Senate Commerce Committee Statement to Senate, No. 3919 — State of New Jersey (December 18, 2023)

Summary

The Senate Commerce Committee of the State of New Jersey, in a statement dated December 18, 2023, reports favorably Senate Bill No. 3919. The bill requires health benefits coverage for an additional orthotic or prosthetic appliance if the covered person's physician determines it is necessary for physical and recreational activities such as running, bicycling, swimming, climbing, skiing, snowboarding and sports. Reimbursement is at the same rate as under the federal Medicare reimbursement schedule. Current law requires coverage of a medically necessary appliance but not of an additional appliance for these activities. The bill applies to health service corporations, insurers, health maintenance organizations and the State and school employee health benefits programs.

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SENATE COMMERCE COMMITTEE

STATEMENT TO

SENATE, No.
3919

STATE
OF NEW JERSEY

DATED: DECEMBER
18, 2023

The Senate Commerce Committee reports favorably Senate
Bill No. 3919.

This
bill requires health benefits coverage for an additional prosthetic appliance
under certain circumstances.

The
bill requires health benefits coverage for an additional orthotic or prosthetic
appliance from any licensed orthotist or prosthetist, or any certified
pedorthist, 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.

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.

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