Bill > S836

This bill aims to improve insurance coverage for individuals with limb loss and limb difference by mandating comprehensive coverage for prosthetic and orthotic devices across various state healthcare programs and insurance plans. The legislation defines prosthetic devices as artificial limb devices that replace part or all of an arm or leg, including devices designed specifically for athletic purposes, and orthotic devices as supportive devices used to align, correct, or prevent body deformities and assist with joint or body part motion. The bill requires insurance providers, including the state employee health insurance commission, MassHealth, and private health insurance plans, to provide coverage for prosthetic and orthotic devices that are custom-built or fitted for specific enrollees, with the goal of maximizing the individual's ability to perform physical activities like ambulation, running, biking, and swimming, as well as improving upper limb function. Additionally, the bill stipulates that this coverage must include repair and replacement of such devices for physical or athletic purposes. For MassHealth members, the bill also requires a detailed written prescription from a licensed physician or independent nurse practitioner, which must include specific information about the patient and medical justification for the device.

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https://malegislature.gov/Bills/194/S836