Bill > H1178

This bill aims to improve insurance coverage for individuals with limb loss and limb difference by establishing comprehensive regulations for prosthetic and orthotic devices across various types of health insurance in Massachusetts. 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. It mandates that insurers provide coverage for both daily-use and activity-specific prosthetic and orthotic devices, ensuring that individuals can maximize their mobility and upper limb function for activities like running, biking, swimming, and showering. The legislation prohibits insurers from denying coverage based on a person's actual or perceived disability, requires nondiscriminatory utilization determinations, and ensures that cost-sharing for these devices is not more restrictive than coverage for inpatient surgical services. Additionally, the bill requires health plans to provide access to at least two prosthetic and orthotic providers in-network, with provisions for out-of-network referrals when necessary, and allows for device replacement without lifetime-use restrictions when medically justified by changes in a patient's physiological condition or device functionality.

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https://malegislature.gov/Bills/194/H1178