An Act concerning foot care and supplementing Titles 17 and 26 of the Revised Statutes and Title 17B of the New Jersey Statutes.

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

1. A hospital service corporation contract that 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, that provides hospital or medical expense benefits that include foot care services shall be deemed to include foot care services provided by a podiatric physician.

If the contract excludes coverage for routine foot care services, the term routine foot care services shall mean the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails; except that the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails in the presence of metabolic disease shall not be considered routine foot care services. The hospital service corporation shall make available to a participating health care provider, upon request, a list specifying the types of foot care services, and their related diagnostic and procedure codes, that are excluded under the contract.

Reimbursement for covered services shall be equal for all providers performing the same services as indicated by the procedure code assigned to the service.

This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

2. A medical service corporation contract that 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, that provides hospital or medical expense benefits that include foot care services shall be deemed to include foot care services provided by a podiatric physician.

If the contract excludes coverage for routine foot care services, the term routine foot care services shall mean the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails; except that the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails in the presence of metabolic disease shall not be considered routine foot care services. The medical service corporation shall make available to a participating health care provider, upon request, a list specifying the types of foot care services, and their related diagnostic and procedure codes, that are excluded under the contract.

Reimbursement for covered services shall be equal for all providers performing the same services as indicated by the procedure code assigned to the service.

This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.

3. A health service corporation contract that is delivered, issued, executed, or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-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, that provides hospital or medical expense benefits that include foot care services shall be deemed to include foot care services provided by a podiatric physician.

If the contract excludes coverage for routine foot care services, the term routine foot care services shall mean the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails; except that the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails in the presence of metabolic disease shall not be considered routine foot care services. The health service corporation shall make available to a participating health care provider, upon request, a list specifying the types of foot care services, and their related diagnostic and procedure codes, that are excluded under the contract.

Reimbursement for covered services shall be equal for all providers performing the same services as indicated by the procedure code assigned to the service.

This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.

4. An individual health insurance policy that is delivered, issued, executed, or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, 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, that provides hospital or medical expense benefits that include foot care services shall be deemed to include foot care services provided by a podiatric physician.

If the policy excludes coverage for routine foot care services, the term routine foot care services shall mean the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails; except that the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails in the presence of metabolic disease shall not be considered routine foot care services. The insurer shall make available to a participating health care provider, upon request, a list specifying the types of foot care services, and their related diagnostic and procedure codes, that are excluded under the policy.

Reimbursement for covered services shall be equal for all providers performing the same services as indicated by the procedure code assigned to the service.

This section shall apply to those policies in which the insurer has reserved the right to change the premium.

5. A group health insurance policy that is delivered, issued, executed, or renewed in this State pursuant to chapter 27 of Title 17B of the New Jersey Statutes, 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, that provides hospital or medical expense benefits that include foot care services shall be deemed to include foot care services provided by a podiatric physician.

Reimbursement for covered services shall be equal for all providers performing the same services as indicated by the procedure code assigned to the service.

This section shall apply to those policies in which the insurer has reserved the right to change the premium.

6. An individual health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 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, that provides hospital or medical expense benefits that include foot care services shall be deemed to include foot care services provided by a podiatric physician.

If the health benefits plan excludes coverage for routine foot care services, the term routine foot care services shall mean the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails; except that the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails in the presence of metabolic disease shall not be considered routine foot care services. The carrier shall make available to a participating health care provider, upon request, a list specifying the types of foot care services, and their related diagnostic and procedure codes, that are excluded under the plan.

Reimbursement for covered services shall be equal for all providers performing the same services as indicated by the procedure code assigned to the service.

This section shall apply to those individual health benefits plans in which the carrier has reserved the right to change the premium.

7. A small employer health benefits plan that 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, that provides hospital or medical expense benefits that include foot care services shall be deemed to include foot care services provided by a podiatric physician.

Reimbursement for covered services shall be equal for all providers performing the same services as indicated by the procedure code assigned to the service.

This section shall apply to those small employer health benefits plans in which the carrier has reserved the right to change the premium.

8. Every certificate of authority to establish and operate a health maintenance organization issued or continued in this State pursuant to P.L.1973, c.337 (C.26:2J-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, for a health maintenance organization which provides health care services for foot care shall be deemed to include foot care services provided by a podiatric physician.

If the contract excludes coverage for routine foot care services, the term routine foot care services shall mean the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails; except that the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails in the presence of metabolic disease shall not be considered routine foot care services. The health maintenance organization shall make available to a participating health care provider, upon request, a list specifying the types of foot care services, and their related diagnostic and procedure codes, that are excluded under the contract.

Reimbursement for covered services shall be equal for all providers performing the same services as indicated by the procedure code assigned to the service.

The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.

9. This act shall take effect on the first day of the fourth month next following the date of enactment and shall apply to policies, contracts, or plans issued or renewed on or after the effective date.

STATEMENT

This bill would require that a health benefits plan of a hospital, medical or health service corporation, individual, small employer or large group commercial insurer, or health maintenance organization that provides coverage for foot care services would be deemed to include foot care services provided by a podiatric physician.

If the health benefits plan excludes coverage for routine foot care services, the term "routine foot care services" would mean the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails; except that the treatment or removal of asymptomatic corns, asymptomatic calluses, or asymptomatic toenails in the presence of metabolic disease would not be considered routine foot care services. The bill would also require the carrier to make available to a participating health care provider, upon request, a list specifying the types of foot care services, and their related diagnostic and procedure codes, that are excluded under the plan.

The bill would additionally require that reimbursement for a covered service be equal for all providers performing the same service, as indicated by the procedure code assigned to the service.