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A2308
ASSEMBLY, No. 2308
STATE OF NEW JERSEY
222nd LEGISLATURE
�
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Assemblywoman LUANNE M. PETERPAUL
District 11 (Monmouth)
Co-Sponsored by:
Assemblywomen Donlon and Morales
SYNOPSIS
���� Requires health insurance carriers to provide
coverage for enrollment of student in recovery high school alternative
education program.
CURRENT VERSION OF TEXT
���� Introduced Pending Technical Review by Legislative
Counsel.
��
An Act
concerning health insurance coverage 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 benefits delivered through the
psychiatric Collaborative Care Model
.
����
Coverage provided pursuant
to this section shall include benefits for the enrollment of a student in a
recovery high school alternative education program established pursuant to
P.L.2015, c.254 (C.18A:35-29 et seq.), if placement in the recovery high school
alternative education program is determined to be clinically appropriate by a
certified alcohol and drug counselor, licensed clinical alcohol and drug
counselor, treating physician, treatment facility, or district student
assistance counselor using the criteria for substance use disorder or
dependency as defined by the most recent Diagnostic and Statistical Manual of
Mental Disorders.
���� (2)�� As used in this section:
���� "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.
���� �Psychiatric
Collaborative Care Model� means the evidence-based, integrated behavioral
health service delivery method wherein a primary care provider and a care
manager collaborate with a psychiatric consultant to provide care to a
patient.� �Psychiatric Collaborative Care Model� shall include those benefits
that are billed using the following list of Current Procedural Terminology
(CPT) codes, which list shall be updated by the Commissioner of Banking and
Insurance whenever the codes are altered or supplemented:
���� (a)�� 99492 � Initial
psychiatric collaborative care management;
���� (b)�� 99493 � Subsequent
psychiatric collaborative care management; and
���� (c)�� 99494 � Initial or
subsequent psychiatric collaborative care management, additional time.
���� "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.2022, c.33, 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 s.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 benefits delivered through the psychiatric
Collaborative Care Model.
����
Coverage provided pursuant
to this section shall include benefits for the enrollment of a student in a
recovery high school alternative education program established pursuant to
P.L.2015, c.254 (C.18A:35-29 et seq.), if placement in the recovery high school
alternative education program is determined to be clinically appropriate by a
certified alcohol and drug counselor, licensed clinical alcohol and drug
counselor, treating physician, treatment facility, or district student
assistance counselor using the criteria for substance use disorder or
dependency as defined by the most recent Diagnostic and Statistical Manual of
Mental Disorders.
���� (2)�� As used in this section:
���� "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.
���� �Psychiatric Collaborative
Care Model� means the evidence-based, integrated behavioral health service
delivery method wherein a primary care provider and a care manager collaborate
with a psychiatric consultant to provide care to a patient.� �Psychiatric
Collaborative Care Model� shall include those benefits that are billed using
the following list of Current Procedural Terminology (CPT) codes, which list
shall be updated by the Commissioner of Banking and Insurance whenever the
codes are altered or supplemented:
���� (a)�� 99492 � Initial
psychiatric collaborative care management;
���� (b)�� 99493 � Subsequent
psychiatric collaborative care management; and
���� (c)�� 99494 � Initial or
subsequent psychiatric collaborative care management, additional time.
���� "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.2022, c.33, s.2)
���� 3.��� Section 3 of P.L.1999,
c.106 (C.17:48E-35.20) is amended to read as follows:
���� 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 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 benefits delivered through the psychiatric
Collaborative Care Model.
����
Coverage provided pursuant
to this section shall include benefits for the enrollment of a student in a
recovery high school alternative education program established pursuant to
P.L.2015, c.254 (C.18A:35-29 et seq.), if placement in the recovery high school
alternative education program is determined to be clinically appropriate by a
certified alcohol and drug counselor, licensed clinical alcohol and drug
counselor, treating physician, treatment facility, or district student
assistance counselor using the criteria for substance use disorder or
dependency as defined by the most recent Diagnostic and Statistical Manual of
Mental Disorders.
���� (2)�� As used in this section:
���� "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.
���� �Psychiatric Collaborative
Care Model� means the evidence-based, integrated behavioral health service
delivery method wherein a primary care provider and a care manager collaborate
with a psychiatric consultant to provide care to a patient.� �Psychiatric
Collaborative Care Model� shall include those benefits that are billed using
the following list of Current Procedural Terminology (CPT) codes, which list
shall be updated by the Commissioner of Banking and Insurance whenever the
codes are altered or supplemented:
���� (a)�� 99492 � Initial
psychiatric collaborative care management;
���� (b)�� 99493 � Subsequent
psychiatric collaborative care management; and
���� (c)�� 99494 � Initial or
subsequent psychiatric collaborative care management, additional time.
���� "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.2022, c.33, 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 benefits delivered through the psychiatric
Collaborative Care Model.
����
Coverage provided pursuant
to this section shall include benefits for the enrollment of a student in a
recovery high school alternative education program established pursuant to
P.L.2015, c.254 (C.18A:35-29 et seq.), if placement in the recovery high school
alternative education program is determined to be clinically appropriate by a
certified alcohol and drug counselor, licensed clinical alcohol and drug
counselor, treating physician, treatment facility, or district student
assistance counselor using the criteria for substance use disorder or
dependency as defined by the most recent Diagnostic and Statistical Manual of
Mental Disorders.
���� (2)�� As used in this section:
���� "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.
���� �Psychiatric Collaborative
Care Model� means the evidence-based, integrated behavioral health service
delivery method wherein a primary care provider and a care manager collaborate
with a psychiatric consultant to provide care to a patient.� �Psychiatric
Collaborative Care Model� shall include those benefits that are billed using
the following list of Current Procedural Terminology (CPT) codes, which list
shall be updated by the Commissioner of Banking and Insurance whenever the
codes are altered or supplemented:
���� (a)�� 99492 � Initial
psychiatric collaborative care management;
���� (b)�� 99493 � Subsequent
psychiatric collaborative care management; and
���� (c)�� 99494 � Initial or
subsequent psychiatric collaborative care management, additional time.
���� "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.2022, c.33, 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 benefits delivered through the psychiatric
Collaborative Care Model.
����
Coverage provided pursuant
to this section shall include benefits for the enrollment of a student in a
recovery high school alternative education program established pursuant to
P.L.2015, c.254 (C.18A:35-29 et seq.), if placement in the recovery high school
alternative education program is determined to be clinically appropriate by a
certified alcohol and drug counselor, licensed clinical alcohol and drug
counselor, treating physician, treatment facility, or district student
assistance counselor using the criteria for substance use disorder or
dependency as defined by the most recent Diagnostic and Statistical Manual of
Mental Disorders.
���� (2)�� As used in this section:
���� "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.
���� �Psychiatric Collaborative
Care Model� means the evidence-based, integrated behavioral health service
delivery method wherein a primary care provider and a care manager collaborate
with a psychiatric consultant to provide care to a patient.� �Psychiatric
Collaborative Care Model� shall include those benefits that are billed using
the following list of Current Procedural Terminology (CPT) codes, which list
shall be updated by the Commissioner of Banking and Insurance whenever the
codes are altered or supplemented:
���� (a)�� 99492 � Initial
psychiatric collaborative care management;
���� (b)�� 99493 � Subsequent
psychiatric collaborative care management; and
���� (c)�� 99494 � Initial or
subsequent psychiatric collaborative care management, additional time.
���� "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.2022, c.33, 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 benefits delivered through the psychiatric
Collaborative Care Model.
����
Coverage provided pursuant
to this section shall include benefits for the enrollment of a student in a
recovery high school alternative education program established pursuant to
P.L.2015, c.254 (C.18A:35-29 et seq.), if placement in the recovery high school
alternative education program is determined to be clinically appropriate by a
certified alcohol and drug counselor, licensed clinical alcohol and drug
counselor, treating physician, treatment facility, or district student
assistance counselor using the criteria for substance use disorder or
dependency as defined by the most recent Diagnostic and Statistical Manual of
Mental Disorders.
���� (2)�� As used in this section:
���� "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.
���� �Psychiatric Collaborative
Care Model� means the evidence-based, integrated behavioral health service
delivery method wherein a primary care provider and a care manager collaborate
with a psychiatric consultant to provide care to a patient.� �Psychiatric
Collaborative Care Model� shall include those benefits that are billed using
the following list of Current Procedural Terminology (CPT) codes, which list
shall be updated by the Commissioner of Banking and Insurance whenever the
codes are altered or supplemented:
���� (a)�� 99492 � Initial
psychiatric collaborative care management;
���� (b)�� 99493 � Subsequent
psychiatric collaborative care management; and
���� (c)�� 99494 � Initial or
subsequent psychiatric collaborative care management, additional time.
���� "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.2022, c.33, 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 benefits delivered through the psychiatric
Collaborative Care Model.
����
Coverage provided pursuant
to this section shall include benefits for the enrollment of a student in a
recovery high school alternative education program established pursuant to
P.L.2015, c.254 (C.18A:35-29 et seq.), if placement in the recovery high school
alternative education program is determined to be clinically appropriate by a
certified alcohol and drug counselor, licensed clinical alcohol and drug
counselor, treating physician, treatment facility, or district student
assistance counselor using the criteria for substance use disorder or
dependency as defined by the most recent Diagnostic and Statistical Manual of
Mental Disorders.
���� (2)�� As used in this section:
���� "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.
���� �Psychiatric Collaborative
Care Model� means the evidence-based, integrated behavioral health service
delivery method wherein a primary care provider and a care manager collaborate
with a psychiatric consultant to provide care to a patient.� �Psychiatric
Collaborative Care Model� shall include those benefits that are billed using
the following list of Current Procedural Terminology (CPT) codes, which list
shall be updated by the Commissioner of Banking and Insurance whenever the
codes are altered or supplemented:
���� (a)�� 99492 � Initial
psychiatric collaborative care management;
���� (b)�� 99493 � Subsequent
psychiatric collaborative care management; and
���� (c)�� 99494 � Initial or
subsequent psychiatric collaborative care management, additional time.
���� "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.2022, c.33, 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 benefits delivered through the psychiatric
Collaborative Care Model.
����
Coverage provided pursuant
to this section shall include benefits for the enrollment of a student in a
recovery high school alternative education program established pursuant to
P.L.2015, c.254 (C.18A:35-29 et seq.), if placement in the recovery high school
alternative education program is determined to be clinically appropriate by a
certified alcohol and drug counselor, licensed clinical alcohol and drug
counselor, treating physician, treatment facility, or district student
assistance counselor using the criteria for substance use disorder or
dependency as defined by the most recent Diagnostic and Statistical Manual of
Mental Disorders.
���� (2)�� As used in this section:
���� "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.
���� �Psychiatric Collaborative
Care Model� means the evidence-based, integrated behavioral health service
delivery method wherein a primary care provider and a care manager collaborate
with a psychiatric consultant to provide care to a patient.� �Psychiatric
Collaborative Care Model� shall include those benefits that are billed using
the following list of Current Procedural Terminology (CPT) codes, which list
shall be updated by the Commissioner of Banking and Insurance whenever the
codes are altered or supplemented:
���� (a)�� 99492 � Initial
psychiatric collaborative care management;
���� (b)�� 99493 � Subsequent
psychiatric collaborative care management; and
���� (c)�� 99494 � Initial or
subsequent psychiatric collaborative care management, additional time.
���� "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.2022, c.33, s.8)
���� 9.��� 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 benefits delivered through the psychiatric
Collaborative Care Model.
����
Coverage provided pursuant
to this section shall include benefits for the enrollment of a student in a
recovery high school alternative education program established pursuant to
P.L.2015, c.254 (C.18A:35-29 et seq.), if placement in the recovery high school
alternative education program is determined to be clinically appropriate by a
certified alcohol and drug counselor, licensed clinical alcohol and drug
counselor, treating physician, treatment facility, or district student
assistance counselor using the criteria for substance use disorder or
dependency as defined by the most recent Diagnostic and Statistical Manual of Mental
Disorders.
���� 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.2022, c.33, s.10)
���� 10.� This act shall take
effect on the 60th day after enactment and shall apply to all contracts and
policies delivered, issued, executed, or renewed on or after that date.
STATEMENT
���� This bill requires hospital,
medical and health service corporations, commercial insurers, health
maintenance organizations, health benefits plans issued pursuant to the New
Jersey Individual Health Coverage and Small Employer Health Benefits Programs,
the State Health Benefits Program, and the School Employees� Health Benefits
Program, to provide coverage for benefits for the enrollment of a student in a
recovery high school alternative education program established pursuant to
State law.� The bill requires health insurance coverage only if placement in
the recovery high school alternative education program is determined to be
clinically appropriate by a certified alcohol and drug counselor, licensed
clinical alcohol and drug counselor, treating physician, treatment facility, or
district student assistance counselor using the criteria for substance use
disorder or dependency as defined by the most recent Diagnostic and Statistical
Manual of Mental Disorders.
���� Under current law, a �recovery
high school alternative education program� means an alternative education
program that serves students diagnosed with substance use disorder or
dependency as defined by the most recent Diagnostic and Statistical Manual of Mental
Disorders, and that provides a comprehensive four-year high school education in
an alternative public school setting and a structured plan of recovery that is
aligned with the national framework of evidence-based practices for recovery
high schools.