Bill Text: NJ A5133 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires health insurance and Medicaid coverage for the treatment of stuttering.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced) 2024-12-16 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A5133 Detail]
Download: New_Jersey-2024-A5133-Introduced.html
Sponsored by:
Assemblywoman ALIXON COLLAZOS-GILL
District 27 (Essex and Passaic)
Assemblywoman ANDREA KATZ
District 8 (Atlantic and Burlington)
Assemblywoman SHAMA A. HAIDER
District 37 (Bergen)
Co-Sponsored by:
Assemblywoman Park
SYNOPSIS
Requires health insurance and Medicaid coverage for the treatment of stuttering.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning insurance and Medicaid coverage for the treatment of stuttering 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 or medical expense benefits and is delivered, issued, executed or renewed in this State, 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 provide benefits to any subscriber for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the subscriber's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract, except that no deductible, coinsurance, copayment, annual benefit limit, or any other cost-sharing requirement shall be imposed.
c. The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
d. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
2. a. A medical service corporation contract that provides hospital or 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 provide benefits to any subscriber for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the subscriber's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract, except that no deductible, coinsurance, copayment, annual benefit limit, or any other cost-sharing requirement shall be imposed.
c. The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
d. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
3. a. A health service corporation contract that provides hospital or 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 al.), 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 provide benefits to any subscriber for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the subscriber's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract, except that no deductible, coinsurance, copayment, annual benefit limit, or any other cost-sharing requirement shall be imposed.
c. The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
d. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech therapy"
means speech therapy that helps a person restore or improve skills and
functioning for daily living that have been lost or impaired.
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 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 provide benefits to any insured for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the insured's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the policy, except that no deductible, coinsurance, copayment, annual benefit limit, or any other cost-sharing requirement shall be imposed.
c. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
d. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
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 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 provide benefits to any insured for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the insured's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the policy, except that no deductible, coinsurance, copayment, annual benefit limit, or any other cost-sharing requirement shall be imposed.
c. This section shall
apply to those policies in which the insurer has reserved the right to change
the premium.
d. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
6. a. 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 provide benefits to any covered person for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the covered person's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the health benefits plan, except that no deductible, coinsurance, copayment, annual benefit limit, or any other cost-sharing requirement shall be imposed.
c. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
d. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
7. a. 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 provide benefits to any covered person for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the covered person's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the health benefits plan, except that no deductible, coinsurance, copayment, annual benefit limit, or any other cost-sharing requirement shall be imposed.
c. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
d. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
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, shall provide benefits to any enrollee for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the enrollee's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract, except that no deductible, coinsurance, copayment, annual benefit limit, or any other cost-sharing requirement shall be imposed.
c. This section shall apply to those contracts for health care services under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.
d. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech
therapy" means speech therapy that helps a person restore or improve
skills and functioning for daily living that have been lost or impaired.
9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the covered person's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract, except that no deductible, coinsurance, copayment, annual benefit limit, or any other cost-sharing requirement shall be imposed.
c. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
10. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the covered person's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract, except that no deductible, coinsurance, copayment, annual benefit limit, or any other cost-sharing requirement shall be imposed.
c. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech
therapy" means speech therapy that helps a person restore or improve
skills and functioning for daily living that have been lost or impaired.
11. a. Notwithstanding any State law or regulation to the contrary, the Department of Human Services shall provide benefits to persons served under the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy, as determined medically necessary by the person's medical doctor. The benefits shall be provided whether the services are delivered in-person or through telemedicine or telehealth. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. Any copayment, coinsurance, deductible, or annual benefit limit that may be required pursuant to the contract for services covered pursuant to subsection a. of this section shall not apply.
c. The department may take any administrative action necessary to effectuate the provisions of this section, including modifying or amending any applicable contract or promulgating, amending, or repealing any guidance, guidelines, or rules, which rules or amendments thereto shall be effective immediately upon filing with the Office of Administrative Law for a period not to exceed 12 months, and may, thereafter, be amended, adopted or readopted in accordance with the provisions of the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).
d. As used in this section:
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living.
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
12. This act shall take effect on the 90th day next following enactment and shall apply to policies, plans, and contracts delivered, executed, issued, or renewed on or after that date.
STATEMENT
This bill requires health insurers (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, the State Health Benefits Program, and the School Employees' Health Benefits Program) and the State Medicaid program to provide coverage for medical expenses incurred in the treatment of stuttering, including habilitative speech therapy and rehabilitative speech therapy. Whether treatment is a medical necessity is to be determined by the covered person's medical doctor.
The bill requires coverage to be provided whether the services are delivered in-person or through telemedicine or telehealth, without the imposition of any prior authorization or other utilization management requirements, and without cost-sharing.
Pursuant to the bill, "habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living; and "rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
