NJ Parity Law
Schwelke, Eric
Description
Collection
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
Note: The information contained in this message may be
privileged and confidential and protected from
disclosure. If the reader of this message is not the
intended recipient, or an employee or agent responsible
for delivering this message to the intended recipient, you
are hereby notified that any dissemination, distribution
or copying of this communication is strictly prohibited.
If you have received this communication in error, please
notify us immediately by replying to the message and
deleting it from your computer. Thank you.
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
Note: The information contained in this message may be
privileged and confidential and protected from
disclosure. If the reader of this message is not the
intended recipient, or an employee or agent responsible
for delivering this message to the intended recipient, you
are hereby notified that any dissemination, distribution
or copying of this communication is strictly prohibited.
If you have received this communication in error, please
notify us immediately by replying to the message and
deleting it from your computer. Thank you.
Citation
Schwelke, Eric, “NJ Parity Law,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/233121.
