Coughlin, Vainieri Huttle, Lampitt, Danielsen, Downey, Quijano & Jasey Bill to Expand Health Coverage for Behavioral Health Care, Enhance Enforcement and Oversight of Mental Health Parity Receives Final Legislative Approval

(TRENTON) – Legislation sponsored by Assembly Democrats Craig Coughlin, Valerie Vainieri Huttle, Pamela Lampitt, Joe Danielsen, Joann Downey, Annette Quijano and Mila Jasey to expand health insurance coverage for behavioral health care services and enhance enforcement and oversight of mental health parity was approved today by a vote of 73-3.

The bill (A-2031) would require plans to provide coverage for medically necessary behavioral health care services and to meet the requirements of a 2008 federal law, which prevents certain health insurers that provide mental or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical or surgical benefits, commonly referred to as mental health parity.

“Ensuring coverage for mental health services will have a meaningful impact on thousands of lives across our state,” said Assembly Speaker Coughlin (D-Middlesex). “On average, one in five Americans experience mental health issues. Access to health care is a basic human right and everyone deserves the necessary treatment and coverage as it relates to one’s mental health.”

The bill would expand health coverage to include “behavioral health care services,” which is defined in the legislation 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, and autism.

“This ensures that people who are suffering from mental illness or addiction will have access to the services essential to their recovery,” said Vainieri Huttle (D-Bergen). “Individuals who are struggling with a mental illness or addiction should not have to jump through hoops to get help.”

“The need for health care is not limited to physical ailments,” said Lampitt
(D-Camden, Burlington). “People who are dealing with these problems deserve our help, not our indifference. This will help ensure equal coverage of treatment for mental illness and addiction.”

“Mental illness doesn’t just impact the person who is struggling with the disease,” said Danielsen (D-Middlesex, Somerset). “It is in the best interest of society, as well as the individual, to ensure that these illnesses are covered, and those that need treatment have access to it.”

“These issues, if left untreated, can be disruptive to public safety,” said Downey
(D-Monmouth). “We not only have an obligation to these individuals to ensure they get the treatment they need, but to the public at large which must deal with the repercussions.”

The bill also supplements the “Health Care Quality Act” which places certain restrictions on carriers to ensure parity with respect to imposing non-quantitative treatment limitations, the use of out-of-network providers, and in-plan exceptions for behavioral health care services.

“Mental illness is a real heath condition and should be treated as such,” said Quijano (D-Union). “It should be treated just as any other health condition, such as diabetes, hypertension or asthma. There should be no distinctions in the way that it is categorized and treated.”

“Mental illness is often a taboo topic, both for the sufferer and their family members, and this lack of openness can lead to obstacles in care” said Jasey (D-Essex, Morris). “This bill is yet another step in helping people eliminate some of the many barriers that prevent them from getting the comprehensive care that they need.”

In addition, the bill specifies that a benefit determination for treatment of a substance use disorder, including but not limited to prior approval and medical necessity determinations, the clinical review criteria must be the most recent Treatment Criteria for addictive, substance-related, and co-occurring conditions established by the American Society of Addiction Medicine. No additional criteria may be used during utilization review or benefit determination for treatment of substance use disorders. It also prohibits a carrier that provides coverage for prescription drugs from excluding coverage for any FDA-approved forms of medication assisted treatment prescribed for alcohol dependence or opioid dependence under the same American Society of Addiction Medicine guidelines. Other bill highlights includes requiring carriers to submit an annual report containing certain information regarding compliance with the bill’s provisions to the Department of Banking and Insurance on or before March 1.

The bill now heads to the Governor’s desk.