Bill > HB383

This bill requires the Maryland Medical Assistance Program and certain health insurers to provide comprehensive coverage for orthoses (custom-designed medical devices used to treat neuromuscular or musculoskeletal disorders) beginning January 1, 2026. The legislation mandates that insurers, health service plans, and health maintenance organizations must provide annual coverage for orthoses, their components, repairs, and replacements under specific conditions. Replacements will be covered without lifetime use restrictions if a healthcare provider determines they are necessary due to changes in the patient's physiological condition, irreparable changes to the orthosis, or when repair costs would exceed 60% of replacement costs. The bill ensures that orthosis coverage cannot be subject to higher copayments than other medical benefits and prohibits annual or lifetime dollar maximums. Importantly, medical necessity determinations must align with Medicare coverage guidelines, and coverage includes orthoses that help patients complete daily living activities, job-related tasks, and physical activities. The bill also requires entities to report on their compliance with these new coverage requirements, with a joint report to be submitted to legislative committees by December 31, 2031, detailing the number and total amount of claims paid for orthosis coverage.