Lawmakers OK insurance mandate for drug rehab treatment

Senate and Assembly panels on Monday advanced a bill that would implement the broad strokes of two proposals Gov. Chris Christie made earlier this month during a State of the State address that focused on “the crisis of drug addiction.”

The bipartisan legislation would mandate insurance coverage for the first 28 days of inpatient or intensive outpatient drug rehabilitation treatment for any patient whose doctor deems it medically necessary. It would also mandate up to six months of coverage for regular outpatient treatment. The new requirements, if the measure becomes law, would apply to the roughly 30 percent of New Jersey residents with insurance plans subject to state regulation.

Another provision would limit any initial prescription a doctor writes for opioid-based painkillers to a five-day supply. Some prescriptions currently provide patients with up to a 30-day supply of opioid drugs, which can lead to addiction even if used properly.

“It has been ironic, if not tragic, that while we provide for prescription drug access, we have historically failed to provide addiction treatment to those same families,” former Gov. James E. McGreevey, who works for a non-profit substance abuse and mental health treatment program in Hudson and Essex counties, told a Senate panel Monday.

“For those clients and their families who have insurance and who have suffered the painful anguish of prison and addiction, the bill you have crafted offers a critical pathway to a healthier, sober place,” McGreevey said.

Despite concerns raised by some of the state's largest insurance companies and other groups, the bill passed 7-0 in the Senate Health, Human Services and Senior Citizens Committee and 10-0 with one abstention in the Assembly Financial Institutions and Insurance Committee. Ward Sanders, president of the New Jersey Association of Health Plans, warned that the coverage mandates would drive up premiums for people covered by state-regulated plans, which includes state employees and many local government workers and teachers, but ultimately said that his group wouldn't oppose the bill.

The measure now heads to the full Senate and Assembly for votes, which are likely to occur next month, sponsors said.

The bill would accomplish part of what Christie called for in his State of the State address earlier this month.

During his State of the State address on Jan. 10, Christie challenged the Legislature to pass a law within 30 days mandating that “no citizen with health insurance can be denied coverage for the first six months of inpatient or outpatient drug rehabilitation treatment.”

Christie also said that the ability of doctors to write for prescriptions for a 30-day supply of opioid painkillers was “dangerous, ill-advised and absolutely unnecessary” and called for restricting the supply of such medicine to five days.​

The bill's requirement mandating an insurance company's coverage of inpatient and intensive outpatient treatment is less that what Christie called for, but the legislation is still the first of its kind in the country, according to the New Jersey Association of Health Plans.

Democratic Sen. Joseph Vitale of Middlesex County, a sponsor of the Senate version of the bill, said that the measure discussed Monday had the support of most lawmakers and of Christie himself.

“All the amendments we made to this bill, he supports,” Vitale said of Christie, whose office did not respond to a request for comment.

Under the bill, an insurance company must cover the first four weeks of inpatient or intensive outpatient drug rehabilitation treatment for any patient whose doctor deems it medically necessary. After 28 days, the company can order a review of the need for further treatment, Vitale said.

In addition, Vitale said, insurance companies would not be able to deny coverage for regular outpatient treatment for up to six months.

On the whole, he said, the bill empowers medical providers, such as doctors, hospitals or treatment facilities, to determine the course of treatment as opposed to insurance companies.

John Koufos, executive director of the non-profit New Jersey Reentry Corp., said the bill would allow for more continuity in a patient’s progression through different types of treatment and support programs.

“It gives organizations like us at Reentry the opportunity to set forth a services care plan, things like helping people remove warrants from municipal courts that may be looking for them, helping to find housing, helping them find food stamps,” Koufos said. “I think any insurance company that now on the front end has to pay out as a result of this bill may recoup on the back end when we’re finding less people on Medicaid, more people employed.”

Several members of the Assembly panel who considered the measure Monday said they hoped one day to expand the benefits of the bill to cover other groups of people, such as those on Medicaid, but agreed that the bill was a step in the right direction.

"I'm really heartened by the actions that were taken here today," said Assemblyman Craig Coughlin, D-Middlesex. "This is a critical piece of legislation."


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