Requires choices of a question or proposal printed on a ballot include a brief phrase stating the effect of such choice should such choice win such question or proposal

2025 Regular Session Introduced by Keith Brown and 4 co-sponsors

Requires health plans and Medicaid in NJ to cover medical treatment for stuttering, including habilitative and rehabilitative speech therapy, in-person or telemedicine.

REFERRED TO ELECTION LAW

Summary — A5133 (reported by Assembly Financial Institutions & Insurance Committee, 4/10/2025)

Status and next steps
- Introduced: December 16, 2024
- Committee action: Reported favorably with amendments by the Assembly Financial Institutions & Insurance Committee (April 10, 2025); referred to the Assembly Health Committee.
- Companion: S3558. Prior-session related bills: A10294, A7950.

Purpose
- Requires health insurance plans and the State Medicaid program in New Jersey to cover medical expenses for the treatment of stuttering, including both habilitative and rehabilitative speech therapy. Coverage must be available for services delivered in-person or via telemedicine/telehealth.

Key provisions
- Covered plans: Applies to hospital, medical and health service corporation contracts; individual and group health insurance policies; health maintenance organizations; plans under the NJ Individual and Small Employer Health Benefits Programs; the State Health Benefits Program (SHBP); the School Employees’ Health Benefits Program (SEHBP); and Medicaid—generally for contracts/policies delivered, issued, or renewed on or after the bill’s effective date. Provisions apply to contracts in which the insurer has reserved the right to change premium.
- Covered services: Medical expenses for treatment of stuttering, expressly including habilitative speech therapy and rehabilitative speech therapy.
- Delivery modes: Coverage must be provided whether services are delivered in-person or through telemedicine/telehealth.
- Medical determination: Whether treatment is medically necessary — and whether stuttering is neurogenic or developmental — is to be determined by the covered person’s medical doctor.
- Definitions:
- Habilitative speech therapy: therapy that helps a person keep, learn, or improve skills and functioning for daily living.
- Rehabilitative speech therapy: therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
- Committee amendment change: The committee removed language from the originally introduced bill that would have prohibited cost‑sharing (deductibles, copayments, coinsurance, annual limits) and would have barred prior authorization or other utilization management. As reported, the bill requires coverage but no longer forbids insurers or programs from applying usual cost‑sharing or utilization management consistent with other covered services.

Who is affected
- Individuals with stuttering (children and adults) covered by private health plans, HMOs, state employee and school employee plans, and Medicaid in New Jersey.
- Insurers, health service and medical/hospital service corporations, health plan administrators, and state Medicaid/benefits administrators.

Implementation / Fiscal notes
- The bill sets coverage requirements for policies issued/renewed on or after the act’s effective date; it applies to contracts reserving the right to change premiums. The committee report does not include a fiscal estimate; potential premium or program cost impacts would depend on utilization, benefit design, and whether plans apply cost‑sharing or utilization controls.