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NJ A5052
Bill
Status
1/20/2026
Primary Sponsor
Andrea Katz
Click for details
AI Summary
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Mandates health insurance carriers and Medicaid provide coverage for screening, prevention, and treatment of behavioral health issues in children aged 18 and younger
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Requires insurers to accept and reimburse claims using an "at-risk diagnosis," allowing providers to bill for preventive care without a formal mental health diagnosis
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Permits providers to use alternative billing codes, including Social Determinants of Health Z-codes, instead of traditional DSM or DC:0-5 diagnostic codes
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Applies to all health plans including commercial insurers, HMOs, State Health Benefits Program, School Employees' Health Benefits Program, and NJ FamilyCare/Medicaid
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Takes effect 90 days after enactment and applies to policies issued or renewed after that date
Legislative Description
Requires health insurance and Medicaid coverage for screening, prevention, and treatment services of behavioral health issues affecting children.
Bills and Joint Resolutions Signed by the Governor
Last Action
Approved P.L.2025, c.369.
1/20/2026