Would Require Public Health Insurance Providers to Cover Mental and Nervous Disorders, Alcohol and Substance Abuse as Any Other Medical Illness
A bipartisan bill sponsored by Senators Joseph F. Vitale, Bob Gordon and Diane Allen which would require public health insurance providers to cover the treatment of mental and nervous disorders, alcoholism and substance abuse under the same terms and conditions as other medical illnesses was approved today by the full Senate.
“Substance abuse and other mental disorders are illnesses just like heart disease or cancer, yet our healthcare system tends to discriminate against mental illness when it comes to covering treatment,” said Allen (R- Burlington). “The consequences of failing to provide adequate care and treatment to those suffering from these diseases can be disastrous for patients and their families and unfairly attaches a stigma to very real, painful, and debilitating conditions. This legislation ends this sort of discrimination in our state health benefits plans.”
The bill, S-1253, would expand mandated health insurance coverage for the treatment of mental and nervous disorders and substance and alcohol abuse disorders under the State Health Benefits Plan (SHBP) and the School Employee Health Benefits Program (SEHBP).
“It has long been established that mental health disorders and drug and alcohol dependencies are medical diseases, but unfortunately New Jersey’s health insurance companies have not caught up and therefore do not always cover the cost of treatment,” said Senator Vitale, D-Middlesex. “By ensuring that the state’s two largest health care plans – the State Health Benefits Plan and the School Employee Health Benefits Program – cover these mental health and dependency disorders, we are making a statement that all insures need to update their policies.”
The bill would require that insurance providers participating in the public health insurance plans provide coverage for all mental and nervous disorders included in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, regardless of whether or not the disease is biologically-based or not, under the same terms and conditions as provided for any other illness under the health insurance policy. Current law only requires that a health insurance contract provide coverage for biologically-based mental illnesses, such as bipolar disorder or schizophrenia, as opposed to non-biologically-based mental illnesses, such as Post Traumatic Stress Disorder (PTSD).
“This bill would ensure that medical criteria rather than arbitrary insurance criteria are used when determining whether someone with a mental health disease or disorder or a substance abuse addiction are able to access treatment,” said Senator Gordon, D-Bergen and Passaic. “It is about ensuring equal footing in terms of treatment for all who are ill whether it is a physical illness or an addiction or mental health disorder such as post traumatic stress disorder.”
The bill would also require parity when it comes to the treatment of alcoholism and other substance-use disorders under the same terms and conditions applied to other diseases or illnesses.
The bill sponsors noted that the change in law is consistent with other federally-mandated mental disorder and substance abuse parity laws, including the Affordable Care Act (ACA) and the Mental Health Parity Act of 1996 and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Under these three laws, if an insurer covers both mental health and medical and surgical benefits, they are required to do so in compliance with parity requirements similar to what’s in Senators Vitale, Gordon and Allen’s bill.
The bill was approved with a vote of 30-6. It now heads to the General Assembly.