Bill > HB1391

This bill amends Pennsylvania insurance law to require health insurance policies to provide coverage for custom medical devices like prosthetics, orthotics, and pedorthic devices when prescribed by authorized healthcare professionals. The bill mandates that insurers cover the initial fitting, repair, and replacement of these devices when medically necessary, and requires that such devices be provided by licensed professionals in Pennsylvania who are contracted with the insurer. The bill defines various technical terms like "custom-fabricated device" and "prosthesis" and specifies that insurers may require preauthorization to determine medical necessity. Importantly, the bill requires that Medicaid and contracted insurers reimburse for these devices at the same rate as the Federal Medicare reimbursement schedule. The coverage extends to devices used for sports purposes and is subject to standard policy copayments and deductibles. Healthcare providers prescribing these devices must document the medical necessity of the prescription. The bill will apply to health insurance policies for which forms or rates are filed 180 days after its effective date, and it will take effect 60 days after passage. This legislation aims to ensure comprehensive and standardized coverage for patients requiring specialized medical devices.

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https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=H&type=B&bn=1391