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Assembly Panel Clears Coughlin Bill to Expand Health Coverage for Behavioral Health Care, Enhances Enforcement and Oversight of Mental Health Parity

(TRENTON) – An Assembly panel on Monday released legislation sponsored by Assemblyman Craig Coughlin that expands health insurance coverage for behavioral health care services and enhances enforcement and oversight of mental health parity.

The bill (A-4498) would require plans to provide coverage for medically necessary behavioral health care services and to meet the requirements of a 2008 federal law, which prevents certain health insurers that provide mental or substance use disorder benefits form imposing less favorable benefit limitations on those benefits that on medical or surgical benefits, commonly referred to as mental health parity.

“This bill amends several New Jersey statutes which will require health insurance plans to treat biologically based mental illnesses the same as any other sickness under their health insurance coverage,” said Coughlin (D-Middlesex). “The intent of the legislation is to expand coverage for behavioral health care services and ensure residents receive the best care without judgement or insensitivity to their situations.”

The bill would expand health coverage to include “behavioral health care services,” which is defined in the legislation as procedures or services rendered by a health care provider or health care facility for the treatment of mental illness, emotional disorders, or drug or alcohol abuse.

Under the bill, certain provisions of the statutes that would be construed to change the manner in which health maintenance organization determines:
1.) whether a mental health care service meets the medical necessity standard as established by the health maintenance organization; and
2.) which providers would be entitled to reimbursement or to be participating providers, as appropriate, for mental health services under the enrollee agreement.

“Mental illness, emotional disorders, and drug or alcohol abuse are negatively branded and often discriminated against when it comes to treatment of these illnesses,” Coughlin added. “With the recommendations made in this bill, we can change the way individuals who are suffering from these illnesses are treated and ensure fairness in their treatment under behavioral health care services.”

The bill also specifies that a benefit determination for treatment of a substance use disorder, including but not limited to prior approval and medical necessity determinations, the clinical review criteria must be the most recent Treatment Criteria for Addictive, Substance-related, and Co-Occurring Conditions established by the American Society of Addiction Medicine. No additional criteria may be used during utilization review or benefit determination for treatment of substance use disorders. It also prohibits a carrier that provides coverage for prescription drugs form excluding coverage for any FDA-approved forms of medication assisted treatment prescribed for alcohol dependence or opioid dependence under the same American Society of Addiction Medicine guidelines.

The Assembly Financial Institutions and Insurance Committee approved the measure and it will now go to the Assembly Speaker for further consideration.