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On Monday, January 30, 2017, legislation incorporating Governor Christie’s proposals to expand and enhance health benefits coverage for drug addiction treatment, and other related measures, is scheduled for committee hearings:

Senate Health, Human Services & Senior Citizens Committee: 9:00 a.m., 1st Floor, Committee Room 4

  • S-3 (Vitale, Sweeney) – Requires health insurance coverage for treatment of substance use disorders; places certain restrictions on the prescription of opioid and certain other drugs; concerns continuing education related thereto.

The text for A-3 and S-3 is not yet available, but NJBIA has learned that the bills will include some form of the following provisions:

  • Will apply to commercial market and all public employee health benefits plans, but not to NJ Medicaid program.
  • Includes 5-day prescribing restriction on opioid medications.
  • Benefits for inpatient and outpatient treatment are unlimited, for first 180 days per calendar year, at in-network facilities, and services must be prescribed by a licensed health care provider.
  • No prior authorization or other type of utilization management (UM) if provider determines treatment is medically necessary.
  • From day 29 forward, insurer can review need for continued treatment every three weeks.
  • After first 180 days of treatment, insurer can require medical necessity review, prior authorization, and/or other UM processes.
  • Initial 180 days are counted on in-patient basis; unused inpatient days can be exchanged for two outpatient days/provider visits.
  • Attorney General authorized to investigate violations, including fraud and abuse.

Assembly Financial Institutions & Insurance Committee: 10:00 a.m., 4th Floor, Committee Room 16

  • A-3 (Prieto, Bramnick, Conaway, Rible) – Requires health insurance carriers, SHBP, and SEHBP to cover treatment for substance use disorders and places certain restrictions on opioid and certain other prescription drugs.
  • A-4205 (Lampitt, Vainieri Huttle, Benson) – Requires continued coverage of prescription drugs for certain medical conditions.
  • A-4498 (Coughlin, Vainieri Huttle, Lampitt, Singleton) – Expands health insurance coverage for behavioral health care services and enhances enforcement and oversight of mental health parity laws.

Senate Commerce Committee: 1:00 p.m., 1st Floor, Committee Room 6

  • S-2703 (Lesniak, Pou) – Restricts medical expense coverage for opioid drugs unless prescribing health care professional follows certain guidelines.

Please contact me with any questions or comments.

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