Source: https://www.njleg.state.nj.us/2018/Bills/A2500/2031_U1.HTM
Timestamp: 2019-05-27 00:03:51
Document Index: 449978616

Matched Legal Cases: ['arts 146', 'arts 146', 'arts 146', 'arts 146', 'arts 146', 'arts 146', 'arts 146', 'arts 146', 'arts 146']

A2031 ACS AFI 9/13/18
Assemblymen Johnson, Benson, Conaway, Assemblywomen McKnight, Chaparro, Assemblyman Wolfe, Assemblywoman Pinkin, Assemblyman Gusciora, Assemblywoman Mosquera, Assemblymen Houghtaling, Giblin, McKeon, Assemblywoman Pintor Marin, Assemblyman Bramnick, Assemblywoman Murphy, Assemblymen Freiman, Karabinchak, Assemblywoman Carter, Assemblymen DeAngelo, Mazzeo, Armato, Verrelli, Zwicker, Assemblywomen Schepisi, Timberlake, Lopez and Assemblyman Schaer
Enhances enforcement and oversight of behavioral health parity laws.
Substitute as adopted by the Assembly Financial Institutions and Insurance Committee.
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 [biologically-based mental illness] behavioral health care services 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. 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. 156.115(a)(3). ["Biologically-based mental illness"]
“Behavioral health care services" means [a mental or nervous condition that is caused by a biological disorder of the brain and results in a clinically significant or psychological syndrome or pattern that substantially limits the functioning of the person with the illness, including but not limited to, schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, panic disorder and pervasive developmental disorder or autism] procedures or services rendered by a health care provider or health care facility for the treatment of mental illness, emotional disorders, pervasive developmental disorder and autism, or drug or alcohol abuse.
"Same terms and conditions" means that the hospital service corporation cannot apply different copayments, deductibles or benefit limits to [biologically-based mental health] behavioral health care services benefits than those applied to other medical or surgical benefits.
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 [biologically-based mental illness] behavioral health care services 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. 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. 156.115(a)(3). ["Biologically-based mental illness"]
"Same terms and conditions" means that the medical service corporation cannot apply different copayments, deductibles or benefit limits to [biologically-based mental health] behavioral health care services benefits than those applied to other medical or surgical benefits.
3. 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 [biologically-based mental illness] behavioral health care services 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. 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. 156.115(a)(3). ["Biologically-based mental illness"]
"Same terms and conditions" means that the health service corporation cannot apply different copayments, deductibles or benefit limits to [biologically-based mental health] behavioral health care services benefits than those applied to other medical or surgical benefits.
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 [biologically-based mental illness] behavioral health care services 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. 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. 156.115(a)(3). ["Biologically-based mental illness"]
"Same terms and conditions" means that the insurer cannot apply different copayments, deductibles or benefit limits to [biologically-based mental health] behavioral health care services benefits than those applied to other medical or surgical benefits.
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 [biologically-based mental illness] behavioral health care services 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. 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. 156.115(a)(3). ["Biologically-based mental illness"]
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 [biologically-based mental illness] behavioral health care services 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. 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. 156.115(a)(3). ["Biologically-based mental illness"]
"Same terms and conditions" means that the plan cannot apply different copayments, deductibles or benefit limits to [biologically-based mental health] behavioral health care services benefits than those applied to other medical or surgical benefits.
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 [biologically-based mental illness] behavioral health care services 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. 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. 156.115(a)(3). ["Biologically-based mental illness"]
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 [biologically-based mental illness] behavioral health care services 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. 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. 156.115(a)(3). ["Biologically-based mental illness"]
"Same terms and conditions" means that the health maintenance organization cannot apply different copayments, deductibles, or health care services limits to [biologically-based mental] behavioral health care services than those applied to other medical or surgical health care services.
["Biologically-based mental illness"] “Behavioral health care services” means [a mental or nervous condition that is caused by a biological disorder of the brain and results in a clinically significant or psychological syndrome or pattern that substantially limits the functioning of the person with the illness including, but not limited to, schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, panic disorder and pervasive developmental disorder or autism] procedures or services rendered by a health care provider or health care facility for the treatment of mental illness, emotional disorders, pervasive developmental disorder and autism, or drug or alcohol abuse.
"Same terms and conditions" means that a carrier cannot apply different copayments, deductibles or benefit limits to [biologically-based mental health] behavioral health care services benefits than those applied to other medical or surgical benefits.
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 [biologically-based mental illness] behavioral health care services 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. 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. 156.115(a)(3).
c.] 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 [and Senior Services] 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 biologically-based mental illness] behavioral health care services, shall promptly notify that person of the coverage required by 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, pervasive developmental disorder and autism, or drug or alcohol abuse.
c. A carrier that provides hospital or medical expense benefits through individual or group contracts shall submit an annual report to the department on or before March 1 that contains the following information:
(3) The results of an analysis that demonstrates that for the medical necessity criteria described in paragraph (1) of this subsection and for selected NQTLs identified in paragraph (2) of this subsection, as written and in operation, the processes, strategies, evidentiary standards, or other factors used to apply the medical necessity criteria and selected NQTLs to behavioral health care benefits are comparable to, and are no more stringently applied than the processes, strategies, evidentiary standards, or other factors used to apply the medical necessity criteria and selected NQTLs, as written and in operation, to medical and surgical benefits. A determination of which selected NQTLs require analysis will be determined by the department; at a minimum, the results of the analysis shall entail the following, provided that some NQTLs may not necessitate all of the steps described below:
(b) identify and define the specific evidentiary standards used to define the factors and any other evidentiary standards relied upon in designing each NQTL;
(4) Maintaining and regularly reviewing for possible parity violations a publically available consumer complaint log regarding behavioral health care coverage, provided that the names of specific carriers will be redacted and not disclosed on the complaint log.