New Jersey's Massive Behavioral Health and Opioid Law goes Live in fewer than three Months

While Congress bickers over national health care initiatives, New Jersey is moving forward with huge changes to the way health care is practiced and reimbursed in the State. Governor Christie recently signed into law a new bill that overhauls the current insurance requirements for behavioral health and substance dependence coverage. The bill also severely limits a provider's power to prescribe opioid medications, and creates rules, documentation requirements, and educational requirements related to opioid prescription. Also included in the bill are unrelated provisions that better define the roles of advanced practice nurses.

The bill operates by amending several existing laws related to insurance, prescription practices, continuing education for health care providers, and related laws. The bill amends these laws to target three major areas: insurance coverage for behavioral health and substance dependence; prescription limits on opioids; and education requirements for the use and prescription of opioid medications.

With respect to insurance coverage, health insurers will be required to provide unlimited impatient and outpatient benefits for coverage of substance use disorders at in-network facilities. The first 180 days of treatment must be covered without pre-authorization and providers are prohibited from requiring prepayment. If no in-network treatment facility is "immediately available," the insurer must make an exception to their current network to ensure admission within 24 hours. This requirement is listed under the section covering both inpatient and outpatient care.

As far as impatient care goes, the insurer must cover the first 28 days without retrospective or concurrent review of medical necessity. The patient is entitled to remain in care without discharge until all of the internal and external appeals are exhausted.

Insurers are also required to provide prescription benefits for the treatment of substance use disorder without prior approval. No insurer can deny coverage for substance dependency treatment based on the presence of concurrent diagnoses, whether related or unrelated to the dependency diagnosis. Finally, the law exempts insurers that provide coverage to patients receiving benefits under certain state-sponsored medical assistance programs.

The next major section of the bill applies to providers. This section restricts the initial prescriptions of opioid medications to a "five-day supply" when being used for acute pain. Providers will be required to complete a list of actions outlined in the bill before "issuing an initial prescription of a Schedule II controlled dangerous substance or any other opioid drug" for treatment of acute or chronic pain. Providers must take similar steps before issuing a third prescription, including but not limited to entering into a "pain management agreement" with the patient. These requirements do not apply when treating patients receiving hospice, palliative care, and cancer treatments.

The third major section of the bill establishes or directs a professional licensing board to establish educational requirements related to opioid dependency. Examples of professions impacted by these educational mandates are doctors, advanced practice nurses, registered nurses, dentists, and pharmacists.

The bill also creates and specifies requirements for advanced practice nurses and their collaborating physicians. It grants authority to advanced practice nurses to perform certain tasks, order studies, and make diagnoses. This section of the bill is not specifically related to substance dependency or behavioral health.

Because the Legislature wants to address substance abuse problems quickly, the Division of Consumer Affairs is given the authority to adopt interim regulations without going through the normal process under the Administrative Procedures Act. These temporary regulations remain in effect until the Division creates rules through the regular process. The Division must adopt its interim regulations no later than 90 days after the effective date of the bill. The bill will become effective on or about May 16, 2017.