Bill Text: NJ A2008 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires health insurers that cover speech therapy and SHBP to provide coverage for certain services.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2010-02-08 - Introduced, Referred to Assembly Health and Senior Services Committee [A2008 Detail]
Download: New_Jersey-2010-A2008-Introduced.html
Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington and Camden)
Co-Sponsored by:
Assemblywoman Voss and Assemblyman McKeon
SYNOPSIS
Requires health insurers that cover speech therapy and SHBP to provide coverage for certain services.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health benefits coverage for speech therapy 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 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.368 (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, which provides coverage for audiology and speech-language pathology services, shall provide coverage for expenses incurred for audiology and speech-language pathology services provided to a covered person that are determined by the covered person's treating physician to be necessary to:
(1) prevent or ameliorate the physical or developmental effects of an illness, condition, injury, or disability in speech, communication, feeding, or swallowing function;
(2) restore previously attained speech, communication, feeding, or swallowing function;
(3) address a medically or neurologically based etiology that has impaired or would congenitally impair speech, communication, feeding or swallowing function, including, but not limited to, hearing impairment, cleft palate, stuttering, and voice disorders; or
(4) address the interruption of a typically developing process, including, but not limited to, the acquisition of functional speech, communication, feeding, or swallowing skills.
b. The benefits shall be provided to the same extent as for any other condition under the contract.
c. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. a. A 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, which provides coverage for audiology and speech-language pathology services, shall provide coverage for expenses incurred for audiology and speech-language pathology services provided to a covered person that are determined by the covered person's treating physician to be necessary to:
(1) prevent or ameliorate the physical or developmental effects of an illness, condition, injury, or disability in speech, communication, feeding, or swallowing function;
(2) restore previously attained speech, communication, feeding, or swallowing function;
(3) address a medically or neurologically based etiology that has impaired or would congenitally impair speech, communication, feeding or swallowing function, including, but not limited to, hearing impairment, cleft palate, stuttering, and voice disorders; or
(4) address the interruption of a typically developing process, including, but not limited to, the acquisition of functional speech, communication, feeding, or swallowing skills.
b. The benefits shall be provided to the same extent as for any other condition under the contract.
c. This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. a. A 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, which provides coverage for audiology and speech-language pathology services, shall provide coverage for expenses incurred for audiology and speech-language pathology services provided to a covered person that are determined by the covered person's treating physician to be necessary to:
(1) prevent or ameliorate the physical or developmental effects of an illness, condition, injury, or disability in speech, communication, feeding, or swallowing function;
(2) restore previously attained speech, communication, feeding, or swallowing function;
(3) address a medically or neurologically based etiology that has impaired or would congenitally impair speech, communication, feeding or swallowing function, including, but not limited to, hearing impairment, cleft palate, stuttering, and voice disorders; or
(4) address the interruption of a typically developing process, including, but not limited to, the acquisition of functional speech, communication, feeding, or swallowing skills.
b. The benefits shall be provided to the same extent as for any other condition under the contract.
c. This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. a. An individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 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, which provides coverage for audiology and speech-language pathology services, shall provide coverage for expenses incurred for audiology and speech-language pathology services provided to a covered person that are determined by the covered person's treating physician to be necessary to:
(1) prevent or ameliorate the physical or developmental effects of an illness, condition, injury, or disability in speech, communication, feeding, or swallowing function;
(2) restore previously attained speech, communication, feeding, or swallowing function;
(3) address a medically or neurologically based etiology that has impaired or would congenitally impair speech, communication, feeding or swallowing function, including, but not limited to, hearing impairment, cleft palate, stuttering, and voice disorders; or
(4) address the interruption of a typically developing process, including, but not limited to, the acquisition of functional speech, communication, feeding, or swallowing skills.
b. The benefits shall be provided to the same extent as for any other condition under the policy.
c. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
5. a. A group health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 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, which provides coverage for audiology and speech-language pathology services, shall provide coverage for expenses incurred for audiology and speech-language pathology services provided to a covered person that are determined by the covered person's treating physician to be necessary to:
(1) prevent or ameliorate the physical or developmental effects of an illness, condition, injury, or disability in speech, communication, feeding, or swallowing function;
(2) restore previously attained speech, communication, feeding, or swallowing function;
(3) address a medically or neurologically based etiology that has impaired or would congenitally impair speech, communication, feeding or swallowing function, including, but not limited to, hearing impairment, cleft palate, stuttering, and voice disorders; or
(4) address the interruption of a typically developing process, including, but not limited to, the acquisition of functional speech, communication, feeding, or swallowing skills.
b. The benefits shall be provided to the same extent as for any other condition under the policy.
c. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
6. a. An individual health benefits plan that is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), on or after the effective date of this act, which provides coverage for audiology and speech-language pathology services, shall provide coverage for expenses incurred for audiology and speech-language pathology services provided to a covered person that are determined by the covered person's treating physician to be necessary to:
(1) prevent or ameliorate the physical or developmental effects of an illness, condition, injury, or disability in speech, communication, feeding, or swallowing function;
(2) restore previously attained speech, communication, feeding, or swallowing function;
(3) address a medically or neurologically based etiology that has impaired or would congenitally impair speech, communication, feeding or swallowing function, including, but not limited to, hearing impairment, cleft palate, stuttering, and voice disorders; or
(4) address the interruption of a typically developing process, including, but not limited to, the acquisition of functional speech, communication, feeding, or swallowing skills.
b. The benefits shall be provided to the same extent as for any other condition under the health benefits plan.
c. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
7. a. A small employer health benefits plan that is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), on or after the effective date of this act, which provides coverage for audiology and speech-language pathology services, shall provide coverage for expenses incurred for audiology and speech-language pathology services provided to a covered person that are determined by the covered person's treating physician to be necessary to:
(1) prevent or ameliorate the physical or developmental effects of an illness, condition, injury, or disability in speech, communication, feeding, or swallowing function;
(2) restore previously attained speech, communication, feeding, or swallowing function;
(3) address a medically or neurologically based etiology that has impaired or would congenitally impair speech, communication, feeding or swallowing function, including, but not limited to, hearing impairment, cleft palate, stuttering, and voice disorders; or
(4) address the interruption of a typically developing process, including, but not limited to, the acquisition of functional speech, communication, feeding, or swallowing skills.
b. The benefits shall be provided to the same extent as for any other condition under the health benefits plan.
c. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
8. a. A health maintenance organization contract for health care services that 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 Banking and Insurance, on or after the effective date of this act, which provides health care services for audiology and speech-language pathology, shall provide health care services for expenses incurred for audiology and speech-language pathology services provided to a covered person that are determined by the covered person's treating physician to be necessary to:
(1) prevent or ameliorate the physical or developmental effects of an illness, condition, injury, or disability in speech, communication, feeding, or swallowing function;
(2) restore previously attained speech, communication, feeding, or swallowing function;
(3) address a medically or neurologically based etiology that has impaired or would congenitally impair speech, communication, feeding or swallowing function, including, but not limited to, hearing impairment, cleft palate, stuttering, and voice disorders; or
(4) address the interruption of a typically developing process, including, but not limited to, the acquisition of functional speech, communication, feeding, or swallowing skills.
b. The health care services shall be provided to the same extent as for any other condition under the contract.
c. This section shall apply to those contracts for health care services under which the right to change the schedule of charges for enrollee coverage is reserved.
9. The State Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses incurred for audiology and speech-language pathology services provided to a covered person that are determined by the covered person's treating physician to be necessary to:
(1) prevent or ameliorate the physical or developmental effects of an illness, condition, injury, or disability in speech, communication, feeding, or swallowing function;
(2) restore previously attained speech, communication, feeding, or swallowing function;
(3) address a medically or neurologically based etiology that has impaired or would congenitally impair speech, communication, feeding or swallowing function, including, but not limited to, hearing impairment, cleft palate, stuttering, and voice disorders; or
(4) address the interruption of a typically developing process, including, but not limited to, the acquisition of functional speech, communication, feeding, or swallowing skills.
10. This act shall take effect on the 60th day after enactment and shall apply to all contracts and policies issued on or after the effective date.
STATEMENT
This bill requires health insurance carriers (hospital, medical and health service corporations, individual, small employer and larger group commercial insurers, and health maintenance organizations) that provide coverage for audiology and speech-language pathology services, and also the State Health Benefits Program, to provide coverage for expenses incurred for certain audiology and speech-language pathology services that are provided to a covered person.
The covered services must be determined by the covered person's treating physician to be necessary to:
· prevent or ameliorate the physical or developmental effects of an illness, condition, injury, or disability in speech, communication, feeding, or swallowing function;
· restore previously attained speech, communication, feeding, or swallowing function;
· address a medically or neurologically based etiology that has impaired or would congenitally impair speech, communication, feeding or swallowing function, including, but not limited to, hearing impairment, cleft palate, stuttering, and voice disorders; or
· address the interruption of a typically developing process, including, but not limited to, the acquisition of functional speech, communication, feeding, or swallowing skills.
The bill takes effect on the 60th day after enactment and applies to all contracts and policies issued on or after the effective date.
