1003_I1

							            ASSEMBLY, No. 1003

STATE OF NEW JERSEY
              212th LEGISLATURE
        PRE-FILED FOR INTRODUCTION IN THE 2006 SESSION



Sponsored by:
Assemblyman VINCENT PRIETO
District 32 (Bergen and Hudson)
Assemblyman NEIL M. COHEN
District 20 (Union)
Assemblyman BRIAN E. RUMPF
District 9 (Atlantic, Burlington and Ocean)
Assemblyman CHRISTOPHER J. CONNORS
District 9 (Atlantic, Burlington and Ocean)
Assemblyman FREDERICK SCALERA
District 36 (Bergen, Essex and Passaic)

Co-Sponsored by:
Assemblymen Diegnan and Conners




SYNOPSIS
   Requires that chiropractic physicians, podiatric physicians, allopathic
physicians, and osteopathic physicians be reimbursed at same rate as other
health care providers under various health and accident plans.

CURRENT VERSION OF TEXT
  Introduced Pending Technical Review by Legislative Counsel
                                A1003 PRIETO, COHEN
                                          2

 1   AN ACT concerning reimbursement for certain health care services
 2     performed by chiropractic physicians and podiatric physicians,
 3     amending P.L.1975, c.125 and P.L.1988, c.119 and
 4     supplementing various parts of the statutory law.
 5
 6      BE IT ENACTED by the Senate and General Assembly of the State
 7   of New Jersey:
 8
 9      1. Section 1 of P.L.1975, c.125 (C.17B: 27-51.1) is amended to
10   read as follows:
11      1. Notwithstanding any provision of a policy or contract of
12   group health insurance, hereafter delivered or issued for delivery in
13   this State, whenever such a policy or contract provides for
14   reimbursement for any service which is within the lawful scope of
15   practice of a duly licensed [chiropractor] chiropractic physician or
16   podiatric physician, a person covered under such group health
17   policy or contract or the [chiropractor] chiropractic physician or
18   podiatric physician rendering such service shall be entitled to
19   reimbursement for such service [when the said service is performed
20   by a chiropractor. The foregoing provision] at the same rate as is
21   applied to licensed allopathic or osteopathic physicians, or other
22   health care providers, whichever rate is greater. Reimbursement
23   shall be provided at the same rate, regardless of the terminology or
24   billing code used to describe the condition or complaint, diagnosis,
25   service or treatment, without discrimination as to the usual and
26   customary procedures of the allopathic, osteopathic, podiatric or
27   chiropractic physician, when similar services are rendered, as in the
28   case of osteopathic manipulation and chiropractic manipulation or
29   adjustment, which may have different codes but shall be paid at the
30   same rate.       Chiropractic adjunctive procedures and podiatric
31   adjunctive procedures shall not be bundled together for
32   reimbursement purposes, unless similar adjunctive procedures are
33   bundled together for all classes or disciplines of physicians.
34      A group health insurance policy or contract may not place any
35   limitation or condition on the diagnosis, services or treatment
36   rendered by a chiropractic physician or podiatric physician covered
37   by this section, or upon the reimbursement thereof, unless that
38   limitation or condition also applies to all classes or disciplines of
39   physicians.
40      The provisions of this section shall be liberally construed in
41   favor of reimbursement of [chiropractors] chiropractic physicians
42   and podiatric physicians and access to such treatment.
43      If there is a discrepancy of reimbursement rates, or conditions on
44   services in contravention of this section, the correction of that
45   discrepancy shall be an elevation of the lower to the higher
       EXPLANATION – Matter enclosed in bold-faced brackets [thus] in the above bill is
     not enacted and is intended to be omitted in the law.

       Matter underlined thus is new matter.
                           A1003 PRIETO, COHEN
                                     3

 1   reimbursement rate or a reduction of the limitations or restrictions
 2   on the affected health care provider.
 3      A group health insurer shall not impose disparate deductibles
 4   purely on the basis of the provider's license. Deductibles shall only
 5   be dictated by the insured and which plan is obtained by the insured
 6   and shall not vary based on the physician or discipline rendering
 7   that service.
 8      The provisions of this section shall apply to those group health
 9   insurance policies or contracts in which the insurer has reserved the
10   right to change the premium
11   (cf: P.L.1975, c.125, s.1).
12
13      2. (New section) Notwithstanding any provision of a policy or
14   contract of individual health insurance delivered or issued for
15   delivery in this State on or after the effective date of this act,
16   whenever such a policy or contract provides for reimbursement for
17   any service which is within the lawful scope of practice of a duly
18   licensed chiropractic physician or podiatric physician, a person
19   covered under that individual health insurance policy or contract or
20   the chiropractic physician or podiatric physician rendering that
21   service shall be entitled to reimbursement for that service at the
22   same rate or fee as is applied to licensed allopathic or osteopathic
23   physicians, or other health care providers, whichever rate is greater.
24   Reimbursement shall be provided at the same rate, regardless of the
25   terminology or billing code used to describe the condition or
26   complaint, diagnosis, service or treatment, without discrimination
27   as to the usual and customary procedures of the allopathic,
28   osteopathic, podiatric or chiropractic physician, when similar
29   services are rendered, as in the case of osteopathic manipulation and
30   chiropractic manipulation or adjustment, which may have different
31   codes but shall be paid at the same rate. Chiropractic adjunctive
32   procedures and podiatric adjunctive procedures shall not be bundled
33   together for reimbursement purposes, unless similar adjunctive
34   procedures are bundled together for all classes or disciplines of
35   physicians.
36      An individual health insurance policy or contract may not place
37   any limitation or condition on the services, diagnosis or treatment
38   rendered by a chiropractic physician or podiatric physician covered
39   by this section, or upon the reimbursement thereof, unless that
40   limitation or condition also applies to all classes or disciplines of
41   physicians.
42      The provisions of this section shall be liberally construed in
43   favor of reimbursement of chiropractic physicians and podiatric
44   physicians and access to such treatment.
45      If there is a discrepancy of reimbursement rates, or conditions on
46   services in contravention of this section, the correction of that
47   discrepancy shall be an elevation of the lower to the higher
48   reimbursement rate or a reduction of the limitations or restrictions
                           A1003 PRIETO, COHEN
                                     4

 1   on the affected health care provider.
 2      An individual health insurer shall not impose disparate
 3   deductibles purely on the basis of the provider's license.
 4   Deductibles shall only be dictated by the insured and which plan is
 5   obtained by the insured and shall not vary based on the physician or
 6   discipline rendering that service.
 7      The provisions of this section shall apply to those individual
 8   health insurance policies or contracts in which the insurer has
 9   reserved the right to change the premium
10
11      3.    (New section)       Notwithstanding any provision of an
12   individual or group hospital service corporation contract delivered
13   or issued for delivery in this State on or after the effective date of
14   this act, whenever such a contract provides for reimbursement for
15   any service which is within the lawful scope of practice of a duly
16   licensed chiropractic physician or podiatric physician, a person
17   covered under that contract or the chiropractic physician or
18   podiatric physician rendering that service shall be entitled to
19   reimbursement for that service at the same rate or fee as is applied
20   to licensed allopathic or osteopathic physicians, or other health care
21   providers, whichever rate is greater. Reimbursement shall be
22   provided at the same rate, regardless of the terminology or billing
23   code used to describe the condition or complaint, diagnosis, service
24   or treatment, without discrimination as to the usual and customary
25   procedures of the allopathic, osteopathic, podiatric or chiropractic
26   physician, when similar services are rendered, as in the case of
27   osteopathic manipulation and chiropractic manipulation or
28   adjustment, which may have different codes but shall be paid at the
29   same rate.       Chiropractic adjunctive procedures and podiatric
30   adjunctive procedures shall not be bundled together for
31   reimbursement purposes, unless similar adjunctive procedures are
32   bundled together for all classes or disciplines of physicians.
33      A hospital service contract may not place any limitation or
34   condition on the services, diagnosis or treatment rendered by a
35   chiropractic physician or podiatric physician covered by this
36   section, or upon the reimbursement thereof, unless that limitation or
37   condition also applies to all classes or disciplines of physicians.
38      The provisions of this section shall be liberally construed in
39   favor of reimbursement of chiropractic physicians and podiatric
40   physicians and access to such treatment.
41      If there is a discrepancy of reimbursement rates, or conditions on
42   services in contravention of this section, the correction of that
43   discrepancy shall be an elevation of the lower to the higher
44   reimbursement rate or a reduction of the limitations or restrictions
45   on the affected health care provider.
46      A hospital service corporation shall not impose disparate
47   deductibles purely on the basis of the provider's license.
48   Deductibles shall only be dictated by the insured and which plan is
                           A1003 PRIETO, COHEN
                                     5

 1   obtained by the insured and shall not vary based on the physician or
 2   discipline rendering that service.
 3      The provisions of this section shall apply to those hospital
 4   service corporation contracts in which the hospital service
 5   corporation has reserved the right to change the premium
 6
 7      4.    (New section)       Notwithstanding any provision of an
 8   individual or group medical service corporation contract delivered
 9   or issued for delivery in this State on or after the effective date of
10   this act, whenever such a contract provides for reimbursement for
11   any service which is within the lawful scope of practice of a duly
12   licensed chiropractic physician or podiatric physician, a person
13   covered under that contract or the chiropractic physician or
14   podiatric physician rendering that service shall be entitled to
15   reimbursement for that service at the same rate or fee as is applied
16   to licensed allopathic or osteopathic physicians, or other health care
17   providers, whichever rate is greater. Reimbursement shall be
18   provided at the same rate, regardless of the terminology or billing
19   code used to describe the condition or complaint, diagnosis, service
20   or treatment, without discrimination as to the usual and customary
21   procedures of the allopathic, osteopathic, podiatric or chiropractic
22   physician, when similar services are rendered, as in the case of
23   osteopathic manipulation and chiropractic manipulation or
24   adjustment, which may have different codes but shall be paid at the
25   same rate.       Chiropractic adjunctive procedures and podiatric
26   adjunctive procedures shall not be bundled together for
27   reimbursement purposes, unless similar adjunctive procedures are
28   bundled together for all classes or disciplines of physicians.
29      A medical service corporation contract may not place any
30   limitation or condition on the services, diagnosis or treatment
31   rendered by a chiropractic physician or podiatric physician covered
32   by this section, or upon the reimbursement thereof, unless that
33   limitation or condition also applies to all classes or disciplines of
34   physicians.
35      The provisions of this section shall be liberally construed in
36   favor of reimbursement of chiropractic physicians and podiatric
37   physicians and access to such treatment.
38      If there is a discrepancy of reimbursement rates, or conditions on
39   services in contravention of this section, the correction of that
40   discrepancy shall be an elevation of the lower to the higher
41   reimbursement rate or a reduction of the limitations or restrictions
42   on the affected health care provider.
43      A medical service corporation shall not impose disparate
44   deductibles purely on the basis of the provider's license.
45   Deductibles shall only be dictated by the insured and which plan is
46   obtained by the insured and shall not vary based on the physician or
47   discipline rendering that service.
48      The provisions of this section shall apply to those medical
                           A1003 PRIETO, COHEN
                                     6

 1   service corporation contracts in which the medical service
 2   corporation has reserved the right to change the premium
 3
 4      5.    (New section)       Notwithstanding any provision of an
 5   individual or group health service corporation contract delivered or
 6   issued for delivery in this State on or after the effective date of this
 7   act, whenever such a contract provides for reimbursement for any
 8   service which is within the lawful scope of practice of a duly
 9   licensed chiropractic physician or podiatric physician, a person
10   covered under that contract or the chiropractic physician or
11   podiatric physician rendering that service shall be entitled to
12   reimbursement for that service at the same rate or fee as is applied
13   to licensed allopathic or osteopathic physicians, or other health care
14   providers, whichever rate is greater. Reimbursement shall be
15   provided at the same rate, regardless of the terminology or billing
16   code used to describe the condition or complaint, diagnosis, service
17   or treatment, without discrimination as to the usual and customary
18   procedures of the allopathic, osteopathic, podiatric or chiropractic
19   physician, when similar services are rendered, as in the case of
20   osteopathic manipulation and chiropractic manipulation or
21   adjustment, which may have different codes but shall be paid at the
22   same rate.       Chiropractic adjunctive procedures and podiatric
23   adjunctive procedures shall not be bundled together for
24   reimbursement purposes, unless similar adjunctive procedures are
25   bundled together for all classes or disciplines of physicians.
26      A health service corporation contract may not place any
27   limitation or condition on the services, diagnosis or treatment
28   rendered by a chiropractic physician or podiatric physician covered
29   by this section, or upon the reimbursement thereof, unless that
30   limitation or condition also applies to all classes or disciplines of
31   physicians.
32      The provisions of this section shall be liberally construed in
33   favor of reimbursement of chiropractic physicians and podiatric
34   physicians and access to such treatment.
35      If there is a discrepancy of reimbursement rates, or conditions on
36   services in contravention of this section, the correction of that
37   discrepancy shall be an elevation of the lower to the higher
38   reimbursement rate or a reduction of the limitations or restrictions
39   on the affected health care provider.
40      A health service corporation shall not impose disparate
41   deductibles purely on the basis of the provider's license.
42   Deductibles shall only be dictated by the insured and which plan is
43   obtained by the insured and shall not vary based on the physician or
44   discipline rendering that service.
45      The provisions of this section shall apply to those health service
46   corporation contracts in which the health service corporation has
47   reserved the right to change the premium.
48      6. (New section) Notwithstanding any provision of a health
                           A1003 PRIETO, COHEN
                                     7

 1   maintenance organization enrollee agreement delivered or issued
 2   for delivery in this State on or after the effective date of this act,
 3   whenever such an agreement provides coverage for any health care
 4   services which are within the lawful scope of practice of a duly
 5   licensed chiropractic physician or podiatric physician, an enrollee
 6   covered under that agreement or the chiropractic physician or
 7   podiatric physician rendering that service shall be entitled to that
 8   service, or reimbursement for that service, as the case may be, at the
 9   same rate or fee as is applied to licensed allopathic or osteopathic
10   physicians, or other health care providers, whichever rate is greater.
11   Services, or reimbursement for services, shall be provided at the
12   same rate, regardless of the terminology or billing code used to
13   describe the condition or complaint, diagnosis, service or treatment,
14   without discrimination as to the usual and customary procedures of
15   the allopathic, osteopathic, podiatric or chiropractic physician,
16   when similar services are rendered, as in the case of osteopathic
17   manipulation and chiropractic manipulation or adjustment, which
18   may have different codes but shall be paid at the same rate.
19   Chiropractic adjunctive procedures and podiatric adjunctive
20   procedures shall not be bundled together for reimbursement
21   purposes, unless similar adjunctive procedures are bundled together
22   for all classes or disciplines of physicians.
23      An enrollee agreement may not place any limitation or condition
24   on the services, diagnosis or treatment rendered by a chiropractic
25   physician or podiatric physician covered by this section, or upon the
26   reimbursement thereof, unless that limitation or condition also
27   applies to all classes or disciplines of physicians.
28      The provisions of this section shall be liberally construed in
29   favor of reimbursement of chiropractic physicians and podiatric
30   physicians and access to such treatment.
31      If there is a discrepancy of reimbursement rates, or conditions on
32   services in contravention of this section, the correction of that
33   discrepancy shall be an elevation of the lower to the higher
34   reimbursement rate or a reduction of the limitations or restrictions
35   on the affected health care provider.
36      A health maintenance organization shall not impose disparate
37   deductibles purely on the basis of the provider's license.
38   Deductibles shall only be dictated by the insured and which plan is
39   obtained by the insured and shall not vary based on the physician or
40   discipline rendering that service.
41      The provisions of this section shall apply to those enrollee
42   agreements in which the health maintenance organization has
43   reserved the right to change the schedule of charges.
44
45      7. (New section) Whenever, pursuant to R.S.34:15-15, an
46   employer provides medical, surgical or other treatment, or payment
47   or reimbursement therefore, for any service which is within the
48   lawful scope of practice of a duly licensed chiropractic physician or
                          A1003 PRIETO, COHEN
                                    8

 1   podiatric physician, an employee or the chiropractic physician or
 2   podiatric physician rendering that service shall be entitled to that
 3   service or to reimbursement for that service as the case may be, at
 4   the same rate or fee as is applied to licensed allopathic or
 5   osteopathic physicians, or other health care providers, whichever
 6   rate is greater. Treatment, or payment or reimbursement for
 7   services, shall be provided at the same rate, regardless of the
 8   terminology or billing code used to describe the condition or
 9   complaint, diagnosis, service or treatment, without discrimination
10   as to the usual and customary procedures of the allopathic,
11   osteopathic, podiatric or chiropractic physician, when similar
12   services are rendered, as in the case of osteopathic manipulation and
13   chiropractic manipulation or adjustment, which may have different
14   codes but shall be paid at the same rate. Chiropractic adjunctive
15   procedures and podiatric adjunctive procedures shall not be bundled
16   together for reimbursement purposes, unless similar adjunctive
17   procedures are bundled together for all classes or disciplines of
18   physicians.
19      An employer may not place any limitation or condition on the
20   services, diagnosis or treatment rendered by a chiropractic
21   physician or podiatric physician covered by this section, or upon the
22   reimbursement thereof, unless that limitation or condition also
23   applies to all classes or disciplines of physicians.
24      The provisions of this section shall be liberally construed in
25   favor of reimbursement of chiropractic physicians and podiatric
26   physicians and access to such treatment.
27      If there is a discrepancy of reimbursement rates, or conditions on
28   services in contravention of this section, the correction of that
29   discrepancy shall be an elevation of the lower to the higher
30   reimbursement rate or a reduction of the limitations or restrictions
31   on the affected health care provider.
32      A workers' compensation insurance carrier shall not impose
33   disparate deductibles purely on the basis of the provider's license.
34   Deductibles shall only be dictated by the insured and which plan is
35   obtained by the insured and shall not vary based on the physician or
36   discipline rendering that service.
37
38      8. Section 10 of P.L.1988, c.119 (C.39:6A-4.6) is amended to
39   read as follows:
40      10. a. The Commissioner of Banking and Insurance shall,
41   within 90 days after the effective date of P.L.1990, c.8 (C.17:33B-1
42   et al.), promulgate medical fee schedules on a regional basis for the
43   reimbursement of health care providers providing services or
44   equipment for medical expense benefits for which payment is to be
45   made by an automobile insurer under personal injury protection
46   coverage pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.), or by an
47   insurer under medical expense benefits coverage pursuant to section
48   2 of P.L.1991, c.154 (C.17:28-1.6). These fee schedules shall be
                           A1003 PRIETO, COHEN
                                     9

 1   promulgated on the basis of the type of service provided, and shall
 2   incorporate the reasonable and prevailing fees of 75% of the
 3   practitioners within the region. If, in the case of a specialist
 4   provider, there are fewer than 50 specialists within a region, the fee
 5   schedule shall incorporate the reasonable and prevailing fees of the
 6   specialist providers on a Statewide basis. The commissioner may
 7   contract with a proprietary purveyor of fee schedules for the
 8   maintenance of the fee schedule, which shall be adjusted biennially
 9   for inflation and for the addition of new medical procedures.
10      b. The fee schedule may provide for reimbursement for
11   appropriate services on the basis of a diagnostic-related (DRG)
12   payment by diagnostic code where appropriate, and may establish
13   the use of a single fee, rather than an unbundled fee, for a group of
14   services if those services are commonly provided together. In the
15   case of multiple procedures performed simultaneously, the fee
16   schedule and regulations promulgated pursuant thereto may also
17   provide for a standard fee for a primary procedure, and proportional
18   reductions in the cost of the additional procedures.
19      c. No health care provider may demand or request any payment
20   from any person in excess of those permitted by the medical fee
21   schedules established pursuant to this section, nor shall any person
22   be liable to any health care provider for any amount of money
23   which results from the charging of fees in excess of those permitted
24   by the medical fee schedules established pursuant to this section.
25      d. Notwithstanding any provision of this section to the contrary,
26   whenever the medical fees schedules established pursuant to this
27   section provide for payment or reimbursement for any service
28   which is within the lawful scope of practice of a duly licensed
29   chiropractic physician or podiatric physician, a person covered for
30   medical expense benefits or the chiropractic physician or podiatric
31   physician rendering that service shall be entitled to reimbursement
32   for that service at the same rate or fee as is applied to licensed
33   allopathic or osteopathic physicians, or other health care providers,
34   whichever rate is greater. Reimbursement shall be provided at the
35   same rate, regardless of the terminology or billing code used to
36   describe the condition or complaint, diagnosis, service or treatment,
37   without discrimination as to the usual and customary procedures of
38   the allopathic, osteopathic, podiatric or chiropractic physician,
39   when similar services are rendered, as in the case of osteopathic
40   manipulation and chiropractic manipulation or adjustment, which
41   may have different codes but shall be paid at the same rate.
42   Chiropractic adjunctive procedures and podiatric adjunctive
43   procedures shall not be bundled together for reimbursement
44   purposes, unless similar adjunctive procedures are bundled together
45   for all classes or disciplines of physicians.
46      The medical fee schedules may not place any limitation or
47   condition on the services, diagnosis or treatment rendered by
48   chiropractic physician or podiatric physician covered by this
                           A1003 PRIETO, COHEN
                                    10

 1   subsection, or upon the reimbursement thereof, unless that
 2   limitation or condition also applies to all classes or disciplines of
 3   physicians.
 4      The provisions of this subsection shall be liberally construed in
 5   favor of reimbursement of chiropractic physicians and podiatric
 6   physicians and access to such treatment.
 7      If there is a discrepancy of reimbursement rates, or conditions on
 8   services in contravention of this section, the correction of that
 9   discrepancy shall be an elevation of the lower to the higher
10   reimbursement rate or a reduction of the limitations or restrictions
11   on the affected health care provider.
12      The medical fee schedules shall not impose disparate deductibles
13   purely on the basis of the provider's license. Deductibles shall only
14   be dictated by the insured and which plan is obtained by the insured
15   and shall not vary based on the physician or discipline rendering
16   that service.
17   (cf: P.L.1997, c.151, s.33)
18
19      9. This act shall take effect immediately.
20
21
22                               STATEMENT
23
24
25      This bill provides that, with respect to certain health insurance
26   policies issued by hospital, medical and health service corporations,
27   commercial individual and group insurers and health maintenance
28   organizations, worker's compensation coverage and automobile
29   insurance personal injury protection, whenever any covered health
30   care service is within the lawful scope of practice of a chiropractic
31   physician or podiatric physician, a covered individual or the
32   chiropractic physician or podiatric physician rendering that service
33   shall be entitled to reimbursement for that service at the same rate
34   as is applied to licensed allopathic or osteopathic physicians, or
35   other health care providers, whichever is greater. Under the bill, a
36   policy or contract may not place any limitation or condition on the
37   services, diagnosis or treatment rendered by a chiropractic
38   physician, or podiatric physician, or upon the reimbursement
39   thereof, unless that limitation or condition also applies to all classes
40   or disciplines of physicians.
41      As provided in the bill, reimbursement shall be provided at the
42   same rate, regardless of the terminology or billing code used.
43   Where there is a discrepancy of reimbursement rates, or conditions
44   on services, the correction of that discrepancy shall be an elevation
45   of the lower to the higher reimbursement rate or a reduction of the
46   limitations or restrictions on the affected health care provider. The
47   bill also provides that carriers or employers shall not impose
48   disparate deductibles purely on the basis of the provider's license.
                         A1003 PRIETO, COHEN
                                  11

1   Deductibles shall only be dictated by the insured and which plan is
2   obtained by the insured and shall not vary based on the physician or
3   discipline rendering that service.