This bill (NJ A2749) requires health insurance plans and Medicaid (NJ FamilyCare) to cover preventive behavioral health services for children under 18, including screenings and early intervention without requiring a formal mental health diagnosis. It mandates insurers to accept "at-risk diagnosis" billing - using Social Determinants of Health Z-codes instead of standard mental health codes - to pay for preventive care like therapy or screenings for children showing potential behavioral health needs. The coverage must be provided at the same level as other medical services, applying to all health plans sold in New Jersey, state employee health programs, and Medicaid managed care organizations. The bill was withdrawn after being approved as P.L.2025, c.369.
ACR 113 proposes a constitutional amendment to prohibit New Jersey health insurance carriers from denying coverage or excluding benefits based on a person's preexisting health condition. This would apply to private insurers, health maintenance organizations (HMOs), health service corporations, and state-run programs like the State Health Benefits Program. The amendment explicitly excludes self-funded employer health plans, which are governed by federal law. If approved by voters, it would become part of the state constitution, requiring insurers regulated by New Jersey to cover preexisting conditions without restrictions.
This New Jersey bill (A 2649) requires all health insurance plans sold in the state to cover annual mental health screenings as part of standard coverage for mental health conditions and substance use disorders. It applies to hospital service, medical service, and health service insurance contracts, mandating that insurers provide this coverage under the same terms and conditions as physical health care - meaning no stricter copays, deductibles, or review processes for mental health than for other medical services. The law aligns with federal parity requirements and specifically adds the annual screening as a covered benefit. This directly affects all health insurance companies operating in New Jersey and their policyholders, ensuring access to preventative mental health care without additional cost barriers.
This bill requires all health insurance policies in New Jersey - covering hospital, medical, and individual/group plans - to cover diagnosis and treatment for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). It mandates coverage for specific treatments including antibiotics, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy, as prescribed by a physician. Insurance plans must provide this coverage "to the same extent as for any other condition," meaning no additional cost-sharing or limitations beyond standard coverage. The requirement applies to all relevant policies renewed or issued in New Jersey after the bill's effective date.
This bill requires health insurance carriers to pay claims within 30 days for electronic submissions and 40 days for paper submissions if the claim is complete and meets coverage criteria. If a claim is incomplete (e.g., missing documentation or coding errors), carriers must notify healthcare providers within the same deadlines about what is needed. The bill also mandates standardized electronic claim forms, requires acknowledgment of electronic claim receipts within two business days, and prohibits carriers from delaying payment due to pending coordination of benefits information. These provisions directly affect insurers, healthcare providers, and patients by reducing claim processing delays.
This bill requires all health insurance carriers in New Jersey (including HMOs, health service corporations, and state program administrators) to cover medically necessary care for children and teens under 18 with "complex medical needs," as defined by the bill. Key provisions mandate that insurers must approve such coverage within three days of a doctor's written request and cannot require pre-approvals or precertification for covered services. "Complex medical needs" refers to serious conditions that are life-threatening, persistently disabling, emergent, or require specialized care to prevent serious harm. The law applies immediately to new health plans and directly affects families of young people with qualifying high-risk medical conditions.
This resolution urges Congress to pass the "Find It Early Act" (S. 1410), which would require all health insurance plans to cover additional breast cancer screenings - like ultrasounds and MRIs - without cost-sharing for women with dense breasts or other risk factors (such as family history). It directly affects women over 40 with dense breast tissue, who face higher cancer risks and may miss early detection due to mammogram limitations. The key provision would eliminate out-of-pocket costs for these supplemental screenings, improving access to early detection. The resolution emphasizes that early detection significantly boosts survival rates (99% when caught before spreading vs. 30% later). This is a procedural resolution, not a law, seeking to encourage federal action on insurance coverage.
This bill requires New Jersey health insurance companies and plans to cover medical services, equipment, and prescriptions for children and teens under 18 with diagnosed complex medical needs, as determined necessary by a licensed doctor. Key provisions include: insurers must approve covered benefits within three days of a doctor's written request and cannot require pre-approvals or precertification for services already covered under the plan. It defines "complex medical needs" as conditions that are life-threatening, persistently disabling, require specialized care, or involve high-risk procedures. The law applies to all health plans issued in New Jersey on or after its effective date.
This bill creates a new Medicaid Managed Care Organization (MCO) Oversight Program within New Jersey's Department of Human Services to monitor health insurance companies (MCOs) that manage Medicaid and NJ FamilyCare services. It requires MCOs to submit quarterly data on providers and beneficiaries, and mandates annual verification that 100% of providers listed in public directories are Medicaid-eligible. The oversight program will independently check 20% of provider contact information and directory accuracy each year to ensure MCOs meet standards for access to care. This directly affects MCOs and aims to improve care access for Medicaid and NJ FamilyCare enrollees, addressing past audit findings about inadequate provider networks.
This bill requires health insurance plans in New Jersey to cover medically necessary home care for disabled or elderly residents. It defines "disabled" as total permanent inability to work due to medical conditions and "elderly" as 65+ with mobility issues. Home care - covering preventative, primary, or specialty treatment provided in a patient's home - must be covered on the same terms as other medical services, excluding custodial care. Insurance contracts must include this coverage for all subscribers, effective upon the bill's enactment, without creating new network requirements.
