJRS to require insurers to cover behavioral health services provided at licensed inpatient and outpatient health care facilities; state licensed detoxification facilities; residential treatment facility or behavioral health care facility, including a minimum of 90 days per year for inpatient residential care; and at office visits with a qualified provider when such treatment is determined medically necessary by a qualifying provider. Treatment or participation at any facility shall not preclude additional treatment at other eligible facility. Additionally, A1228 provides the only authorization or prerequisite allowed for such treatment to be the determination of medical necessity and prescription for treatment by a qualified physician. A1228 further amends NJRS C.17:48-6a, C.17:48A-7a, C.17:48E-34, C.17B:26-2.1, C.17B:27-46.1, and adds new sections to require the above of every group or individual contract, plan, or policy providing hospital or medical expense benefits; small employer health benefits plan; plan offered by a health maintenance organization; contract purchased by the State Health Benefits Commission; and contracts purchased by the School Employees’ Health Benefits Commission.

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 A2031
Introduced 1/9/2018
Sponsor Assemblyman Coughlin (D); Huttle (D); Lampitt (D); Danielsen (D); Downey (D); Quijano (D); Jasey (D)/ Senator Gordon (D); Kean (R); Vitale (D)
Status Signed into Law by Governor
Status

The bills amend 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. A2031/S1339 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, A2031/S1339 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.

Primary Focus Enforcement
Title/Description Establishes Behavioral Health Insurance Claims Advocacy Program
Citation A3276
Introduced 2/12/2018
Sponsor Assemblywoman Vainieri Huttle (D)
Status Pending
Summary

A3276 amends 2017 NJRS C26:2S-1 to establish the Behavioral Health Insurance Claims Advocacy Program within the Department of Banking and Insurance to assist and advocate for covered individuals with issues concerning behavioral health services, claims, denials, and appeals. A website and toll-free phone number must be maintained and made accessible for consumers.

Primary Focus Mandated Benefit
Title/Description Requires health insurers and State Health Benefits Commission to provide coverage for posttraumatic stress disorder under same conditions as other sickness
Citation A2932
Introduced 2/1/2018
Sponsor Assemblyman McKeon (D)
Status Pending
Summary

A2932 amends 2017 NJRS to require insurers to provide mental health benefits for posttraumatic stress disorder under the same terms and conditions provided for any other disorder.
A 2932 amends C.17:48-6v, C.17:48A-7u, C.17:48E-35.20, C.17B26-2.1s, C.17B:27-46.1v, C.17B:27A-7.5, C. 17B:27A-19.7, C. 26:2J-4.20, C.34:11A-15, and C.52:14-17.29d 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 benefits plans; small employer health benefit plans; and enrollee agreements delivered, issued, executed or renewed in New Jersey or approved by the Commissioner of Health and Senior Services. Section 11 amends the NJRS to define Posttraumatic Stress Disorder as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. Section 12 amends the NJRS to require the above of every contract purchased by the State Health Benefits Commission.

Primary Focus Telehealth
Title/Description Provides for Medicaid coverage and reimbursement for mental health services provided through telepsychiatry.
Citation A3006
Introduced 2/8/2018
Sponsor Assemblyman Dancer (R)
Status Pending
Summary

A3006 amends 2017 NJRS C.30:4D-6 to add a paragraph requiring, pending federal approval, Medicaid reimbursement for mental health services provided via telepsychiatry at a rate commensurate with the cost of providing such services traditionally.

Primary Focus Mandated Benefit
Title/Description Requires health insurers and SHBP to provide certain mental health benefits for eating disorders under same terms and conditions as other illnesses and diseases.
Citation A3056
Introduced 2/8/2018
Sponsor Assemblywoman Lopez (D)
Status Pending
Summary

A3056 amends 2017 NJRS to require insurers to provide mental health benefits for eating disorders under the same terms and conditions provided for any other disorder. It also 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, and C. 26:2J-4.20 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 benefits plans; small employer health benefit plans; and enrollee agreements delivered, issued, executed or renewed in New Jersey or approved by the Commissioner of Banking and Insurance. Section 9 amends NJRS C.52:14-17.29d to define eating disorders as “all eating disorders, including but not limited to, anorexia, bulimia, and binge-eating disorder.”

Primary Focus Mandated Benefit
Title/Description Requires health benefits coverage for juvenile depression screenings
Citation S1000
Introduced 1/16/2018
Sponsor Sen. Vitale (D)
Status Pending
Summary

S1000 amends 2017 NJRS to require insurers to provide coverage for depression screenings of individuals under 18 years of age, including a screening performed by a pediatrician using a nationally-recognized depression screening tool. This coverage must be provided under the same terms and conditions afforded to other conditions under the contract. Section 1 amends NJRS C.17:48-1 et seq., C.17:48A-1 et seq., NJRS C.17:48E-1 et seq., NJRS C.17B:26, C.17B:27, C.17B:27A-2, C. 17B:27A-17, and C. 26:2J-1 et seq. to require the above of hospital service corporation contracts, medical service corporation contracts, health service corporation contracts, individual health insurance policies, group health insurance policies, individual health benefits plans, small employer health benefit plans, and any enrollee agreements delivered, issued, executed or renewed in New Jersey or approved by the Commissioner of Banking and Insurance. Section 9 amends NJRS to require the State Health Benefit Commission to provide such benefit in every contract purchased by the commission and Section 10 requires the School Employees’ Health Benefit Commission to provide such benefit in every contract purchased by the commission.

Primary Focus Mandated Benefit
Title/Description Requires certain health benefits plans to provide treatment for substance abuse and dependency when determined medically necessary by physician or psychologist.
Citation A.1593
Introduced 1/9/2018
Sponsor Assemblyman Conaway (D)
Status Pending
Summary

A1593 amends NJRS by requiring insurers to cover treatment for substance use disorders or dependency provided at licensed inpatient and outpatient health care facilities, residential facilities, or state licensed detoxification facilities when determined medically necessary by a qualifying provider. Treatment or participation at any facility shall not preclude additional treatment at other eligible facility. Additionally, A1593 provides the only authorization or prerequisite allowed for such treatment to be the determination of medical necessity and prescription for treatment by a qualified physician. A1593 further amends NJRS C.17:48-6a, C.17:48A-7a, C.17:48E-34, C.17B:26-2.1, C.17B:27-46.1 respectively and adds new sections to require the above of group or individual contract providing hospital or medical expense benefits, insurance policies, or plans; small employer health benefits plan; plans offered by health maintenance organization; contracts purchased by the State Health Benefits Commission; and contracts purchased by the School Employees’ Health Benefits Commission.

Primary Focus Mandated Benefit
Title/Description Requires certain health benefits plans to provide coverage for outpatient behavioral health care services.
Citation A.1724
Introduced 1/9/2018
Sponsor Assemblywoman Vainieri Huttle (D)
Status Pending
Summary

A1724 amends NJRS by requiring insurers to cover treatment for behavioral health disorder services provided at outpatient health care facilities, outpatient treatment at state licensed detoxification or residential facilities, office visits, and treatment at home and community-based service facilities when determined medically necessary by a qualifying provider. Treatment or participation at any facility, hospital or office may not preclude additional treatment at other eligible facilities. Additionally, A1724 prohibits the use of utilization management review for such benefits, and provides the only authorization or prerequisite allowed for such treatment to be the determination of medical necessity and prescription for treatment by a qualified physician. A1593 amends NJRS C.17:48-6a, C.17:48A-7a, C.17:48E-34, C.17B:26-2.1, C.17B:27-46.1 respectively and adds new sections to require the above of group or individual contract providing hospital or medical expense benefits, insurance policies, or plans; small employer health benefits plan; plans offered by health maintenance organization; contracts purchased by the State Health Benefits Commission; and contracts purchased by the School Employees’ Health Benefits Commission.

2016-2017

A4498
Senate S 2919
Introduced 1/2017
Sponsor Assmbs. Coughlin, Vainieri Huttle, Lampitt, Singleton and Sens. Gordon, Kean, and Vitale
Status Dead 9/2017
Summary

 This bill would change the sections of the state insurance law about behavioral health coverage by doing the following:

  • Specifies that plans must comply with all sections of federal law about parity and their implementing regulations
  • Defines non-quantitative treatment limitations (NQTLs) identically to how they are defined the the final regulations of the Federal Parity Law
  • Requires plans to allow people access to out-of-network providers if no in-network providers are available
  • Requires plans to use the criteria of the American Society of Addiction Medicine when making medical necessity determinations for substance use disorders
  • Requires all insurance plans subject to state jurisdiction to submit annual reports that demonstrate their compliance with the Federal Parity Law, including information that shows that NQTLs for behavioral health services are applied no more restrictively than those used for other medical services
  • Requires the Department of Banking and Insurance to submit annual reports showing how they are implementing the Federal Parity Law and relevant sections of state law
A 1928
Introuced 1/2016
Sponsor Assmb. Coughlin
Status Dead 1/2016
Summary

This bill tried to change the sections of the state insurance law about mental health coverage to include eating disorders as covered conditions, with anorexia, bulimia, and binge eating disorders specifically mentioned.

A2912
Senate S 289
Introduced 1/2016
Sponsor Assmbs. Dancer, Vainieri Huttle, Sumter and Sens. Vitale, Gordon, and Barnes
Status Dead 1/2016
Summary This bill tried to change state law so that Medicaid would cover telepsychiatry mental health services.
A3303
Senate S 1730
Introduced 1/2016
Sponsor Asmbs. Vanieri-Huttle, Benson, Lagana, Sumter, Eustace, and Sen. Vitale
Status Dead 5/2017
Summary

This bill tried to change state law so that Medicaid would reimburse for “evidence-based” outpatient behavioral health services at the same rate that Medicare reimburses for those services. What constitutes “evidence-based” would be determined by criteria provided by the Commissioner of Human Services, in consultation with the Commissioner of Children and Families.

A 354
Senate S 1966
Sponsor Rep. Benson, Rep. Kean, and Sen. Bateman
Status Dead 3/2016
Summary

This bill tried to change the sections of the state insurance law about autism coverage in the following ways:

  • Specifically lists autistic disorder, Asperger’s disorder, childhood disintegrative disorder, rett’s disorder, fragile X syndrome, pervasive developmental disorder not otherwise specified, central auditory processing disorder, childhood apraxia of speech, sensory processing disorder, and social communication disorder as covered conditions
  • Specifies that diagnoses should be based on criteria in the DSM or ICD
  • Specifies that attorney fees should be included in any award for a successful lawsuit brought against an insurance plan for failing to comply with these sections of the insurance law

2014-2015

A 800
Introduced 1/2014
Sponsor Assmb. Coughlin
Status Dead 1/2014
Summary

This bill tried to change the sections of the state insurance law about mental health coverage to include eating disorders as covered conditions, with anorexia, bulimia, and binge eating disorders specifically mentioned.

A1289
Senate S 1219
Introduced 1/2014
Sponsor Assmbs. Dancer, Vainieri Huttle, Sumter and Sens. Vitale, Gordon
Status Dead 1/2014
Summary This bill tried to change state law so that Medicaid would cover telepsychiatry mental health services.
A 3737
Senate S 105
Introduced 1/2014
Sponsor Reps. Fuentes, Conaway, Lagana, Benson and Sen. Bucco
Status Dead 9/2014
Summary

This bill tried to change the sections of the insurance law about coverage for alcohol use disorders so that they would also apply to other substance use disorders. It also would require plans to cover at least 30 days of inpatient care.

A 272
Senate S 144
Introduced 1/2014
Sponsor Rep. Simon, Rep. Kean, and Sen. Bateman
Status Dead 1/2014
Summary

This bill tried to change the sections of the state insurance law about autism coverage in the following ways:

  • Specifically lists autistic disorder, Asperger’s disorder, childhood disintegrative disorder, rett’s disorder, fragile X syndrome, pervasive developmental disorder not otherwise specified, central auditory processing disorder, childhood apraxia of speech, sensory processing disorder, and social communication disorder as covered conditions
  • Specifies that diagnoses should be based on criteria in the DSM or ICD
  • Specifies that attorney fees should be included in any award for a successful lawsuit brought against an insurance plan for failing to comply with these sections of the insurance law

2012-2013

A 1665
Senate S 1253
Introduced 1/2012
Sponsor Assmbs. Johnson, Vainieri Huttle, Diegnan, Gusciora, and Sens. Vitale, Gordon, and Allen
Status Vetoed by the Governor 8/2013
Summary

This bill tried to change the sections of the state insurance law about mental health coverage to include all mental health conditions in the DSM. The bill would have required the section of the state insurance law about alcohol use disorder coverage so that it would have applied to all substance use disorders. The bill also would have expanded the definition of “same terms and conditions” to include the following:

A 1278
Introduced 1/2012
Sponsor Assmb. Coughlin
Status Dead 9/2012
Summary This bill tried to change the sections of the state insurance law about mental health coverage to include eating disorders as covered conditions, with anorexia, bulimia, and binge eating disorders specifically mentioned.
A4127
Senate S3024
Introduced 5/2013
Sponsor Assmbs. Dancer, Vainieri Huttle, Sumter and Sens. Vitale, Gordon
Status Dead 11/2013
Summary This bill tried to change state law so that Medicaid would cover telepsychiatry mental health services.
S 499
Introduced 1/2012
Sponsor Sen. Bucco
Status Dead 1/2012
Summary This bill tried to change the sections of the insurance law about coverage for alcohol use disorders so that they would also apply to other substance use disorders. It also would require plans to cover at least 30 days of inpatient care.
A3981
Senate S 2752
Introduced 4/2013
Sponsor Rep. Simon and Sen. Bateman
Status Dead 5/2013
Summary

This bill tried to change the sections of the state insurance law about autism coverage in the following ways:

  • Specifically lists autistic disorder, Asperger’s disorder, childhood disintegrative disorder, rett’s disorder, fragile X syndrome, pervasive developmental disorder not otherwise specified, central auditory processing disorder, childhood apraxia of speech, sensory processing disorder, and social communication disorder as covered conditions
  • Specifies that diagnoses should be based on criteria in the DSM or ICD
  • Specifies that attorney fees should be included in any award for a successful lawsuit brought against an insurance plan for failing to comply with these sections of the insurance law

2010-2011

A 968
Senate S 796
Introduced 1/2010
Sponsor Assmbs. Gordon, Vainieri Huttle, Greenstein Diegnan, and Sens. Buono and Vitale
Status Dead 1/2010
Summary

This bill tried to change the sections of the state law about mental health coverage in the following ways:

A3970
Senate S 948
Introduced 2/2010
Sponsor Assmb. Coughlin, Sen. Vitale, Sen. Codey
Status Dead 5/2011
Summary

This bill tried to change the sections of the state insurance law about mental health coverage to include eating disorders as covered conditions, with anorexia, bulimia, and binge eating disorders specifically mentioned.

S1091
Introduced 2/2010
Sponsor Sen. Bucco
Status Dead 2/2010
Summary This bill tried to change the sections of the insurance law about coverage for alcohol use disorders so that they would also apply to other substance use disorders. It also would require plans to cover at least 30 days of inpatient care.

2008-2009

A2077
Senate S 607
Introduced 1/2008
Sponsor Assmbs. Gordon, Vainieri Huttle, Greenstein Diegnan, Evans, Cruz-Perez and Sens. Buono and Vitale
Status Dead 3/2010
Summary

This bill tried to change the sections of the state law about mental health coverage in the following ways:

  • Includes substance use disorders
  • Includes dysthymic disorder, post-traumatic stress disorder, borderline personality disorder, anorexia, bulimia, other eating disorders, and any other condition in the DSM included by the Commissioner of Banking and Insurance (with consultation from the Commissioner of Health and Senior Services)
  • Financial requirements, annual maximums, lifetime maximums and treatment limitations must be “no more restrictive” for behavioral health services and other medical services
A3664
Senate S 1940
Introduced 6/2008
Sponsor Assmb. Love, Sen. Vitale, Sen. Singer
Status Dead 1/2009
Summary This bill tried to change the sections of the state insurance law about mental health coverage to include eating disorders as covered conditions, with anorexia, bulimia, and binge eating disorders specifically mentioned.
S 172
Introduced 1/2008
Sponsor Sen. Bucco
Status Dead 1/2008
Summary This bill tried to change the sections of the insurance law about coverage for alcohol use disorders so that they would also apply to other substance use disorders. It also would require plans to cover at least 30 days of inpatient care.

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