New Jersey 2024-2025 Regular Session

New Jersey Senate Bill S4018 Compare Versions

Only one version of the bill is available at this time.

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1	1	SENATE, No. 4018 STATE OF NEW JERSEY 221st LEGISLATURE INTRODUCED JANUARY 14, 2025
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3	3	SENATE, No. 4018
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5	5	STATE OF NEW JERSEY
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7	7	221st LEGISLATURE
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11	11	INTRODUCED JANUARY 14, 2025
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15	15	Sponsored by: Senator JOSEPH F. VITALE District 19 (Middlesex) SYNOPSIS Requires health insurance and Medicaid coverage for screening, prevention, and treatment services of behavioral health issues affecting children. CURRENT VERSION OF TEXT As introduced.
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19	19	Sponsored by:
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21	21	Senator JOSEPH F. VITALE
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23	23	District 19 (Middlesex)
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33	33	SYNOPSIS
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35	35	Requires health insurance and Medicaid coverage for screening, prevention, and treatment services of behavioral health issues affecting children.
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39	39	CURRENT VERSION OF TEXT
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41	41	As introduced.
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45	45	An Act concerning insurance and Medicaid coverage for preventive care for developmental and behavioral needs in children and supplementing various parts of the statutory law. Be It Enacted by the Senate and General Assembly of the State of New Jersey: 1. a. A carrier that offers a health benefits plan in this State shall provide benefits to any subscriber for medical expenses incurred in screening, prevention, and treatment services of behavioral health issues in children. A carrier shall accept and reimburse claims for screening, prevention, and treatment using an at-risk diagnosis. b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract. c. As used in this section: "At-risk diagnosis" means a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, when billing for services, without a formal mental health diagnosis, for children who are 18 years of age or younger. "Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State. "Screening, prevention, and treatment" includes the prevention and early identification of mental health conditions, without a behavioral health diagnosis. Services may include, but are not limited to, screenings and individual, group, and family psychotherapy to individuals with potential mental health disorders not yet diagnosed. 2. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person for medical expenses incurred in the screening, prevention, and treatment services of behavioral health issues in children. The contract shall allow for acceptance and reimbursement of claims for screening, prevention, and treatment using an at-risk diagnosis. b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract. c. As used in this section: "At-risk diagnosis" means a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, when billing for services, without a formal mental health diagnosis, for children who are 18 years of age or younger. "Screening, prevention, and treatment" includes the prevention and early identification of mental health conditions, without a behavioral health diagnosis. Services may include, but are not limited to, screenings and individual, group, and family psychotherapy to individuals with potential mental health disorders not yet diagnosed. 3. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person for medical expenses incurred in the screening, prevention, and treatment services of behavioral health issues in children. The contract shall allow for acceptance and reimbursement of claims for screening, prevention, and treatment using an at-risk diagnosis. b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract. c. As used in this section: "At-risk diagnosis" means a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, when billing for services, without a formal mental health diagnosis, for children who are 18 years of age or younger. "Screening, prevention, and treatment" includes the prevention and early identification of mental health conditions, without a behavioral health diagnosis. Services may include, but are not limited to, screenings and individual, group, and family psychotherapy to individuals with potential mental health disorders not yet diagnosed. 4. a. Notwithstanding any law, rule, or regulation to the contrary, the Division of Medical Assistance and Health Services within the Department of Human Services, or a managed care organization that contracts with the division to provide medical services to beneficiaries of the NJ FamilyCare program, shall ensure the provision of benefits for medical expenses incurred in screening, prevention, and treatment services of behavioral health issues in children. The division or the managed care organization shall accept and reimburse claims for screening, prevention, and treatment using an at-risk diagnosis. b. The department may take any administrative action necessary to effectuate the provisions of this section, including modifying or amending any applicable contract or promulgating, amending, or repealing any guidance, guidelines, or rules, which rules or amendments thereto shall be effective immediately upon filing with the Office of Administrative Law for a period not to exceed 12 months, and may, thereafter, be amended, adopted or readopted in accordance with the provisions of the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). c. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program. d. As used in this section: "At-risk diagnosis" means a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, when billing for services, without a formal mental health diagnosis, for children who are 18 years of age or younger. "Screening, prevention, and treatment" includes the prevention and early identification of mental health conditions, without a behavioral health diagnosis. Services may include, but are not limited to, screenings and individual, group, and family psychotherapy to individuals with potential mental health disorders not yet diagnosed. 5. This act shall take effect on the 90th day next following enactment and shall apply to policies, plans, and contracts delivered, executed, issued, or renewed on or after that date. STATEMENT This bill requires health insurers (health, hospital and medical service corporations, commercial individual and group health 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) and the State Medicaid program to provide benefits to any covered person for medical expenses incurred relating to screening, prevention, and treatment of behavioral health issues in children. Carriers and the State Medicaid program are required to accept and reimburse claims for screening, prevention, and treatment using an at-risk diagnosis. As used in the bill, an "at-risk diagnosis" is a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood when billing for services, without a formal mental health diagnosis for children who are 18 years of age or younger.
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47	47	An Act concerning insurance and Medicaid coverage for preventive care for developmental and behavioral needs in children and supplementing various parts of the statutory law.
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51	51	Be It Enacted by the Senate and General Assembly of the State of New Jersey:
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55	55	1. a. A carrier that offers a health benefits plan in this State shall provide benefits to any subscriber for medical expenses incurred in screening, prevention, and treatment services of behavioral health issues in children. A carrier shall accept and reimburse claims for screening, prevention, and treatment using an at-risk diagnosis.
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57	57	b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract.
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59	59	c. As used in this section:
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61	61	"At-risk diagnosis" means a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, when billing for services, without a formal mental health diagnosis, for children who are 18 years of age or younger.
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63	63	"Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State.
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65	65	"Screening, prevention, and treatment" includes the prevention and early identification of mental health conditions, without a behavioral health diagnosis. Services may include, but are not limited to, screenings and individual, group, and family psychotherapy to individuals with potential mental health disorders not yet diagnosed.
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69	69	2. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person for medical expenses incurred in the screening, prevention, and treatment services of behavioral health issues in children. The contract shall allow for acceptance and reimbursement of claims for screening, prevention, and treatment using an at-risk diagnosis.
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71	71	b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract.
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73	73	c. As used in this section:
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75	75	"At-risk diagnosis" means a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, when billing for services, without a formal mental health diagnosis, for children who are 18 years of age or younger.
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77	77	"Screening, prevention, and treatment" includes the prevention and early identification of mental health conditions, without a behavioral health diagnosis. Services may include, but are not limited to, screenings and individual, group, and family psychotherapy to individuals with potential mental health disorders not yet diagnosed.
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81	81	3. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person for medical expenses incurred in the screening, prevention, and treatment services of behavioral health issues in children. The contract shall allow for acceptance and reimbursement of claims for screening, prevention, and treatment using an at-risk diagnosis.
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83	83	b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract.
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85	85	c. As used in this section:
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87	87	"At-risk diagnosis" means a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, when billing for services, without a formal mental health diagnosis, for children who are 18 years of age or younger.
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89	89	"Screening, prevention, and treatment" includes the prevention and early identification of mental health conditions, without a behavioral health diagnosis. Services may include, but are not limited to, screenings and individual, group, and family psychotherapy to individuals with potential mental health disorders not yet diagnosed.
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93	93	4. a. Notwithstanding any law, rule, or regulation to the contrary, the Division of Medical Assistance and Health Services within the Department of Human Services, or a managed care organization that contracts with the division to provide medical services to beneficiaries of the NJ FamilyCare program, shall ensure the provision of benefits for medical expenses incurred in screening, prevention, and treatment services of behavioral health issues in children. The division or the managed care organization shall accept and reimburse claims for screening, prevention, and treatment using an at-risk diagnosis.
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95	95	b. The department may take any administrative action necessary to effectuate the provisions of this section, including modifying or amending any applicable contract or promulgating, amending, or repealing any guidance, guidelines, or rules, which rules or amendments thereto shall be effective immediately upon filing with the Office of Administrative Law for a period not to exceed 12 months, and may, thereafter, be amended, adopted or readopted in accordance with the provisions of the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).
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97	97	c. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
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99	99	d. As used in this section:
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101	101	"At-risk diagnosis" means a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, when billing for services, without a formal mental health diagnosis, for children who are 18 years of age or younger.
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103	103	"Screening, prevention, and treatment" includes the prevention and early identification of mental health conditions, without a behavioral health diagnosis. Services may include, but are not limited to, screenings and individual, group, and family psychotherapy to individuals with potential mental health disorders not yet diagnosed.
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105	105	5. This act shall take effect on the 90th day next following enactment and shall apply to policies, plans, and contracts delivered, executed, issued, or renewed on or after that date.
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111	111	STATEMENT
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115	115	This bill requires health insurers (health, hospital and medical service corporations, commercial individual and group health 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) and the State Medicaid program to provide benefits to any covered person for medical expenses incurred relating to screening, prevention, and treatment of behavioral health issues in children. Carriers and the State Medicaid program are required to accept and reimburse claims for screening, prevention, and treatment using an at-risk diagnosis.
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117	117	As used in the bill, an "at-risk diagnosis" is a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and instead, promotes preventive care. Allowing providers to bill for an "at-risk diagnosis" authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood when billing for services, without a formal mental health diagnosis for children who are 18 years of age or younger.