52:14-17.29d Definitions.
268 words·~1 min read·
/nj/title-52/chapter-14/52-14-17-29d·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
1. As used in this act:
"Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation or health maintenance organization authorized to issue health benefits plans in this State.
"Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders.
"Psychiatric Collaborative Care Model" means the evidence-based, integrated behavioral health service delivery method wherein a primary care provider and a care manager collaborate with a psychiatric consultant to provide care to a patient. "Psychiatric Collaborative Care Model" shall include those benefits that are billed using the following list of Current Procedural Terminology
(CPT)codes, which list shall be updated by the Commissioner of Banking and Insurance whenever the codes are altered or supplemented:
(a)99492 - Initial psychiatric collaborative care management;
(b)99493 - Subsequent psychiatric collaborative care management; and
(c)99494 - Initial or subsequent psychiatric collaborative care management, additional time.
"Same terms and conditions" means that a carrier cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.
"Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
L.1999, c.441, s.1; amended 2019, c.58, s.9; 2022, c.33, s.9.