New Jersey's Addiction Treatment Parity Law (A2031/S1339)

What the Law Requires

A2031/S1339 requires hospital, medical, and health service corporations; commercial insurers; health maintenance organizations; New Jersey Individual Health Coverage and Small Employer Health Benefits Program plans; the State Health Benefits Program; and the School Employees' Health Benefits Program to provide coverage for medically necessary behavioral health care services and to meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. In plain English: state-regulated plans must cover SUD treatment on par with any medical or surgical benefit.

ASAM Criteria Requirement

For any utilization review or benefit determination involving SUD treatment — including prior authorization and medical necessity decisions — the clinical review criteria shall be the most recent Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions established by the American Society of Addiction Medicine. This is the single most impactful provision for people seeking inpatient rehab: carriers cannot use internal criteria more restrictive than ASAM.

Non-Quantitative Treatment Limitations (NQTLs)

The law places restrictions on carriers around imposing non-quantitative treatment limitations — things like fail-first requirements, step therapy, provider network limits, and out-of-network exception processes — to ensure they're not stricter for behavioral health than for medical/surgical care. It also requires carriers to submit annual parity compliance reports to the NJ Department of Banking and Insurance.

What the Law Does Not Cover

Self-funded ERISA plans — typically large-employer plans where the employer pays claims directly and uses an insurance company as administrator only — are governed by federal MHPAEA, not by A2031. The parity protections are similar but enforcement is federal (DOL/EBSA) rather than NJ DOBI. Most midsize and small employer plans, and individual marketplace plans, are state-regulated and fully covered by A2031.

How to File a Parity Appeal

If a carrier denies preauthorization or coverage on grounds that appear to violate ASAM or parity: first, file an internal appeal with the carrier (required as a first step). If the internal appeal fails, file with NJ Department of Banking and Insurance, Office of Managed Care Chief — (609) 777-9470, or PO Box 325, Trenton, NJ 08625-0325. For self-funded ERISA plans, the federal Employee Benefits Security Administration toll-free hotline is 1-866-444-EBSA (3272).