ASSEMBLY, No. 2955
STATE OF NEW JERSEY
INTRODUCED MAY 12, 1997
By Assemblymen MORAN and DORIA
An Act concerning reimbursement for certain health care services performed by chiropractors, amending P.L.1975, c.125 and P.L.1988, c.119 and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1975, c.125 (C.17B:27-51.1) is amended to read as follows:
1. Notwithstanding any provision of a policy or contract of group health insurance, hereafter delivered or issued for delivery in this State, whenever such a policy or contract provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed chiropractor, a person covered under such group health policy or contract or the chiropractor rendering such service shall be entitled to reimbursement for such service [when the said service is performed by a chiropractor. The foregoing provision] at the same rate as is applied to licensed physicians and surgeons. If the policy or contract places any limitation or condition on the services, diagnosis or treatment rendered by a chiropractor covered by this section, or upon the reimbursement therefor, that limitation or condition shall be equally applied to the services, diagnosis and treatment rendered by a physician or surgeon, and reimbursement shall be provided at the same rate, regardless of the terminology or billing code used to describe the condition or complaint or service, diagnosis or treatment, without discrimination as to the usual and customary procedures of the physician, surgeon or chiropractor. This section shall be liberally construed in favor of reimbursement of chiropractors.
(cf: P.L.1975, c.125, s.1)
2. (New section) Notwithstanding any provision of a policy or contract of individual health insurance, delivered or issued for delivery in this State on or after the effective date of this act, whenever such a policy or contract provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed chiropractor, a person covered under that individual health policy or contract or the chiropractor rendering that service shall be entitled to reimbursement for that service at the same rate as is applied to licensed physicians and surgeons. If the policy or contract places any limitation or condition on the services, diagnosis or treatment rendered by a chiropractor covered by this section, or upon the reimbursement therefor, that limitation or condition shall be equally applied to the services, diagnosis and treatment rendered by a physician or surgeon, and reimbursement shall be provided at the same rate, regardless of the terminology or billing code used to describe the condition or complaint or service, diagnosis or treatment, without discrimination as to the usual and customary procedures of the physician, surgeon or chiropractor. This section shall be liberally construed in favor of reimbursement of chiropractors.
3. (New section) Notwithstanding any provision of an individual or group hospital service corporation contract, delivered or issued for delivery in this State on or after the effective date of this act, whenever such a contract provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed chiropractor, a person covered under that group or individual hospital service corporation contract or the chiropractor rendering that service shall be entitled to reimbursement for that service at the same rate as is applied to licensed physicians and surgeons. If the contract places any limitation or condition on the services, diagnosis or treatment rendered by a chiropractor covered by this section, or upon the reimbursement therefor, that limitation or condition shall be equally applied to the services, diagnosis and treatment rendered by a physician or surgeon, and reimbursement shall be provided at the same rate, regardless of the terminology or billing code used to describe the condition or complaint or service, diagnosis or treatment, without discrimination as to the usual and customary procedures of the physician, surgeon or chiropractor. This section shall be liberally construed in favor of reimbursement of chiropractors.
4. (New section) Notwithstanding any provision of an individual or group medical service corporation contract, delivered or issued for delivery in this State on or after the effective date of this act, whenever such a contract provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed chiropractor, a person covered under that group or individual medical service corporation contract or the chiropractor rendering that service shall be entitled to reimbursement for that service at the same rate as is applied to licensed physicians and surgeons. If the contract places any limitation or condition on the services, diagnosis or treatment rendered by a chiropractor covered by this section, or upon the reimbursement therefor, that limitation or condition shall be equally applied to the services, diagnosis and treatment rendered by a physician or surgeon, and reimbursement shall be provided at the same rate, regardless of the terminology or billing code used to describe the condition or complaint or service, diagnosis or treatment, without discrimination as to the usual and customary procedures of the physician, surgeon or chiropractor. This section shall be liberally construed in favor of reimbursement of chiropractors.
5. (New section) Notwithstanding any provision of an individual or group health service corporation contract, delivered or issued for delivery in this State on or after the effective date of this act, whenever such a contract provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed chiropractor, a person covered under that group or individual health service corporation contract or the chiropractor rendering that service shall be entitled to reimbursement for that service at the same rate as is applied to licensed physicians and surgeons. If the contract places any limitation or condition on the services, diagnosis or treatment rendered by a chiropractor covered by this section, or upon the reimbursement therefor, that limitation or condition shall be equally applied to the services, diagnosis and treatment rendered by a physician or surgeon, and reimbursement shall be provided at the same rate, regardless of the terminology or billing code used to describe the condition or complaint or service, diagnosis or treatment, without discrimination as to the usual and customary procedures of the physician, surgeon or chiropractor. This section shall be liberally construed in favor of reimbursement of chiropractors.
6. (New section) Notwithstanding any provision of an enrollee agreement delivered or issued for delivery in this State on or after the effective date of this act, whenever such an agreement provides coverage for any health care services which are within the lawful scope of practice of a duly licensed chiropractor, an enrollee covered under that agreement or the chiropractor rendering that service shall be entitled to reimbursement for that service at the same rate as is applied to licensed physicians and surgeons. If the agreement places any limitation or condition on the health care services rendered by a chiropractor covered by this section, or upon the reimbursement therefor, that limitation or condition shall be equally applied to the health care services rendered by a physician or surgeon, and reimbursement shall be provided at the same rate, regardless of the terminology or billing code used to describe the condition or complaint or health care services, without discrimination as to the usual and customary procedures of the physician, surgeon or chiropractor. This section shall be liberally construed in favor of reimbursement of chiropractors.
7. (New section) Whenever, pursuant to R.S.34:15-15, an employer provides medical, surgical or other treatment, or payment or reimbursement therefor, for any service which is within the lawful scope of practice of a duly licensed chiropractor, an employee or the chiropractor rendering that service shall be entitled to payment or reimbursement for that service at the same rate as is applied to licensed physicians and surgeons. If any limitation or condition is placed on the services, diagnosis or treatment rendered by a chiropractor covered by this section, or upon the reimbursement therefor, that limitation or condition shall be equally applied to the services, diagnosis and treatment rendered by a physician or surgeon, and reimbursement shall be provided at the same rate, regardless of the terminology or billing code used to describe the condition or complaint or service, diagnosis or treatment, without discrimination as to the usual and customary procedures of the physician, surgeon or chiropractor. This section shall be liberally construed in favor of payment or reimbursement of chiropractors.
8. Section 10 of P.L.1988, c.119 (C.39:6A-4.6) is amended to read as follows:
10. The Commissioner of Banking and Insurance shall, within 90 days after the effective date of P.L.1990, c.8 (C.17:33B-1 et al.), promulgate medical fee schedules on a regional basis for the reimbursement of health care providers providing services or equipment for medical expense benefits for which payment is to be made by an automobile insurer under personal injury protection coverage pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.), or by an insurer under medical expense benefits coverage pursuant to section 2 of P.L.1991, c.154 (C.17:28-1.6). These fee schedules shall be promulgated on the basis of the type of service provided, and shall incorporate the reasonable and prevailing fees of 75% of the practitioners within the region. If, in the case of a specialist provider, there are fewer than 50 specialists within a region, the fee schedule shall incorporate the reasonable and prevailing fees of the specialist providers on a Statewide basis. These schedules shall be reviewed biannually by the commissioner.
No health care provider may demand or request any payment from any person in excess of those permitted by the medical fee schedules established pursuant to this section, nor shall any person be liable to any health care provider for any amount of money which results from the charging of fees in excess of those permitted by the medical fee schedules established pursuant to this section.
Whenever the medical fee schedules established pursuant to this section provide for payment or reimbursement for any service which is within the lawful scope of practice of a duly licensed chiropractor, the fee for the chiropractor rendering that service shall be the same as for licensed physicians and surgeons rendering the same service. If any limitation or condition is placed on the services, diagnosis or treatment rendered by a chiropractor covered by this section, or upon the fee therefor, that limitation or condition shall be applied equally to the services, diagnosis and treatment rendered by a physician or surgeon, and the fee shall be the same, regardless of the terminology or billing code used to describe the condition or complaint or service, diagnosis or treatment, without discrimination as to the usual and customary procedures of the physician, surgeon or chiropractor. The provisions of this paragraph shall be liberally construed in favor of payment or reimbursement of chiropractors.
(cf: P.L.1991, c.154, s.6)
9. This act shall take effect immediately.
STATEMENT
This bill provides that, with respect to health insurance policies, health maintenance organizations, worker's compensation coverage and automobile insurance personal injury protection, whenever any covered health care service is within the lawful scope of practice of a chiropractor, a covered individual or the chiropractor rendering that service shall be entitled to reimbursement for that service at the same rate as is applied to licensed physicians and surgeons. If the policy or plan places any limitation or condition on services rendered by a chiropractor, or upon the reimbursement therefor, that limitation or condition shall be equally applied to services rendered by a physician or surgeon, and reimbursement shall be provided at the same rate, regardless of the terminology or billing code used.
Requires that chiropractors and physicians be reimbursed at same rate under various health and accident plans.