Statement to Senate No. 4018 — Senate Commerce Committee, State of New Jersey (May 22, 2025)

Summary

Statement to Senate No. 4018, dated May 22, 2025, from the Senate Commerce Committee of the State of New Jersey. The committee reports favorably on Senate Bill No. 4018, which requires health insurers and the State Medicaid program to provide benefits to any covered person for medical expenses incurred relating to screening, prevention, and treatment of behavioral health issues in children. The statement says carriers and the State Medicaid program are required to accept and reimburse claims using an at-risk diagnosis. It describes an at-risk diagnosis as one made after consideration of factors influencing behavioral health and child development that does not lead to a formal mental health diagnosis.

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     SENATE COMMERCE COMMITTEE

                   STATEMENT TO

                 SENATE, No. 4018

 STATE OF NEW JERSEY
                      DATED: MAY 22, 2025

    The Senate Commerce Committee reports favorably Senate Bill
No. 4018.
    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 benefits to any
covered person for medical expenses incurred relating to screening,
prevention, and treatment of behavioral health issues in children.
Carriers and the State Medicaid program are required to accept and
reimburse claims for screening, prevention, and treatment using an
at-risk diagnosis.
    As used in the bill, an “at-risk diagnosis” is a diagnosis made
after consideration of factors influencing behavioral health and
child development, such as family circumstances or life challenges,
that does not lead to a formal mental health diagnosis and instead,
promotes preventive care. Allowing providers to bill for an “at-risk
diagnosis” authorizes providers to use an alternative code, including
a Social Determinants of Health Z-code, to the codes of the
American Psychiatric Association Diagnostic and Statistical Manual
of Mental Disorders or the Diagnostic Classification of Mental
Health and Developmental Disorders of Infancy and Early
Childhood when billing for services, without a formal mental health
diagnosis for children who are 18 years of age or younger.


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