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Coughlin, Vainieri Huttle, Lampitt, Singleton, Danielsen & Downey Bill to Expand Health Coverage for Behavioral Health Care; Enhance Enforcement and Oversight of Mental Health Parity Approved by Assembly

(TRENTON) – Legislation sponsored by Assembly Democrats Craig Coughlin, Valerie Vainieri Huttle, Pamela Lampitt, Troy Singleton, Joe Danielsen and Joann Downey to expand health insurance coverage for behavioral health care services and enhance enforcement and oversight of mental health parity was approved Thursday by the General Assembly.

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, and autism.

“This ensures that people who are suffering from mental illness or addiction will have access to the services essential to their recovery,” said Vainieri Huttle (D-Bergen). “Individuals who are struggling with a mental illness or addiction should not have to jump through hoops to get help.”

“The need for health care is not limited to physical ailments,” said Lampitt (D-Camden/Burlington). “People who are dealing with these problems deserve our help, not our indifference. This will help ensure equal coverage of treatment for mental illness and addiction.”

“Making it harder for people who are battling mental illness and addiction to get help makes no sense,” said Singleton (D-Burlington). “A person who has a mental health condition should not be denied the opportunity to get better because the treatment he or she needs is not covered.”

“Mental illness doesn’t just impact the person who is struggling with the disease,” said Danielsen (D-Middlesex/Somerset). “It is in the best interest of society, as well as the individual, to ensure that these illnesses are covered, and those that need treatment have access to it.”

“These issues, if left untreated, can be disruptive to public safety,” said Downey (D-Monmouth). “We not only have an obligation to these individuals to ensure they get the treatment they need, but to the public at large which must deal with the repercussions.”

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 bill was approved 68-5-4 and now awaits further consideration by the Senate.