Sponsored by:
Assemblyman VINCENT PRIETO
District 32 (Bergen and Hudson)
Assemblyman JOSEPH J. ROBERTS, JR.
District 5 (Camden and Gloucester)
Assemblywoman JOAN M. VOSS
District 38 (Bergen)
Co-Sponsored by:
Assemblymen Ramos, Biondi, Assemblywomen Pou, Vainieri Huttle, Assemblymen Coutinho, Scalera, Diegnan, Assemblywomen Wagner, Lampitt and Jasey
SYNOPSIS
Requires health benefits coverage for certain therapies for the treatment of certain autism disorders.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health benefits coverage for certain therapies for the treatment of certain autism disorders and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding any other provision of law to the contrary, every individual and group hospital service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall, when the covered person's primary diagnosis is Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified or Rhett's Syndrome, provide coverage for expenses incurred for the following treatments when prescribed as medically necessary by the covered person's physician: physical therapy; speech therapy; occupational therapy; and evidence-based behavioral interventions.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.
2. Notwithstanding any other provision of law to the contrary, every individual and group medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall, when the covered person's primary diagnosis is Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified or Rhett's Syndrome, provide coverage for expenses incurred for the following treatments when prescribed as medically necessary by the covered person's physician: physical therapy; speech therapy; occupational therapy; and evidence-based behavioral interventions.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.
3. Notwithstanding any other provision of law to the contrary, every individual and group health service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall, when the covered person's primary diagnosis is Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified or Rhett's Syndrome, provide coverage for expenses incurred for the following treatments when prescribed as medically necessary by the covered person's physician: physical therapy; speech therapy; occupational therapy; and evidence-based behavioral interventions.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.
4. Notwithstanding any other provision of law to the contrary, every individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall, when the covered person's primary diagnosis is Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified or Rhett's Syndrome, provide coverage for expenses incurred for the following treatments when prescribed as medically necessary by the covered person's physician: physical therapy; speech therapy; occupational therapy; and evidence-based behavioral interventions.
The benefits shall be provided to the same extent as for any other medical condition under the policy.
The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
5. Notwithstanding any other provision of law to the contrary, every group health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to chapter 27 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall, when the covered person's primary diagnosis is Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified or Rhett's Syndrome, provide coverage for expenses incurred for the following treatments when prescribed as medically necessary by the covered person's physician: physical therapy; speech therapy; occupational therapy; and evidence-based behavioral interventions.
The benefits shall be provided to the same extent as for any other medical condition under the policy.
The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
6. Notwithstanding any other provision of law to the contrary, an individual health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall, when the covered person's primary diagnosis is Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified or Rhett's Syndrome, provide coverage for expenses incurred for the following treatments when prescribed as medically necessary by the covered person's physician: physical therapy; speech therapy; occupational therapy; and evidence-based behavioral interventions.
The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
The provisions of this section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
7. Notwithstanding any other provision of law to the contrary, a small employer health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall, when the covered person's primary diagnosis is Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified or Rhett's Syndrome, provide coverage for expenses incurred for the following treatments when prescribed as medically necessary by the covered person's physician: physical therapy; speech therapy; occupational therapy; and evidence-based behavioral interventions.
The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
The provisions of this section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
8. Notwithstanding any other provision of law to the contrary, a health maintenance organization enrollee agreement that provides health care services and is delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Health and Senior Services, on or after the effective date of this act, shall, when the covered person's primary diagnosis is Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified or Rhett's Syndrome, provide coverage for expenses incurred for the following treatments when prescribed as medically necessary by the covered person's physician: physical therapy; speech therapy; occupational therapy; and evidence-based behavioral interventions.
The health care services shall be provided to the same extent as for any other medical condition under the enrollee agreement.
The provisions of this section shall apply to those enrollee agreements in which the health maintenance organization has reserved the right to change the premium.
9. Notwithstanding any other provision of law to the contrary, the State Health Benefits Commission shall, when the covered person's primary diagnosis is Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified or Rhett's Syndrome, provide coverage for expenses incurred for the following treatments when prescribed as medically necessary by the covered person's physician: physical therapy; speech therapy; occupational therapy; and evidence-based behavioral interventions.
These benefits shall be provided to the same extent as for any other medical condition under the program.
10. This act shall take effect on the 90th day after enactment.
STATEMENT
This bill requires health insurers to provide health benefits coverage for expenses incurred for certain treatments when prescribed as medically necessary by the covered person's physician upon a diagnosis of autism. When the covered person's primary diagnosis is Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified or Rhett's Syndrome, the covered treatments would include: physical therapy; speech therapy; occupational therapy; and evidence-based behavioral interventions. Insurers covered by the bill include: 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; and the State Health Benefits Program.