NJ Parity Law

Schwelke, Eric

Description

Title:

NJ Parity Law

Creator:

Schwelke, Eric

Date:

12/13/2011

Text:

In response to my post from 12/9/11:

For those on the list from New Jersey:

Let me pose this scenario and would appreciate any insight.

Self-funded plans written in New Jersey from any health insurer may elect to follow the NJ Parity Law (The Mandate) for prosthetics and orthotics. If they state that they do follow the Mandate, are they able to choose which part of the law they want to follow, i.e., they provide the benefits according to the law but do not follow the requirement to pay at the current Medicare fee schedule for the region.

In other words, if they follow the law, can they pick and choose which parts they want to adhere to, or is it all or nothing?

Our corporate legal department says that in fact, companies writing self-funded plans in NJ do have the ability to pick, choose, and use different parts out of the parity law as it benefits them. So, while they can say they provide the benefits required under the law, they don't have to pay the mandated fee, but rely on their contracted fee schedules.

Tricky, tricky.

At this point, no NJ Listserv members have indicated knowledge of this.


Eric Schwelke CPO LPO, Director
Kessler O & P Services
11 Microlab Road
Livingston, NJ 07039
973 992 9700 Ext 201
Success in Motion



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Citation

Schwelke, Eric, “NJ Parity Law,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/233121.