52:14-17.29qq Contracts purchased by the State Health Benefits Commission, behavioral health, children.
2. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person for medical expenses incurred in the screening, prevention, and treatment services of behavioral health issues in children. The contract shall allow for acceptance and reimbursement of claims for screening, prevention, and treatment using an at-risk diagnosis. b. The benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract. c. As used in this section: “At-risk diagnosis” means a diagnosis made after consideration of factors influencing behavioral health and child development, such as family circumstances or life challenges, that does not lead to a formal mental health diagnosis and, instead, promotes preventive care. Allowing providers to bill for an “at-risk diagnosis” authorizes providers to use an alternative code, including a Social Determinants of Health Z-code, to the codes of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood when billing for services, without a formal mental health diagnosis, for children who are 18 years of age or younger. “Screening, prevention, and treatment” includes the prevention and early identification of mental health conditions without a behavioral health diagnosis. Services may include, but are not limited to, screenings and individual, group, and family psychotherapy to individuals with potential mental health disorders not yet diagnosed. L.2025, c.369, s.2.