No. HB 1301
Filed under Insurance.
Coverage for Orthotics and Prosthetics Services; Authorizes AHCA to authorize & pay for specified orthotics & prosthetics services for Medicaid recipients; requires agency to seek federal approval & amend contracts as necessary to implement act; requires individual health insurance policies; group, blanket, & franchise health insurance policies; & health maintenance contracts, respectively, to provide coverage for specified orthotics & prosthetics services; prohibits health insurers & health maintenance organizations from denying claims; requires health insurers & health maintenance organizations to submit annual reports of specified information to OIR.
Plain English Summary
AI-GENERATEDIndividual, group, and HMO health plans in Florida must now cover orthoses and prostheses whenever a provider determines the device is medically necessary for daily living, job duties, or physical recreational activities like running or swimming.
Unlike some coverage mandates, this one is not limited to children or dependents; it reaches any insured or subscriber whose provider makes that medical-necessity finding.
Replacement devices must be covered regardless of how long the current one has been used, and insurers can't deny a claim for someone with limb loss or limb absence if a nondisabled person's equivalent restorative care would be covered.
Medicaid separately gains discretionary authority to pay for the same services, and insurers must start reporting annual claims data for orthotics and prosthetics starting in 2027.
AIAny individual, group, blanket, franchise, or HMO health plan must cover a medically necessary orthosis or prosthesis for any insured or subscriber. There is no age, dependent-status, or disability-category gate on who qualifies.
AIThe required device must be covered whenever a provider finds it medically necessary not just for daily living or work, but for physical recreational activities such as running, biking, or swimming.
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 or HMO cannot deny a prosthesis or orthosis claim for a person with limb loss or limb absence 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 any Medicaid recipient, subject to federal approval.
AIStarting July 1, 2027, each health insurer and HMO subject to these sections must report the total number of orthotics and prosthetics claims submitted and paid, including the amount paid, to "the office."