SENATE, No. 1390

STATE OF NEW JERSEY

217th LEGISLATURE

 

INTRODUCED FEBRUARY 11, 2016

 


 

Sponsored by:

Senator  NIA H. GILL

District 34 (Essex and Passaic)

Assemblyman  VINCENT PRIETO

District 32 (Bergen and Hudson)

Assemblywoman  ANGELICA M. JIMENEZ

District 32 (Bergen and Hudson)

 

Co-Sponsored by:

Senator Ruiz

 

 

 

 

SYNOPSIS

     Requires health benefits coverage for orthotic and prosthetic appliances from licensed podiatrists.

 

CURRENT VERSION OF TEXT

     As introduced.

  


An Act concerning health benefits coverage for orthotic and prosthetic appliances from podiatrists and amending P.L.2007, c.345.

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.    Section 1 of P.L.2007, c.345 (C.17:48-6ff) is amended to read as follows:

     1.    a. Every hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, licensed podiatrist, or any certified pedorthist, as determined medically necessary by the covered person's physician.

     As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist" and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) , "licensed podiatrist" has the meaning assigned to it in R.S.45:5-1 et seq., and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18).

     b.    On and after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), a hospital service corporation contract shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.

     c.     The benefits shall be provided to the same extent as for any other medical condition under the contract.

     d.    The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

(cf: P.L.2007, c.345, s.1)

 

     2.    Section 2 of P.L.2007, c.345 (C. 17:48A-7cc) is amended to read as follows:

     2.    a. Every medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, licensed podiatrist, or any certified pedorthist, as determined medically necessary by the covered person's physician.

     As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist" and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) , "licensed podiatrist" has the meaning assigned to it in R.S.45:5-1 et seq., and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18).

     b.    On and after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), a medical service corporation contract shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.

     c.     The benefits shall be provided to the same extent as for any other medical condition under the contract.

     d.    The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.

(cf: P.L.2007, c.345, s.2)

 

     3.    Section 3 of P.L.2007, c.345 (C.17:48E-35.30) is amended to read as follows:

     3.    a. Every health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et al.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, licensed podiatrist, or any certified pedorthist, as determined medically necessary by the covered person's physician.

     As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist" and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) , "licensed podiatrist" has the meaning assigned to it in R.S.45:5-1 et seq., and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18).

     b.    On and after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), a health service corporation contract shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.

     c.     The benefits shall be provided to the same extent as for any other medical condition under the contract.

     d.    The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.

(cf: P.L.2007, c.345, s.3)

 

     4.    Section 4 of P.L.2007, c.345 (C.17B:26-2.1z) is amended to read as follow:

     4.    a.  Every individual health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, licensed podiatrist, or any certified pedorthist, as determined medically necessary by the covered person's physician.

     As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist" and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) , "licensed podiatrist" has the meaning assigned to it in R.S.45:5-1 et seq., and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18).

     b.    On and after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), an individual health insurance policy shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.

     c.     The benefits shall be provided to the same extent as for any other medical condition under the policy.

     d.    The provisions of this section shall apply to all individual health insurance policies in which the insurer has reserved the right to change the premium.

(cf: P.L.2007, c.345, s.4)

 

     5.    Section 5 of P.L.2007, c.345 (C.17B:27-46.1ff) is amended to read as follows:

     5.    a.  Every group health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, licensed podiatrist, or any certified pedorthist, as determined medically necessary by the covered person's physician.

     As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist" and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) , "licensed podiatrist" has the meaning assigned to it in R.S.45:5-1 et seq., and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18).

     b.    On and after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), a group health insurance policy shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.

     c.     The benefits shall be provided to the same extent as for any other medical condition under the policy.

     d.    The provisions of this section shall apply to all group health insurance policies in which the insurer has reserved the right to change the premium.

(cf: P.L.2007, c.345, s.5)

 

     6.    Section 6 of P.L.2007, c.345 (C.17B:27A-7.13) is amended to read as follows:

     6.    a.  Every individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et al.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, licensed podiatrist, or any certified pedorthist, as determined medically necessary by the covered person's physician.

     As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist" and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) , "licensed podiatrist" has the meaning assigned to it in R.S.45:5-1 et seq., and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18).

     b.    On and after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), an individual health benefits plan shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.

     c.     The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.

     d.    The provisions of this section shall apply to all individual health benefits plans in which the carrier has reserved the right to change the premium.

(cf: P.L.2007, c.345, s.6)

 

     7.    Section 7 of P.L.2007, c.345 (C.17B:27A-19.17) is amended to read as follows:

     7.    a.  Every small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, licensed podiatrist, or any certified pedorthist, as determined medically necessary by the covered person's physician.

     As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist" and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) , "licensed podiatrist" has the meaning assigned to it in R.S.45:5-1 et seq., and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18).

     b.    On and after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), a small employer health benefits plan shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.

     c.     The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.

     d.    The provisions of this section shall apply to all small employer health benefits plans in which the carrier has reserved the right to change the premium.

(cf: P.L.2007, c.345, s.7)

 

     8.    Section 8 of P.L.2007, c.345 (C.26:2J-4.31) is amended to read as follows:

     8.    a.  A certificate of authority to establish and operate a health maintenance organization in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.) unless the health maintenance organization provides health care services for any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, licensed podiatrist, or any certified pedorthist, as determined medically necessary by the covered person's physician.

     As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist," and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) , "licensed podiatrist" has the meaning assigned to it in R.S.45:5-1 et seq., and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18).

     b.    On and after the effective date of this act, a health maintenance organization shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.

     c.     The benefits shall be provided to the same extent as for any other medical condition under the enrollee agreement.

     d.    The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.

(cf: P.L.2012, c.17, s.276)

 

     9.    Section 9 P.L.2007, c.345 (C.52:14-17.29m) is amended to read as follows:

     9.    a.  The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.) that provides hospital or medical expense benefits, shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, licensed podiatrist, or any certified pedorthist, as determined medically necessary by the covered person's physician.

     As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist" and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) , "licensed podiatrist" has the meaning assigned to it in R.S.45:5-1 et seq., and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18).

     b.    On and after the effective date of [this act] P.L.2007, c.345 (C.17:48-6ff et al.), a contract purchased by the commission shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.

     c.     The benefits shall be provided to the same extent as for any other medical condition under the contract.

(cf: P.L.2007, c.345, s.9)

 

     10.  This act shall take effect on the 90th day after enactment and shall apply to policies or contracts issued or renewed on or after the effective date.

 

 

STATEMENT

 

     This bill expands the list of health providers for which certain health insurers must provide benefits for expenses incurred in obtaining orthotics or prosthetic appliances for insureds to include licensed podiatrists.  Under current law, health insurers, including health, hospital and medical service corporations, commercial individual and group health insurers, health maintenance organizations, and health benefits plans issued pursuant to the New Jersey Individual Health Coverage (IHC) and Small Employer Health Benefits (SEH) Programs, and the State Health Benefits Program (SHBP), are required to provide health benefits coverage for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, or any certified pedorthist, as determined medically necessary by the covered person's physician.  Under the bill, licensed podiatrists are included in the list of health providers for which health insurers are required to provide benefits.