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Legislation expanding health insurance coverage for substance abuse and opioid drug addiction received final legislative approval on February 15th, and was signed into law by Gov. Chris Christie. The Governor had announced the addiction recovery reforms during his 2017 State of the State address in January, and it was passed in a month by the Legislature.

The law extends the length of in-patient and out-patient rehabilitation programs that insurance must cover and pay for under health benefits plans. While drug addiction is clearly a major problem in New Jersey, NJBIA has raised concerns about the cost of the expanded coverage, particularly the impact it will have on premiums and the ability of business owners to provide health benefits to their employees. To better understand the overall cost impact of the bill, NJBIA had requested that it be reviewed by the legislative budget committees. See NJBIA’s statement on A-3 (Prieto, Bramnick, Conaway, Rible, Lagana, McKeon, Sumter, Benson, Vainieri Huttle, O’Scanlon, Jones, Mukherji, Wimberly)/ S-3 (Vitale, Sweeney, Kean) here.

This new law makes New Jersey the only state in which people with insurance are guaranteed coverage and cannot be retroactively charged for six months of necessary addiction treatment, and establishes the country’s strongest maximum limit of five days’ worth of prescribed opioid pills to keep them out of the hands of children and the vulnerable.

Under the new law:

  • Insurance coverage for treatment of a substance abuse disorder will be required and waiting periods are eliminated;
  • People diagnosed with a substance abuse disorder will have covered treatment for 180 days, including long-term out-patient treatment and insurers may not impose review or utilization management (UM) requirements;
  • Insurers may not impose prior approval restrictions for covered medication-assisted treatments;
  • Health care providers cannot impose pre-payment obligations, and instead, patients will only be required to pay their copayment, deductible or co-insurance for their treatment;
  • Treatment for substance abuse disorders must be covered by the insurer to the same extent as any other covered medical condition without increased copayments, deductibles or co-insurance;
  • A five-day limit for an initial opioid prescription is imposed, to prevent inadvertent addiction to opioid medications; and
  • The Attorney General will monitor this system to prevent waste, fraud or abuse, and to ensure providers are not improperly treating patients or filling beds that could be used by others in need of treatment.

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