SENATE, No. 105

STATE OF NEW JERSEY

216th LEGISLATURE

PRE-FILED FOR INTRODUCTION IN THE 2014 SESSION

 


 

Sponsored by:

Senator ANTHONY R. BUCCO

District 25 (Morris and Somerset)

 

 

 

 

SYNOPSIS

Requires insurers to provide minimum of 30 days inpatient treatment for substance abuse when physician determines treatment is medically necessary.

 

CURRENT VERSION OF TEXT

Introduced Pending Technical Review by Legislative Counsel


An Act concerning health insurance coverage for treatment of substance abuse and revising parts of statutory law.

 

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

1. Section 1 of P.L.1977, c. 115 (C.17:48-6a) is amended to read as follows:

1. No group or individual contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State[,] or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, after the effective date of [this act] P.L. , c. (pending before the Legislature as this bill), unless such contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in connection with the treatment of [alcoholism] substance abuse when such treatment is prescribed by a [doctor of medicine] physician licensed to practice medicine and surgery. Such benefits shall be provided to the same extent as for any other sickness under the contract.

Every contract shall include such benefits for the treatment of [alcoholism] substance abuse as are hereinafter set forth:

a. Inpatient or outpatient care in a [licensed hospital] health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);

b. Treatment at a State-licensed detoxification facility [licensed pursuant to P.L.1975, c.305]; and

c. Confinement as an inpatient or outpatient at a licensed, certified, or [state] State-approved residential treatment facility, for a minimum of 30 days per year for inpatient residential care, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission on [Hospital] Accreditation of Healthcare Organizations.

Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility; provided, however, that the benefit days used do not exceed the total number of benefit days provided for any other sickness under the contract.

The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.

(cf: P.L.1977, c.115, s.1)

 

2. Section 1 of P.L.1977, c.116 (C.17B:27-46.1) is amended to read as follows:

1. No group health insurance [contract] policy providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State[,] or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, after the effective date of [this act] P.L. , c. (pending before the Legislature as this bill), unless such [contract] policy provides benefits to any [subscriber] insured or other person covered thereunder for expenses incurred in connection with the treatment of [alcoholism] substance abuse when such treatment is prescribed by a [doctor of medicine] physician licensed to practice medicine and surgery. Such benefits shall be provided to the same extent as for any other sickness under the [contract] policy.

Every [contract] policy shall include such benefits for the treatment of [alcoholism] substance abuse as are hereinafter set forth:

a. Inpatient or outpatient care in a [licensed hospital] health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);

b. Treatment at a State-licensed detoxification facility [licensed pursuant to P.L.1975, c.305]; and

c. Confinement as an inpatient or outpatient at a licensed, certified, or [state] State-approved residential treatment facility, for a minimum of 30 days per year for inpatient residential care, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission on [Hospital] Accreditation of Healthcare Organizations.

Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility; provided, however, that the benefit days used do not exceed the total number of benefit days provided for any other sickness under the [contract] policy.

The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

(cf: P.L.1977, c.116, s.1)

 

3. Section 1 of P.L.1977, c.117 (C.17:48A-7a) is amended to read as follows:

1. No group or individual contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State[,] or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, after the effective date of [this act] P.L. , c. (pending before the Legislature as this bill), unless such contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in connection with the treatment of [alcoholism] substance abuse when such treatment is prescribed by a [doctor of medicine] physician licensed to practice medicine and surgery. Such benefits shall be provided to the same extent as for any other sickness under the contract.

Every contract shall include such benefits for the treatment of [alcoholism] substance abuse as are hereinafter set forth:

a. Inpatient or outpatient care in a [licensed hospital] health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);

b. Treatment at a State-licensed detoxification facility [licensed pursuant to P.L.1975, c.305]; and

c. Confinement as an inpatient or outpatient at a licensed, certified, or [state] State-approved residential treatment facility, for a minimum of 30 days per year for inpatient residential care, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission on [Hospital] Accreditation of Healthcare Organizations.

Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility; provided, however, that the benefit days used do not exceed the total number of benefit days provided for any other sickness under the contract.

The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.

(cf: P.L.1977, c.117, s.1)

 

4. Section 1 of P.L.1977, c.118 (C.17B:26-2.1) is amended to read as follows:

1. No individual health insurance [contract] policy providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State[,] or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, after the effective date of [this act] P.L. , c. (pending before the Legislature as this bill), unless such [contract] policy provides benefits to any [subscriber] insured or other person covered thereunder for expenses incurred in connection with the treatment of [alcoholism] substance abuse when such treatment is prescribed by a [doctor of medicine] physician licensed to practice medicine and surgery. Such benefits shall be provided to the same extent as for any other sickness under the [contract] policy.

Every [contract] policy shall include such benefits for the treatment of [alcoholism] substance abuse as are hereinafter set forth:

a. Inpatient or outpatient care in a [licensed hospital] health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);

b. Treatment at a State-licensed detoxification facility [licensed pursuant to P.L.1975, c.305]; and

c. Confinement as an inpatient or outpatient at a licensed, certified, or [state] State-approved residential treatment facility, for a minimum of 30 days per year for inpatient residential care, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission on [Hospital] Accreditation of Healthcare Organizations.

Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility; provided, however, that the benefit days used do not exceed the total number of benefit days provided for any other sickness under the [contract] policy.

The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

(cf: P.L.1977, c.118, s.1)

 

5. Section 34 of P.L.1985, c.236 (C.17:48E-34) is amended to read as follows:

34. No group or individual contract providing [health service coverage] hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State[,] or approved for issuance or renewal in this State by the commissioner, on or after the effective date of P.L. , c. (C. )(pending before the Legislature as this bill), unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in connection with the treatment of [alcoholism] substance abuse when the treatment is prescribed by a [doctor of medicine] physician licensed to practice medicine and surgery. Benefits shall be provided to the same extent as for any other sickness under the contract.

Every contract shall include benefits for the treatment of [alcoholism] substance abuse as follows:

a. Inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);

b. Treatment at a State-licensed detoxification facility [licensed pursuant to section 8 of P.L.1975, c.305 (C.26:2B-14)];

c. Confinement as an inpatient or outpatient at a licensed, certified, or [State] State-approved residential treatment facility, for a minimum of 30 days per year for inpatient residential care, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission on [Hospital] Accreditation of Healthcare Organizations.

Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility, if the benefit days used do not exceed the total number of benefit days provided for any other sickness under the contract.

The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.

(cf: P.L.1985, c.236, s.34)

 

6. (New section) A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Health and Senior Services on or after the effective date of this act unless the health maintenance organization provides health care services to any enrollee or other covered person for the treatment of substance abuse when the treatment is prescribed by a physician licensed to practice medicine and surgery. The health care services shall be provided to the same extent as for any other sickness under the contract.

Every contract shall include health care services for the treatment of substance abuse as follows:

a. Inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);

b. Treatment at a State-licensed detoxification facility; and

c. Confinement as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility, for a minimum of 30 days per year for inpatient residential care, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission on Accreditation of Healthcare Organizations.

Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility; except that the benefit days used shall not exceed the total number of benefit days provided for any other sickness under the contract.

The provisions of this section shall apply to all contracts for health care services in which the health maintenance organization has reserved the right to change the schedule of charges.

 

7. (New section) An 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 coverage for the treatment of substance abuse when the treatment is prescribed by a physician licensed to practice medicine and surgery. The benefits shall be provided to the same extent as for any other sickness under the health benefits plan.

Every health benefits plan shall include benefits for the treatment of substance abuse as follows:

a. Inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);

b. Treatment at a State-licensed detoxification facility; and

c. Confinement as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility, for a minimum of 30 days per year for inpatient residential care, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission on Accreditation of Healthcare Organizations.

Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility; except that the benefit days used shall not exceed the total number of benefit days provided for any other sickness under the health benefits plan.

The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium.

 

8. (New section) A 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 coverage for the treatment of substance abuse when the treatment is prescribed by a physician licensed to practice medicine and surgery. The benefits shall be provided to the same extent as for any other sickness under the health benefits plan.

Every health benefits plan shall include benefits for the treatment of substance abuse as follows:

a. Inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);

b. Treatment at a State-licensed detoxification facility; and

c. Confinement as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility, for a minimum of 30 days per year for inpatient residential care, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission on Accreditation of Healthcare Organizations.

Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility; except that the benefit days used shall not exceed the total number of benefit days provided for any other sickness under the health benefits plan.

The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium.

 

9. 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 would require hospital, medical and health service corporations, commercial insurers, health maintenance organizations, and health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits programs to provide coverage for expenses incurred in the treatment of substance abuse when the treatment is prescribed by a physician licensed to practice medicine and surgery.

The bill amends P.L.1977, c.115, 116, 117, and 118 and P.L.1985, c.236, which require hospital, medical and health service corporations, and individual and group health insurers to provide coverage for the treatment of alcoholism. The bill expands that coverage to include other types of substance abuse, including drug abuse, and updates terminology in those statutes. The bill also extends the required substance abuse coverage to health maintenance organizations and the individual and small employer insurance programs, which were not included in the 1977 and 1985 statutes.

Specifically, the bill requires that the coverage include:

   inpatient or outpatient care in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);

   treatment at a State-licensed detoxification facility; and

   confinement as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility, for a minimum of 30 days per year for inpatient residential care, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission on Accreditation of Healthcare Organizations.

Treatment or confinement at any facility is not to preclude further or additional treatment at any other eligible facility, but the benefit days used are not to exceed the total number of benefit days provided for any other sickness under the health benefits plan.

The bill takes effect on the 60th day after enactment and applies to all health insurance contracts and policies delivered, issued, executed, or renewed on or after that date.