A4523

An Act concerning disclosure of certain behavioral health care information to carriers and supplementing Title 45 of the Revised Statues and P.L.2005, c.352 (C.17B:30-48 et seq.).

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. a. Notwithstanding any other law, rule, or regulation to the contrary, a mental health care professional shall provide the following information concerning a patient to a carrier upon request:

(1) The patient’s name, age, sex, address, educational status, identifying number within the insurance program, date of onset of difficulty, date of initial consultation, dates of sessions, whether the sessions are individual or group sessions, and fees;

(2) Diagnostic information, defined as therapeutic characterizations of the type found in the current version of the Diagnostic and Statistical Manual of Mental Disorders or in another professionally recognized diagnostic manual;

(3) Status of the patient as voluntary or involuntary; inpatient or outpatient;

(4) The reason for continuing behavioral health care services, limited to an assessment of the client’s current level of functioning and level of distress. These aspects shall be described as “none,” or by the terms “mild,” “moderate,” “severe” or “extreme”; and

(5) Prognosis, limited to an estimate of the minimal time during which treatment might continue.

b. A carrier shall not request that a mental health care professional provide psychotherapy notes to the carrier.

c. The information provided to a carrier pursuant this section shall be marked “confidential” and, if directed by the patient or an authorized representative, forwarded to the attention of a specific individual. The carrier shall also meet privacy standards under the “Health Insurance Portability and Accountability Act of 1996,” Pub. L. 104-191, and other applicable federal standards with respect to information provided to a carrier pursuant to this section.

d. Nothing in P.L. , c. (C. ) (pending before the Legislature as this bill) shall restrict a patient’s ability to authorize disclosure of the patient’s private health information to a carrier.

e. For the purposes of this section:

"Behavioral health care services" means procedures or services that are rendered by a mental health care professional for the assessment and treatment of a mental illness, emotional disorder, or substance use disorder.

“Carrier” means the same as defined in section 3 of P.L.2005, c.352 (C.17B:30-50).

"Mental health care professional" means an individual who is licensed or certified by this State to provide or administer behavioral health care services in the ordinary course of business or practice of a profession.

“Psychotherapy notes” means notes recorded, in any medium, by a mental health care professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the covered person’s medical record. “Psychotherapy notes” excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.

2. Notwithstanding any law, rule, or regulation to the contrary, a carrier shall not request, or require in any contract or policy, information to be provided from a mental health care professional concerning any covered person, except the information that is permitted to be provided by that professional pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill).

3. This act shall take effect on the first day of the fourth month next following enactment.

STATEMENT

This bill prohibits mental health care professionals from disclosing, and health insurance carriers from demanding, certain information concerning behavioral health care services provided to patients.

Specifically, the bill authorizes a mental health care professional to disclose to a health insurance carrier only the following information:

(2) Diagnostic information, defined as therapeutic characterizations of the type found in the current version of the Diagnostic and Statistical Manual of Mental Disorders, or in another professionally recognized diagnostic manual;

(3) Status of the patient as voluntary or involuntary; or inpatient or outpatient;

(4) The reason for continuing behavioral health care services, limited to an assessment of the client’s current level of functioning and level of distress. These aspects are to be described as “none,” or by the terms “mild,” “moderate,” “severe” or “extreme”; and

(5) Prognosis, limited to an estimate of the minimal time during which treatment might continue.

The bill also provides that the information provided to a carrier pursuant to the bill shall be marked “confidential” and, if directed by the patient or an authorized representative, forwarded to the attention of a specific individual.

The bill also prohibits a health insurance carrier from requesting, or requiring in any contract or policy, information to be provided from a mental health care professional concerning any covered person, except the information described above.

In certain circumstances health insurance carriers have requested, as part of utilization management, information from mental health care professionals that the providers are prohibited from disclosing pursuant to the rules and regulations of the providers’ professional licensure. This bill is intended to reconcile that conflict by codifying certain aspects of those rules of professional licensure and by clearly limiting the information that the carrier can request, or require to be provided, to the information that is permitted to be shared pursuant to those rules.