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A1775
ASSEMBLY, No. 1775
STATE OF NEW JERSEY
222nd LEGISLATURE
�
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Assemblyman ANTHONY S. VERRELLI
District 15 (Hunterdon and Mercer)
Co-Sponsored by:
Assemblywoman Dunn
SYNOPSIS
���� Requires certain health insurers to provide coverage
for counseling and behavioral therapies for any person receiving
medication-assisted treatment.
CURRENT VERSION OF TEXT
���� Introduced Pending Technical Review by Legislative
Counsel.
��
An Act
concerning health insurance coverage for certain
treatment of substance use disorders and amending P.L.1999, c.106 and P.L.1999,
c.441.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� Section 1 of P.L.1999,
c.106 (C.17:48-6v) is amended to read as follows:
���� 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 mental health
conditions and substance use disorders 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. s.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. s.156.115(a)(3).�
Coverage
provided pursuant to this section shall include, but not be limited to,
medication-assisted treatment for opioid addiction for any subscriber or other
person covered under the contract.
���� (2)�� As used in this section:
����
�Medication-assisted
treatment� means the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders.
���� "Mental health
condition" means a condition defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
current version of the Diagnostic and Statistical Manual of Mental Disorders.
���� "Same terms and
conditions" means that the hospital service corporation cannot apply more
restrictive non-quantitative limitations, such as utilization review and other
criteria or more quantitative limitations such as copayments, deductibles, aggregate
or annual limits or benefit limits to mental health condition and substance use
disorder benefits than those applied to substantially all other medical or
surgical benefits.
���� "Substance use
disorder" means a disorder defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
most current version of the Diagnostic and Statistical Manual of Mental
Disorders.
���� b.��� (Deleted by amendment,
P.L.2019, c.58)
���� c.���� The provisions of this
section shall apply to all contracts in which the hospital service corporation
has reserved the right to change the premium.
���� d.��� Nothing in this section
shall reduce the requirement for a hospital service corporation to provide
benefits pursuant to section 1 of P.L.2017, c.28 (C.17:48-6nn).
(cf: P.L.2019, c.58, s.1)
���� 2.��� Section 2 of P.L.1999,
c.106 (C.17:48A-7u) is amended to read as follows:
���� 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 mental health
conditions and substance use disorders 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. s.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. s.156.115(a)(3).�
Coverage
provided pursuant to this section shall include, but not be limited to,
medication-assisted treatment for opioid addiction for any subscriber or other
person covered under the contract.
���� (2)�� As used in this section:
����
�Medication-assisted
treatment� means the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders.
���� "Mental health
condition" means a condition defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
current version of the Diagnostic and Statistical Manual of Mental Disorders.
���� "Same terms and
conditions" means that the medical service corporation cannot apply more
restrictive non-quantitative limitations, such as utilization review and other
criteria or more quantitative limitations such as copayments, deductibles, aggregate
or annual limits or benefit limits to mental health condition and substance use
disorder benefits than those applied to substantially all other medical or
surgical benefits.
���� "Substance use
disorder" means a disorder defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
most current version of the Diagnostic and Statistical Manual of Mental
Disorders.
���� b.��� (Deleted by amendment,
P.L.2019, c.58)
���� c.���� The provisions of this
section shall apply to all contracts in which the medical service corporation
has reserved the right to change the premium.
���� d.��� Nothing in this section
shall reduce the requirement for a medical service corporation to provide
benefits pursuant to section 2 of P.L.2017, c.28 (C.17:48A-7kk).
(cf: P.L.2019, c.58, s.2)
���� 3.��� Section 2 of P.L.1999,
c.106 (C.17:48E-35.20) is amended to read as follows:
���� 2.��� 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 mental
health conditions and substance use disorders 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. s.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. s.156.115(a)(3).�
Coverage
provided pursuant to this section shall include, but not be limited to,
medication-assisted treatment for opioid addiction for any subscriber or other
person covered under the contract.
���� (2)�� As used in this section:
����
�Medication-assisted
treatment� means the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders.
���� "Mental health
condition" means a condition defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
current version of the Diagnostic and Statistical Manual of Mental Disorders.
���� "Same terms and
conditions" means that the health service corporation cannot apply more
restrictive non-quantitative limitations, such as utilization review and other
criteria or more quantitative limitations such as copayments, deductibles, aggregate
or annual limits or benefit limits to mental health condition and substance use
disorder benefits than those applied to substantially all other medical or
surgical benefits.
���� "Substance use
disorder" means a disorder defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
most current version of the Diagnostic and Statistical Manual of Mental
Disorders.
���� b.��� (Deleted by amendment,
P.L.2019, c.58)
���� c.���� The provisions of this
section shall apply to all contracts in which the health service corporation
has reserved the right to change the premium.
���� d.��� Nothing in this section
shall reduce the requirement for a health service corporation to provide
benefits pursuant to section 3 of P.L.2017, c.28 (C.17:48E-35.38).
(cf: P.L.2019, c.58, s.3)
���� 4.��� Section 4 of P.L.1999,
c.106 (C.17B:26-2.1s) is amended to read as follows:
���� 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 mental health
conditions and substance use disorders 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. s.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. s.156.115(a)(3).�
Coverage
provided pursuant to this section shall include, but not be limited to,
medication-assisted treatment for opioid addiction for any covered person.
���� (2)�� As used in this section:
����
�Medication-assisted
treatment� means the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders.
���� "Mental health
condition" means a condition defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
current version of the Diagnostic and Statistical Manual of Mental Disorders.
���� "Same terms and
conditions" means that the insurer cannot apply more restrictive
non-quantitative limitations, such as utilization review and other criteria or
more quantitative limitations such as copayments, deductibles, aggregate or
annual limits or benefit limits to mental health condition and substance use
disorder benefits than those applied to substantially all other medical or
surgical benefits.
���� "Substance use
disorder" means a disorder defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
most current version of the Diagnostic and Statistical Manual of Mental
Disorders.
���� b.��� (Deleted by amendment,
P.L.2019, c.58)
���� c.���� The provisions of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
���� d.��� Nothing in this section
shall reduce the requirement for an insurer to provide benefits pursuant to
section 4 of P.L.2017, c.28 (C.17B:26-2.1hh).
(cf: P.L.2019, c.58, s.4)
���� 5.��� Section 5 of P.L.1999,
c.106 (C.17B:27-46.1v) is amended to read as follows:
���� 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 mental health conditions
and substance use disorders 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. s.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. s.156.115(a)(3).�
Coverage provided pursuant to this
section shall include, but not be limited to, medication-assisted treatment for
opioid addiction for any covered person.
���� (2)�� As used in this section:
����
�Medication-assisted
treatment� means the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders.
���� "Mental health
condition" means a condition defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
current version of the Diagnostic and Statistical Manual of Mental Disorders.
���� "Same terms and
conditions" means that the insurer cannot apply more restrictive
non-quantitative limitations, such as utilization review and other criteria or
more quantitative limitations such as copayments, deductibles, aggregate or
annual limits or benefit limits to mental health condition and substance use
disorder benefits than those applied to substantially all other medical or
surgical benefits.
"Substance use disorder"
means a disorder defined to be consistent with generally recognized independent
standards of current medical practice referenced in the most current version of
the Diagnostic and Statistical Manual of Mental Disorders.
���� b.��� (Deleted by amendment,
P.L.2019, c.59)
���� c.���� The provisions of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
���� d.��� Nothing in this section
shall reduce the requirement for an
insurer to provide benefits
pursuant to section 5 of P.L.2017, c.28 (C.17B:27-46.1nn).
(cf: P.L.2019, c.58, s.5)
���� 6.��� Section 6 of P.L.1999,
c.106 (C.17B:27A-7.5) is amended to read as follows:
���� 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 mental health conditions and substance use disorders 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.
s.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.
s.156.115(a)(3).�
Coverage provided pursuant to this section shall include,
but not be limited to, medication-assisted treatment for opioid addiction for
any covered person.
���� (2)�� As used in this section:
����
�Medication-assisted
treatment� means the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders.
���� "Mental health
condition" means a condition defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
current version of the Diagnostic and Statistical Manual of Mental Disorders.
���� "Same terms and
conditions" means that the plan cannot apply more restrictive
non-quantitative limitations, such as utilization review and other criteria or
more quantitative limitations such as copayments, deductibles, aggregate or
annual limits or benefit limits to mental health condition and substance use
disorder benefits than those applied to substantially all other medical or
surgical benefits.
���� "Substance use
disorder" means a disorder defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
most current version of the Diagnostic and Statistical Manual of Mental
Disorders.
���� b.��� (Deleted by amendment,
P.L.2019, c.58)
���� c.���� The provisions of this
section shall apply to all health benefits plans in which the carrier has
reserved the right to change the premium.
���� d.��� Nothing in this section
shall reduce the requirement for a plan to provide benefits pursuant to section
6 of P.L.2017, c.28 (C.17B:27A-7.21).
(cf: P.L.2019, c.58, s.6)
���� 7.��� Section 7 of P.L.1999,
c.106 (C.17B:27A-19.7) is amended to read as follows:
���� 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 mental health conditions and substance use disorders 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. s.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. s.156.115(a)(3).�
Coverage provided pursuant to this section shall
include, but not be limited to, medication-assisted treatment for opioid
addiction for any covered person.
���� (2)�� As used in this section:
����
�Medication-assisted
treatment� means the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders.
���� "Mental health
condition" means a condition defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
current version of the Diagnostic and Statistical Manual of Mental Disorders.
���� "Same terms and
conditions" means that the plan cannot apply more restrictive
non-quantitative limitations, such as utilization review and other criteria or
more quantitative limitations such as copayments, deductibles, aggregate or
annual limits or benefit limits to mental health condition and substance use
disorder benefits than those applied to substantially all other medical or
surgical benefits.
���� "Substance use
disorder" means a disorder defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
most current version of the Diagnostic and Statistical Manual of Mental
Disorders.
���� b.��� (Deleted by amendment,
P.L.2019, c.58)
���� c.���� The provisions of this
section shall apply to all health benefits plans in which the carrier has
reserved the right to change the premium.
���� d.��� Nothing in this section
shall reduce the requirement for a plan to provide benefits pursuant to section
7 of P.L.2017, c.28 (C.17B:27A-19.25).
(cf: P.L.2019, c.58, s.7)
���� 8.��� Section 8 of P.L.1999,
c.106 (C.26:2J-4.20) is amended to read as follows:
���� 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 mental health
conditions and substance use disorders 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. s.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. s.156.115(a)(3).�
Coverage
provided pursuant to this section shall include, but not be limited to,
medication-assisted treatment for opioid addiction for any enrollee.
���� (2)�� As used in this section:
����
�Medication-assisted
treatment� means the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders.
���� "Mental health
condition" means a condition defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
current version of the Diagnostic and Statistical Manual of Mental Disorders.
���� "Same terms and
conditions" means that the health maintenance organization cannot apply
more restrictive non-quantitative limitations, such as utilization review and
other criteria or more quantitative limitations such as copayments, deductibles,,
aggregate or annual limits or health care services limits to mental health
condition and substance use disorder services than those applied to
substantially all other medical or surgical health care services.
���� "Substance use
disorder" means a disorder defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
most current version of the Diagnostic and Statistical Manual of Mental
Disorders.
���� b.��� (Deleted by amendment,
P.L.2019, c.58)
���� c.���� The provisions of this
section shall apply to enrollee agreements in which the health maintenance
organization has reserved the right to change the premium.
���� d.��� Nothing in this section
shall reduce the requirement for a health maintenance organization to provide
benefits pursuant to section 8 of P.L.2017, c.28 (C.26:2J-4.39).
(cf: P.L.2019, c.58, s.8)
���� 9.��� Section 1 of P.L.1999,
c.441 (C.52:14-17.29d) is amended to read as follows:
���� 1.��� As used in this act:
���� "Carrier" means an
insurance company, health service corporation, hospital service corporation,
medical service corporation or health maintenance organization authorized to
issue health benefits plans in this State.
����
�Medication-assisted
treatment� means the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders.
���� "Mental health
condition" means a condition defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
current version of the Diagnostic and Statistical Manual of Mental Disorders.
���� "Same terms and
conditions" means that a carrier cannot apply more restrictive
non-quantitative limitations, such as utilization review and other criteria or
more quantitative limitations such as copayments, deductibles, aggregate or
annual limits or benefit limits to mental health condition and substance use
disorder benefits than those applied to substantially all other medical or
surgical benefits.
���� "Substance use
disorder" means a disorder defined to be consistent with generally
recognized independent standards of current medical practice referenced in the
most current version of the Diagnostic and Statistical Manual of Mental
Disorders.
(cf: P.L.2019, c.58, s.9)
���� 10.� Section 2 of P.L.1999,
c.441 (C.52:14-17.29e) is amended to read as follows:
���� 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 mental health conditions
and substance use disorders 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. s.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. s.156.115(a)(3).�
Coverage provided pursuant to this section shall
include, but not be limited to, medication-assisted treatment for opioid
addiction for any covered person.
���� b.��� 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 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 mental health
condition or substance use disorder, shall promptly notify that person of the
coverage required by this section.
���� c.���� Nothing in this section
shall reduce the requirement for a carrier to provide benefits pursuant to
section 9 of P.L.2017, c.28 (C.52:14-17.29u).
(cf: P.L.2019, c.58, s.10)
���� 11.� This act shall take
effect on the 90th day after the date of enactment and shall apply to all
health benefits plans currently in effect in the State, or that are delivered,
issued, executed or renewed in this State, 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.
STATEMENT
���� This bill amends existing law
concerning health insurance coverage of mental health conditions and substance
use disorders to add a requirement that health insurers (health, hospital and
medical service corporations, commercial individual and group health insurers,
health maintenance organizations, health benefits plans issued pursuant to the
New Jersey Individual Health Coverage and Small Employer Health Benefits
Programs, and the State Health Benefits Program) provide coverage for medication-assisted
treatment for opioid addiction for any covered person. Under the bill, �medication-assisted
treatment� means the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders.