LEGISLATIVE FISCAL ESTIMATE
[First Reprint]
SENATE, No. 1439
STATE OF NEW JERSEY
221st LEGISLATURE
DATED: JUNE 28, 2024
SUMMARY
Synopsis: Requires health benefits coverage for additional orthotic and
prosthetic appliances under certain circumstances; requires coverage
for orthotic and prosthetic appliances obtained through podiatrists.
Type of Impact: Annual expenditure increase to the State General Fund and certain
local government units.
Agencies Affected: Division of Pensions and Benefits in the Department of the Treasury;
certain local government units.
Office of Legislative Services Estimate
Fiscal Impact Annual
State Expenditure Increase $171,000 to $215,000
Local Expenditure Increase $290,000 to $363,000
Total Expenditure Increase $461,000 to $577,000
 The Office of Legislative Services (OLS) estimates that requiring health benefits coverage for
an additional orthotic or prosthetic applicant under certain circumstances will result in a total
annual increase of $461,000 to $577,000 in State and local government unit expenditures for
the State Health Benefits Program and the School Employees’ Health Benefits Program.
 A report by the New Jersey Mandated Health Benefits Advisory Commission prior to the
passage of the State’s initial mandate for health benefits coverage for orthotic and prosthetic
appliances found that health care premiums for the fully insured group insurance and individual
insurance markets were likely to increase by 0.025 percent due to the mandate. A subsequent
analysis for a related, but limited mandate in Maine suggested that expanding coverage for
prosthetics for devices necessary for recreational activities would increase premiums by up to
0.02 percent.
 The OLS does not know the actual number of covered individuals whose physicians will
determine that an additional prosthetic appliance is medically necessary to engage in physical
recreational activities, but assumes for the purpose of the analysis that half of all covered
Office of Legislative Services Legislative Budget and Finance Office
State House Annex Phone (609) 847-3105
P.O. Box 068 Fax (609) 777-2442
Trenton, New Jersey 08625 www.njleg.state.nj.us
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individuals granted prosthetic devices for medical necessity under current law could be
approved for an additional prosthetic device for recreational use.
BILL DESCRIPTION
This bill requires health benefits coverage for an additional orthotic or prosthetic device from
a licensed specialist if the covered person’s physician determines that an additional appliance is
necessary for physical and recreational activities. This bill also requires health benefits coverage
for an orthotic or prosthetic device from a licensed podiatrist if the covered person’s physician
determines that an appliance is medically necessary.
Current law requires health benefits coverage for one orthotic or prosthetic device from a
licensed specialist per covered person if the covered person’s physician determines that the
appliance is medically necessary.
By law, the reimbursement rate for orthotic and prosthetic appliances is the same as the
reimbursement rate for such appliances under the federal Medicare reimbursement schedule.
FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS estimates that requiring health benefits coverage for an additional orthotic or
prosthetic applicant under certain circumstances will result in a total annual increase of $461,000
to $577,000 in State and local government unit expenditures for the State Health Benefits Program
and the School Employees’ Health Benefits Program.
The OLS does not know the actual number of covered individuals whose physicians will
determine that an additional prosthetic appliance is medically necessary to engage in physical
recreational activities, but assumes for the purpose of this analysis that half of all covered
individuals granted prosthetic devices for medical necessity under current law could be approved
for an additional prosthetic device for recreational use.
A report by the New Jersey Mandated Health Benefits Advisory Commission prior to the
passage of the State’s initial mandate for health benefits coverage for orthotic and prosthetic
appliances found that health care premiums for the fully insured group insurance and individual
insurance markets were likely to increase by 0.025 percent. Under current law, the State Health
Benefits Program and the School Employees’ Health Benefits program are included in the State
mandate.
Based on data from the Plan Year 2024 Rate Setting Analyses, a 0.01 percent increase in
projected costs for incurred medical claims would result in expenditure increases of approximately
$215,000 for the State portion of the State Health Benefits Program, $156,000 for the local portion
of the State Health Benefits Program, and $208,000 for the School Employees’ Health Benefits
Program for Plan Year 2024 before cost-sharing.
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Section: State Government
Analyst: Camryn Mathews
Assistant Fiscal Analyst
Approved: Thomas Koenig
Legislative Budget and Finance Officer
This legislative fiscal estimate has been produced by the Office of Legislative Services due to the
failure of the Executive Branch to respond to our request for a fiscal note.
This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).


Statutes affected:
Introduced: 17:48-6, 17:48A-7, 17:48E-35.30, 17B:26-2.1, 17B:27-46.1, 17B:27A-7.13, 17B:27A-19.17, 26:2J-4.31, 52:14-17.29