New Jersey § 26:2j-4

§ 26:2j-4.

Notwithstanding any provision of law to the contrary, a certificate of authority to

establish and operate a health maintenance organization in this State shall not be

issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this act unless the health maintenance organization

provides health care services to each enrollee for the therapeutic treatment of inherited

metabolic diseases, including the purchase of medical foods and low protein modified

food products, when diagnosed and determined to be medically necessary by the enrollee's

physician. For the purposes of this section, “ inherited metabolic disease ” means a disease caused by an inherited abnormality of body chemistry for which testing

is mandated pursuant to P.L.1977, c. 321 ( C.26:2-110 et seq. ); “ low protein modified food product ” means a food product that is specially formulated to have less than one gram of

protein per serving and is intended to be used under the direction of a physician

for the dietary treatment of an inherited metabolic disease, but does not include

a natural food that is naturally low in protein; and “ medical food ” means a food that is intended for the dietary treatment of a disease or condition

for which nutritional requirements are established by medical evaluation and is formulated

to be consumed or administered enterally under direction of a physician. The health care services shall be provided to the same extent as for any other medical

condition under the contract. The provisions of this section shall apply to all contracts for health care services

by health maintenance organizations under which the right to change the schedule of

charges for enrollee coverage is reserved.