Senate Commerce Committee Statement to Senate, No. 1439 — State of New Jersey (May 13, 2024)

Summary

A Senate Commerce Committee statement to the Senate on Senate Bill No. 1439 with committee amendments, State of New Jersey, dated May 13, 2024, reporting the bill favorably. As amended, the bill requires health benefits coverage for an additional orthotic or prosthetic appliance when the covered person's physician determines it is necessary for physical and recreational activities such as running, swimming, skiing and team sports. Reimbursement is at the same rate as under the federal Medicare reimbursement schedule. The committee amendments require coverage for appliances obtained from a licensed podiatrist, and the bill would apply to health service corporations, commercial insurers, health maintenance organizations and the State Health Benefits Program.

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SENATE COMMERCE COMMITTEE

STATEMENT TO

SENATE, No.
1439

with
committee amendments

STATE
OF NEW JERSEY

DATED: MAY 13,
2024

The Senate Commerce Committee reports favorably and
with committee amendments Senate Bill No. 1439.

As
amended, the bill requires health benefits coverage for an additional orthotic
or prosthetic appliance from any licensed orthotist or prosthetist, any
certified pedorthist, or licensed podiatrist, if the covered person’s physician
determines that the additional appliance is necessary to enable the covered
person to engage in physical and recreational activities, including running,
bicycling, swimming, climbing, skiing, snowboarding, and team and individual
sports. The reimbursement for the additional orthotic or prosthetic appliance
is at the same rate as reimbursement for the appliances under the federal
Medicare reimbursement schedule.

The
bill also requires health benefits coverage for orthotic or prosthetic
appliances, as well as additional orthotics or prosthetic appliances for
engaging in physical and recreational activities, obtained from a licensed
podiatrist.

Current
law requires 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, but does not require coverage of an additional appliance for
physical or recreational activities.

The
bill would apply to hospital, medical, and health service corporations;
commercial individual, small employer, and larger group insurers; health
maintenance organizations; and the State Health Benefits Program and the School
Employees’ Health Benefits Program.

This bill was prefiled for introduction in the
2024-2025 session pending technical review. As reported, the bill includes the
changes required by technical review, which has been performed.

COMMITTEE AMENDMENTS :

The committee amended the bill to require health
benefits coverage for orthotic or
prosthetic appliances obtained from a licensed podiatrist.

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