SENATE COMMERCE COMMITTEE

 

STATEMENT TO

 

SENATE, No. 2180

 

with committee amendments

 

STATE OF NEW JERSEY

 

DATED:  FEBRUARY 9, 2015

 

      The Senate Commerce Committee reports favorably and with committee amendments Senate Bill No. 2180.

      This bill, as amended, 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, without utilization management review, for behavioral health care services when those services are deemed medically necessary by a physician licensed to practice medicine and surgery, licensed psychologist, licensed clinical social worker, certified advanced practice nurse, licensed marriage or family therapist, licensed professional counselor, or licensed physician assistant, acting within their lawful scope of practice.

      The bill amends several statutes, initially enacted in 1977 and 1985, 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 coverage for "behavioral health care services," which is defined 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. 

      The bill also extends the required behavioral health coverage to health maintenance organizations, the individual and small employer insurance programs, the State Health Benefits Program, and the School Employees’ Health Benefits Program, which were not included in the 1977 and 1985 statutes.

      Specifically, the bill, as amended, requires that the coverage for behavioral health care services 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;

·   participation as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility or behavioral health care facility;

·   office visits with a health care provider; and

·   treatment at home and community-based service facilities.

      Treatment or participation at any facility, hospital or office shall not preclude further or additional treatment at any other eligible facility, hospital or office.

      As amended, the bill further provides that, notwithstanding any law or regulation to the contrary, the benefits provided pursuant to the bill shall not be subject to any utilization management review or medical necessity determination other than the determination of medical necessity by a health care provider. 

      The medical necessity determination as specified shall control both the nature and duration of treatment.  However, the bill also provides that this coverage may be subject to limits relating to the use of participating providers and facilities as provided in the contract.

      The amended bill also defines “medical necessity” as health care services and supplies provided by a health care provider appropriate to the evaluation and treatment of disease, condition, illness or injury, consistent with the applicable standard of care, including the evaluation of experimental or investigational services, procedures, drugs or devices.

      The bill also repeals P.L.1999, c.106, which requires mental health parity, meaning coverage under the same terms and conditions as provided for any other sickness, for “biologically-based mental illnesses.”  As the bill requires coverage, without utilization management review, for behavioral health care services, including for all mental health and emotional disorders, P.L.1999, c.106 is superseded by the provisions of this bill.

 

COMMITTEE AMENDMENTS:

      The committee amendments:

      -  provide that the relevant contract, policy or plan providing health benefits must provide coverage for behavioral health care services when those services are deemed medically necessary by a health care provider.  The amendments define a health care provider as the treating: physician licensed to practice medicine and surgery, licensed psychologist, licensed clinical social worker, certified advanced practice nurse, licensed marriage or family therapist, licensed professional counselor, or licensed physician assistant, acting within their lawful scope of practice;

      - require that the contract, policy or plan include, in addition to the other benefits listed in the bill, benefits for:

      (1) Participation as an inpatient or outpatient at a licensed, certified, or State-approved residential treatment facility or behavioral health care facility;

      (2) Office visits with a health care provider; and

      (3) Treatment at home and community-based service facilities;

      - provide that the benefits required to be provided in the bill shall not be subject to utilization management review or a medical necessity determination other than the medical necessity determination by the health care provider and that this medical necessity determination by the health care provider shall control both the nature and duration of treatment;

      - add to the bill a definition of “medical necessity,” which means health care services and supplies provided by a health care provider appropriate to the evaluation and treatment of disease, condition, illness or injury, consistent with the applicable standard of care, including the evaluation of experimental or investigational services, procedures, drugs or devices.