Sponsored by:
Senator JAMES BEACH
District 6 (Burlington and Camden)
Senator M. TERESA RUIZ
District 29 (Essex and Hudson)
Co-Sponsored by:
Senators Johnson and Corrado
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 subscribers 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 subscribers 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 subscribers 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 insureds 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 deductib