Bill > S811

This bill aims to improve outcomes for individuals with limb loss and limb difference by expanding and standardizing prosthetic and orthotic device coverage across various Massachusetts health insurance programs, including MassHealth. The bill defines prosthetic devices as artificial limb devices that replace part or all of an arm or leg, including devices designed for specific physical activities, and orthotic devices as supportive devices used to align, correct, or prevent body deformities. Key provisions include requiring health insurers to provide coverage for both daily-use and activity-specific prosthetic and orthotic devices, ensuring these devices are designed to maximize an individual's ability to ambulate, run, bike, swim, and improve upper limb function. The bill mandates that insurers cannot deny coverage solely based on disability, must provide access to at least two prosthetic providers, and allow device replacements when medically necessary, such as due to changes in a patient's physiological condition or when repair costs exceed 60% of a replacement device's cost. Additionally, the bill stipulates that cost-sharing for these devices cannot be more restrictive than those for inpatient surgical services, and requires insurers to consider these benefits as habilitative or rehabilitative under state and federal essential health benefit requirements. The legislation applies to multiple state health insurance programs, including MassHealth, state employee health plans, and various types of health insurance contracts.

Budget and Finance, Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S811