ASSEMBLY FINANCIAL INSTITUTIONS AND INSURANCE COMMITTEE

STATEMENT TO

ASSEMBLY, No. 5052

STATE OF NEW JERSEY

DATED:  DECEMBER 11, 2025

      The Assembly Financial Institutions and Insurance Committee reports favorably Assembly Bill No. 5052.

      This bill requires health insurers (health, hospital and medical service corporations, commercial individual and group health insurers, health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the School Employees’ Health Benefits Program) and the State Medicaid program to provide benefits to any covered person for medical expenses incurred relating to screening, prevention, and treatment of behavioral health issues in children.  Carriers and the State Medicaid program are required to accept and reimburse claims for screening, prevention, and treatment using an at-risk diagnosis.

      As used in the bill, an “at-risk diagnosis” is 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.