New Jersey Governor Murphy Signs Mental Health Parity Legislation

NJ Insider, Governor’s Press Office

TRENTON, NJ – Governor Phil Murphy recently signed legislation that will enhance enforcement of mental health parity laws by improving transparency and accountability related to the insurance coverage of mental health and substance use disorder treatment services for New Jersey residents.The law (A2031/S1339) requires health insurers to provide coverage for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness and to meet the requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. The federal law enacted in 2008 requires equal coverage for mental and physical health care services.

“No one should have to forego treatment or take on a monumental expense to receive care because of inequities in coverage. We must do everything we can to ensure that individuals who need treatment are able to get it. This new law enhances enforcement and oversight of mental health parity laws to ensure that mental health and substance use disorders are treated on par with physical health conditions,” said Governor Murphy. “Providing access to health care remains a priority for my administration and we will continue to work to remove obstacles that hinder people’s abilities to receive the care they need.”

“On average, one in five Americans experience mental health issues,” said Assembly Speaker Craig Coughlin. “Today, our state is proudly providing these individuals with the health coverage they deserve and ensuring mental health services are at their fingertips. Access to health care is a basic human right and I know that this new law will have a meaningful and positive impact on thousands of lives across our state.”

“We’ve been working hard to end the stigma that too often prevents people from seeking the mental health services they require,” said Senate Republican Leader Tom Kean. “Unfortunately, many who pursue treatment are only dissuaded by insurance limitations that put the cost of care out of reach. This legislation will level the playing field by ensuring that critical behavioral health care services are put on the same footing as treatments for physical ailments that are covered by insurance plans.”
Under the new law, insurance carriers will have to submit an annual report to the New Jersey Department of Banking and Insurance that demonstrates compliance with the mental health parity laws. The law also provides a number of additional transparency provisions, including the development of a report by the department, to be provided to the Legislature and posted publicly, detailing oversight of the bill’s provisions.

The Murphy Administration recognizes that robust consumer outreach and engagement is a critical component of the department’s work and that strengthening a direct line of communication between regulators and those impacted, consumers, families, providers and advocates, is critical to best understand and identify issues related to parity. Commissioner Caride, in recognition of this is announcing a Parity Listening Tour and looks forward to working with mental health advocates and other stakeholders.

“Individuals who need treatment for mental health conditions and substance use disorders should not have to worry about whether these services will be covered in the same manner that services are covered for any other illness,” said Department of Banking and Insurance Commissioner Marlene Caride. “With this new law, New Jersey is sending another strong message that improving access to health care for our residents is a priority. We are committed to ensuring insurance providers are complying with the law and residents who need mental health and substance use disorder treatment get the coverage they deserve.”

“Mental health care is health care. Substance use disorder treatment is health care. Our laws should be clear that these conditions must be covered on par with the way we cover other health care services. Today, New Jersey is taking action to ensure that our laws match our goals,” said Department of Human Services Commissioner Carole Johnson. “I am pleased to join with the Governor, legislative leaders, and the advocates who have led this fight and to continue to work each day to help New Jerseyans with mental health and substance use disorders get the care they need.”

“We applaud Governor Murphy for taking action to strengthen the state’s behavioral health parity requirements,” said mental health advocate Chirlane McCray, First Lady of New York City. “America cannot have a fully functioning behavioral health system if insurance companies do not treat behavioral health on par with physical health. This bill is an important step forward.”

The law applies to health service corporations, commercial 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.

The law is sponsored by Assembly Speaker Craig J. Coughlin, (D-Middlesex), Assemblywoman  Valerie Vainieri Huttle, (D-Bergen), Assemblywoman Pamela Lampitt (D-Burlington and Camden), Assemblyman Joe Danielson (D-Middlesex and Somerset), Assemblywoman Joann Downey, (D-Monmouth), Assemblywoman Annette Quijano (D-Union),  Assemblywoman Mila M. Jasey (D-Essex-Morris), Senate Republican Leader Thomas H. Kean Jr. (R-Morris, Somerset and Union) and Senator Joseph F. Vitale (D-Middlesex). It takes effect on the 60thday after enactment.

The Psychological Toll of Reentry: Early Findings from a Multistate Trial

A study release by the Florida State University Institute for Justice Research and Development highlights key findings on reentry services models. Titled the Psychological Toll of Reentry: Early Findings from a Multistate Trial discusses the transition from a jail or prison impact on the offender, their families, and communities. This report is the second in a series of reports on a multistate, multisite study of a reentry services model referred to as the 5-Key Model for Reentry. The study is currently being implemented in 12 urban and rural counties across four states including Florida, Kentucky, Pennsylvania, and Texas.

In short, recidivism rates are impacted by both individual decision-making and a host of structural barriers including whether or not reentry service supports are available in local communities to individuals leaving incarceration. One important finding is that corrections cannot be the primary source of support for reentry; communities must play more of a role in prevention by helping to prevent recidivism. The largest identified barriers included state identification cards, anxiety, addiction, and employment.

42CFR Part 2: Confidentiality of SUD Patients

Title 42 of the Code of Federal Regulations (42CFR) is the principal set of rules regarding public health in the United States. Part 2 deals specifically with the confidentiality of Substance Use Disorder (SUD) patient records.

42CFR Part 2 is up before Congress again this year. The bills (S. 1012/H.R. 2062) would change federal laws on how a patient’s treatment records are shared. Rep. Blumenauer and Sen. Manchin introduced the bills to their respective chambers in early April. Last year’s Congress introduced similar bills that passed the House, but died in the Senate.

42 CFR was enacted in the 1970s and became effective in 1975. It was revised and updated in 1983 and then remained unchanged for more than 30 years. The purpose of the original rule was simple: encourage people to seek substance use disorder treatment while keeping the records of their treatment private. The rule was intended to help people avoid the stigma of receiving SUD treatment and more specifically the rule prohibited the use of patient information for criminal charges or investigation unless there was a substantial risk of death or bodily harm.

When the Health Insurance Portability and Accountability Act of 1996 was enacted (HIPAA) the stage was set for a possible convergence of the two laws. The long unchanged grace period for 42CFR was over. Amendments were made to the rule in 2017 and again in 2018.

The Legal Action Center – with 40 years of advocacy for criminal justice and substance use disorders and offices in both New York and Washington D.C. – does a good job of outlining what the changes mean to treatment providers. The links provided here give a synopsis of what changed and what stayed the same for both 2017 and 2018.

What Substance Use Treatment Providers Should Know – 2018 Amendments
What Substance Use Treatment Providers Should Know – 2017 Amendments

Essentially, the past amendments and the current proposed bills try to align 42CFR Part 2 more with HIPAA, whose requirements are much broader than Part 2. HIPAA may allow disclosures for operations, some treatments, and payments without consent. However, unlike HIPAA, Part 2 requires consent for a specific purpose, places a time limit on consent, places limits on the type of organization for consent, and prohibits re-disclosure.

The controversy most often plays out between institutions and individuals. Various organization, hospitals, insurance companies, and IT companies want to be able to more easily share and use information. Whether the information is for a course of treatment, the exchange of electronic health records, or the payment of invoices, there is a need to get appropriate information. Meanwhile, patient advocates say a patient may not understand the significance of privacy while in the crisis itself. Only when the patient is denied a job, health insurance, disability insurance, or life insurance does the issue become apparent.

On January 2, 2018, SAMHSA released a final rule on the most recent changes and they became effective on February 2, 2018 with this exception: lawful holders of SUD patient records have until February 2, 2020 to ensure that their agreements with contractors, subcontractors, and legal representatives comply with new disclosure requirements.

Read Full SAMHSA Final Rule 2018

One key component of 42CFR Part 2 that has remained unchanged in the past amendments is the requirement for Patient Consent – and that’s what the proposed legislation addresses. What does not change is the rule prohibiting the use of patient information for criminal charges.

Governor DeSantis Mental Health Listening Session

OBHA Staff

Spearheaded by First Lady Casey DeSantis, Governor Ron DeSantis held an hour-long “listening” session on Thursday, March 28 on mental-health issues with an emphasis on suicide prevention in response to the recent tragic deaths by suicide of two Parkland students. Several agency heads participated in the listening session (DCF, DJJ, Veteran’s Affairs, AHCA, DOH, FDLE, Education, and Elder Affairs) as well as Lt. Governor Nunez, Senator Book, Senator Rouson and Representative Rodrigues. All acknowledged the ongoing difficulties surrounding mental health and suicide. They cited statistics about national life expectancy dropping due to suicides and opioid use and how mental health is a bigger problem than may be widely understood. The Governor urged state agencies to work together to tackle the problem. He said Florida has increased funding for mental-health services, but the “challenge” is to make sure those services are delivered effectively. Ongoing efforts to address the opioid epidemic are being debated in the Legislature. The Senate Children Families and Elder Affairs committee is scheduled to hear a presentation regarding suicide prevention this month. Dr. Maggie Labarta, Meridian, and a Parkland parent have been asked to speak to the committee.

Governor DeSantis Press Release: https://www.flgov.com/2019/03/28/governor-ron-desantis-and-first-lady-casey-desantis-hold-mental-health-listening-session/

Read an article on the listening session here (Melanie quoted): https://thecapitolist.com/gov-desantis-and-first-lady-hold-listening-session-on-mental-health-and-suicide-prevention/.

Archive to the listening session (1 hour): https://thefloridachannel.org/videos/3-28-19-listening-session-on-mental-health/

Mental Health, Suicide Risk, and Suicide Prevention

Compilation from National Institute of Mental Health, Journal of Abnormal Psychology, and Florida Department of Health

Excerpt from suicide versus homicide statistic chart

Here’s a staggering statistic: suicide counts were higher than homicides in 62 of Florida’s 67 counties in 2016. Ninety-three percent of the state experienced more suicides than homicides. Look at the numbers for your county here. The number of Florida suicides is more than double the number of homicides and unfortunately that same trend is seen nationwide. Suicides remain twice as common as homicides in the United States.

When looking at the number of suicides two questions prevail: why and what can be done? There are no easy answers, but researchers are studying and trying to answer both those questions.

Social Media may be partly to blame. Teens and young adults using Social Media are experiencing more depression than ten years ago.

study published on  March 14, 2019 in the Journal of Abnormal Psychology finds the percentage of U.S. teens and young adults reporting mental distress, depression and suicidal thoughts and actions has risen significantly over the past decade. While these problems also increased among adults 26 and older, the increase was not nearly as large as among younger people.

Another study is looking at a possible venue for intervention and prevention of suicides: an NIH study shows many preteens screen positive for suicide risk during ER visits.

A research team found nearly one-third of youth ages 10 to 12 years screened positive for suicide risk in emergency department settings. As part of a larger study on youth suicide risk screening in emergency departments, researchers at the National Institute of Mental Health (NIMH), part of the National Institutes of Health, and collaborators sought to explore how frequently preteen youth ages 10 to 12 screened positive for suicide risk. Notably, 7 percent of the preteens who screened positive for suicide risk were seeking help for physical – not psychiatric – concerns.

Smoking Medical Marijuana is Now Legal: What Employers Need to Know

Governor Ron DeSantis signed SB 182 on March 18. The bill eliminated the ban on smoking medical marijuana in Florida. The change in law may not directly impact the way your organization provides services. However, it could have an impact on you as an employer – particularly if you operate a drug-free or smoke-free campus or facility.

The bill called for elimination of the ban on smoking medical marijuana to go into effect immediately upon becoming law – so smoking medical marijuana became legal on March 18, 2019.

Before amended by SB 182, Florida law did not include the use of medical marijuana in a qualified patient’s place of employment in the definition of “medical use” of the drug – except when permitted by his or her employer. The new law goes further to state “the smoking of marijuana in an enclosed indoor workplace” is not considered “medical use” of the drug.

Under the law, employers are authorized to establish, continue, or enforce a drug-free workplace program or policy and employers are not required to accommodate the medical use of marijuana in any workplace or for any employee working while under the influence of marijuana. Finally, the law clarifies the provisions related to medical marijuana do not create a cause of action against an employer for wrongful discharge or discrimination.

The changes to state law appear fairly straightforward, with appropriate protections for employers who want to enforce drug-free and smoke-free policies.

However, while medical marijuana is legal in Florida, it is still considered an illegal drug under federal law. This can create confusion if an employee requests a reasonable accommodation under the federal Americans with Disabilities Act (ADA) to use medical marijuana while at work to treat a medical condition. The ADA allows employers to prohibit current illegal use of drugs and alcohol in the workplace and to require employees report for duty without engaging in the unlawful use of drugs.

Additionally, federal courts have ruled the ADA does not require a medical marijuana accommodation. Litigation as to the applicability of the ADA in states where medical marijuana is legal have produced verdicts in favor of both employers and employees. Until state and federal laws on the legality of medical marijuana are reconciled, employers should examine their workplace policies carefully and ensure they are consistently and equitably applied.