SENATE, No. 1624
STATE OF NEW JERSEY
INTRODUCED OCTOBER 28, 1996
By Senator EWING
An Act concerning insurance benefits for the treatment of alcoholism, amending P.L.1977, c.115, P.L.1977, c.116, P.L.1977, c.117, P.L.1977, c.118 and P.L.1985, c.236.
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 Insurance after the effective date of this act, unless such contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in connection with the treatment of alcoholism when such treatment is prescribed by a doctor of medicine. 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 as are hereinafter set forth:
a. Inpatient or outpatient care in a health care facility licensed [hospital] pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
b. Treatment at a detoxification facility licensed pursuant to section 8 of P.L.1975, c.305 (C.26:2B-14); and
c. Confinement as an inpatient or outpatient at a licensed, certified, or State approved residential treatment facility, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission [on Hospital] for the Accreditation of Healthcare Organizations or the Commission on Accreditation of Rehabilitation Facilities.
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.
(cf: P.L.1977, c.115, s.1)
2. 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 Insurance after the effective date of this act, unless such contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in connection with the treatment of alcoholism when such treatment is prescribed by a doctor of medicine. 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 as are hereinafter set forth:
a. Inpatient or outpatient care in a health care facility licensed [hospital] pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
b. Treatment at a detoxification facility licensed pursuant to section 8 of P.L.1975, c.305 (C.26:2B-14); and
c. Confinement as an inpatient or outpatient at a licensed, certified, or State approved residential treatment facility, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission [on Hospital] for the Accreditation of Healthcare Organizations or the Commission on Accreditation of Rehabilitation Facilities.
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.
(cf: P.L.1977, c.117, s.1)
3. 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 shall be delivered, issued, executed, or renewed in this State, or approved for issuance or renewal in this State by the commissioner, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in connection with the treatment of alcoholism when the treatment is prescribed by a doctor of medicine. 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 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 detoxification facility licensed pursuant to section 8 of P.L.1975, c.305 (C.26:2B-14); and
c. Confinement as an inpatient or outpatient at a licensed, certified, or State approved residential treatment facility, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission [on Hospital] for the Accreditation of Healthcare Organizations or the Commission on Accreditation of Rehabilitation Facilities.
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.
(cf: P.L.1985, c.236, s.34)
4. Section 1 of P.L.1977, c.118 (C.17B:26-2.1) is amended to read as follows:
1. No health insurance 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 Insurance after the effective date of this act, unless such contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in connection with the treatment of alcoholism when such treatment is prescribed by a doctor of medicine. 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 as are hereinafter set forth:
a. Inpatient or outpatient care in a health care facility licensed [hospital] pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
b. Treatment at a detoxification facility licensed pursuant to section 8 of P.L.1975, c.305 (C.26:2B-14); and
c. Confinement as an inpatient or outpatient at a licensed, certified, or State approved residential treatment facility, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission [on Hospital] for the Accreditation of Healthcare Organizations or the Commission on Accreditation of Rehabilitation Facilities.
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.
(cf: P.L.1977, c.118, s.1)
5. 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 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 Insurance after the effective date of this act, unless such contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in connection with the treatment of alcoholism when such treatment is prescribed by a doctor of medicine. 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 as are hereinafter set forth:
a. Inpatient or outpatient care in a health care facility licensed [hospital] pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.);
b. Treatment at a detoxification facility licensed pursuant to section 8 of P.L.1975, c.305 (C.26:2B-14); and
c. Confinement as an inpatient or outpatient at a licensed, certified, or State approved residential treatment facility, under a program which meets minimum standards of care equivalent to those prescribed by the Joint Commission [on Hospital] for the Accreditation of Healthcare Organizations or the Commission on Accreditation of Rehabilitation Facilities.
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.
(cf: P.L.1977, c.116, s.1)
6. This act shall take effect immediately.
STATEMENT
Hospital service corporations, medical service corporations, health service corporations and commercial health insurers are required by law to provide benefits for the treatment of alcoholism. This bill provides that, to qualify for insurance benefits, a program in a licensed, certified or State approved residential treatment facility must meet the minimum standards of care equivalent to those prescribed by either the Commission on Accreditation of Rehabilitation Facilities or the Joint Commission for the Accreditation of Healthcare Organizations. Currently, only the standards of the Joint Commission for the Accreditation of Healthcare Organizations, formerly the Joint Commission on Hospital Accreditation, are applicable under the law.
Allows Commission on Accreditation of Rehabilitation Facilities to accredit residential treatment facilities in regard to insurance benefits for treatment of alcoholism.