Would Require Public Health Insurance Providers to Cover Mental and Nervous Disorders, Alcohol and Substance Abuse as Any Other Medical Illness
TRENTON – A bill sponsored by Senate Health, Human Services and Senior Citizens Committee Chairman, Senator Joseph F. Vitale, and Health Committee member, Senator Bob Gordon, which would require public health insurance providers to cover the treatment of mental and nervous disorders, alcoholism and substance abuse under the same terms and conditions as other medical illnesses was approved by the Health Committee today by a vote of 8-0, with two abstentions.
“Long ago, we established that mental health disorders and drug and alcohol dependencies should be treated as diseases, but insurance providers in New Jersey and throughout the country have failed to get with the times,” said Senator Vitale, D-Middlesex. “By requiring the two largest health plans for public employees to provide parity coverage for mental illnesses and alcohol and substance abuse disorders, we can make a statement that insurers need to update their policies.”
“This bill would apply medical criteria, rather than arbitrary insurance criteria, to the treatment of all mental health disorders and substance and alcohol abuse disorders,” said Senator Gordon, D-Bergen and Passaic. “This is about providing access to treatment for individuals suffering from alcohol and substance abuse and mental health problems, such as post-traumatic stress disorder, that may not have a biological catalyst. It’s about doing right by the people we insure through the State Health Benefits Plan and the School Employee Health Benefits Program, and it’s about putting medical issues on an even ground when it comes to the terms of coverage.”
The bill, S-1253, would expand mandated health insurance coverage for the treatment of mental and nervous disorders and substance and alcohol abuse disorders under the State Health Benefits Plan (SHBP) and the School Employee Health Benefits Program (SEHBP).
The bill would require that insurance providers participating in the public health insurance plans provide coverage for all mental and nervous disorders included in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, regardless of whether or not the disease is biologically-based or not, under the same terms and conditions as provided for any other illness under the health insurance policy. Current law only requires that a health insurance contract provide coverage for biologically-based mental illnesses, such as bipolar disorder or schizophrenia, as opposed to non-biologically-based mental illnesses, such as Post Traumatic Stress Disorder (PTSD).
The bill would also require parity when it comes to the treatment of alcoholism and other substance-use disorders under the same terms and conditions applied to other diseases or illnesses.
“This is about making sure that public employees covered under the SHBP and the SEHBP have access to the treatment and care they need to get and stay healthy,” said Senator Gordon. “We shouldn’t draw arbitrary distinctions between the causes of a mental health disorder – but rather recognize the severe, harmful impact that these illnesses can have on the people being affected. This bill updates our two largest public employee health plans and ensures that we serve as an example for private insurers throughout the State to follow.”
The bill sponsors noted that the change in law is consistent with other federally-mandated mental disorder and substance abuse parity laws, including the Affordable Care Act (ACA) and the Mental Health Parity Act of 1996 and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Under these three laws, if an insurer covers both mental health and medical and surgical benefits, they are required to do so in compliance with parity requirements similar to what’s in Senator Vitale’s bill.
Both lawmakers added that since the recent tragic shooting in Newtown, Connecticut, there has been an increased call for better mental health coverage for individuals suffering from mental illness. During a recent media interview, Governor Chris Christie noted that the “stigma about mental illness treatment in this country,” serves as contributing factor in gun violence. Today at a news conference in Bradley Beach, Governor Christie said, “We need to have a more effective way to deal with the mentally ill.”
“I agree with the Governor that the stigma regarding mental illness must be overcome, but we need to also be concerned about individuals not having the ability to access the services they need,” said Senator Vitale. “Certainly, we have to do a better job of making mental health treatment and substance abuse treatment available to those in need. The most effective way to ‘deal with the mentally ill’ is to provide access to treatment options. As two of the largest health benefits systems in New Jersey, the SHBP and the SEHBP should take the lead and provide equal coverage for all medically-diagnosable diseases under the same terms as any other illness.”
The bill now heads to the Senate Budget and Appropriations Committee for review, before going to the full Senate for consideration.