No. CS/SB 1110
Filed under Insurance.
Coverage for Orthotics and Prosthetics Services; Authorizing the Agency for Health Care Administration to authorize and pay for specified orthotics and prosthetics services for Medicaid recipients who are eligible individuals; requiring the agency to seek federal approval and amend contracts as necessary to implement the act; requiring individual health insurance policies; group, blanket, and franchise health insurance policies; and health maintenance contracts, respectively, to provide coverage for specified orthotics and prosthetics services for eligible individuals, etc.
Plain English Summary
AI-GENERATEDIndividual, group, and HMO health plans must now cover orthotics and prosthetics for a defined group: minors, dependents up to 26 on a parent's plan, and anyone with a developmental disability.
Required coverage includes devices for daily living and job tasks, but also devices for recreational activities like running, biking, and swimming, whenever a provider deems that medically necessary.
Replacements must be covered regardless of how long a device has been in use, and insurers can't deny a prosthesis as medically unnecessary if a nondisabled person seeking the same physical-function repair would be covered.
Medicaid separately gains discretionary authority to pay for the same benefit, and insurers must start reporting orthotics and prosthetics claims data to state regulators each year starting in 2027.
AIIndividual, group, and HMO plans must cover an orthosis or prosthesis for an eligible individual whenever a provider deems it medically necessary for daily living, job duties, or physical recreational activities such as running or swimming.
AIThe mandate reaches only children under 18, dependents (including those up to 26 remaining on a parent's plan), and people with a developmental disability. Every private-coverage section states it creates no guarantee for anyone outside that definition.
AIA device must be replaced regardless of continuous-use or useful-lifetime limits when the person's condition changes, the device is irreparably damaged, or repairs would cost more than 60 percent of a replacement's cost.
AIAn insurer cannot reject a medically necessary prosthesis or orthosis for a disabled person's physical-function restoration if the same kind of restorative care would be covered for a nondisabled person.
AIAHCA may, but is not required to, authorize and pay for orthoses, prostheses, related materials, instruction, and repairs or replacement for the same eligible-individual population, subject to federal approval.
AIStarting July 1, 2027, each health insurer and HMO subject to these sections must report to the Office of Insurance Regulation how many orthotics and prosthetics claims it received and how many it paid.