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

Summary

The Senate Commerce Committee of the State of New Jersey, in a statement dated May 22, 2025, reports favorably Senate Bill No. 4018. The bill requires health insurers and the State Medicaid program to cover screening, prevention and treatment of behavioral health issues in children. Carriers and the State Medicaid program must accept and reimburse claims using an "at-risk diagnosis," made after considering factors such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis. Providers may bill with an alternative code, including a Social Determinants of Health Z-code, without a formal mental health diagnosis for children 18 years of age or younger.

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Full text

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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