SENATE, No. 624

STATE OF NEW JERSEY

218th LEGISLATURE

 

PRE-FILED FOR INTRODUCTION IN THE 2018 SESSION

 


 

Senator  GERALD CARDINALE

District 39 (Bergen and Passaic)

Sponsored by:

Senator  ROBERT M. GORDON

District 38 (Bergen and Passaic)

 

 

 

 

SYNOPSIS

     Limits patient information behavioral health care providers may disclose to health insurance carriers.

 

CURRENT VERSION OF TEXT

     Introduced Pending Technical Review by Legislative Counsel.

  


An Act concerning disclosure of certain behavioral health care information and supplementing Title 45 of the Revised Statutes and P.L.2005, c.352.

 

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

 

     1.    a.  Notwithstanding any other law, rule or regulation to the contrary, a mental health care professional shall not disclose information concerning a patient to a carrier, except the following information: 

     (1)  The patient’s name, age, sex, address, educational status, identifying number within the insurance program, date of onset of difficulty, date of initial consultation, dates of sessions, whether the sessions are individual or group sessions, and fees;

     (2)  Diagnostic information, defined as therapeutic characterizations of the type found in the current version of the Diagnostic and Statistical Manual of Mental Disorders or in another professionally recognized diagnostic manual;

     (3)  Status of the patient as voluntary or involuntary; inpatient or outpatient;

     (4)  The reason for continuing behavioral health care services, limited to an assessment of the client’s current level of functioning and level of distress.  These aspects shall be described as “none,” or by the terms “mild,” “moderate,” “severe” or “extreme;” and

     (5)  Prognosis, limited to an estimate of the minimal time during which treatment might continue.

     b.    The information provided to a carrier pursuant this section shall be marked “Confidential” and, if directed by the patient or an authorized representative, forwarded to the attention of a specific individual.

     c.    For the purposes of this section:

     "Behavioral health care services" means procedures or services rendered by a health care provider for the assessment and treatment of mental illness, emotional disorders, or substance abuse.

     “Carrier” means the same as defined in section 3 of P.L.2005, c.352 (C.17B:30-50).

     "Mental health care professional" means an individual licensed or certified by this State to provide or administer behavioral health care services in the ordinary course of business or practice of a profession.

 

     2.    Notwithstanding any law, rule or regulation to the contrary, a payer shall not request, or require in any contract or policy, information to be provided from a mental health care professional concerning  any  covered  person, except   the  information  that   is

permitted to be provided by that professional pursuant to section 1 of P.L.    , c.     (C.       ) (pending before the Legislature as this bill).

 

     3.    This act shall take effect on the first day of the fourth month next following enactment.

 

 

STATEMENT

 

     This bill prohibits mental health care providers from disclosing, and health insurance carriers from demanding, certain information concerning behavioral health care services provided to their patients.

     Specifically, the bill restricts the information a mental health care professional may disclose to a health insurance carrier to the following information:

     (1)  The patient’s name, age, sex, address, educational status, identifying number within the insurance program, date of onset of difficulty, date of initial consultation, dates of sessions, whether the sessions are individual or group sessions, and fees;

     (2)  Diagnostic information, defined as therapeutic characterizations of the type found in the current version of the Diagnostic and Statistical Manual of Mental Disorders or in another professionally recognized diagnostic manual;

     (3)  Status of the patient as voluntary or involuntary; or inpatient or outpatient;

     (4)  The reason for continuing behavioral health care services, limited to an assessment of the client’s current level of functioning and level of distress. These aspects shall be described as “none,” or by the terms “mild,” “moderate,” “severe” or “extreme;” and

     (5)  Prognosis, limited to an estimate of the minimal time during which treatment might continue.

     The bill also provides that the information provided to a carrier pursuant to the bill shall be marked “Confidential” and, if directed by the patient or an authorized representative, forwarded to the attention of a specific individual.

     The bill also prohibits a health insurance carrier from requesting, or requiring in any contract or policy, information to be provided from a mental health care professional concerning any covered person, except the information described above.

     In certain circumstances health insurance carriers have requested, as part of utilization management, information from mental health care providers that the providers are prohibited from disclosing pursuant to the rules and regulations of the providers’ professional licensure. This bill is intended to reconcile that conflict

by codifying certain aspects of those rules of professional licensure and by clearly limiting the information that the carrier can request, or require to be provided, to the information that is permitted to be shared pursuant to those rules.