Bill > HB2333

This bill mandates that various types of health insurance providers in Arizona, including hospital service corporations, medical service corporations, health care services organizations, disability insurers, and group or blanket disability insurers, must provide coverage for prosthetic devices and orthotic devices that is at least as good as Medicare Part B coverage, and not on less favorable terms than other medical benefits, for policies issued or renewed on or after January 1, 2027. This coverage must include the purchase, fitting, adjustment, repair, and replacement of these devices to restore function and appearance, as well as necessary materials and rehabilitative benefits, with the determination of medical necessity made by a healthcare provider who selects the most appropriate device. Insurers must clearly outline these rights in their policies, provide written denial letters if coverage is refused, and cannot impose separate or more restrictive cost-sharing for these devices than for other medical services. Furthermore, insurers must ensure access to at least two distinct prosthetic and orthotic device providers in Arizona and facilitate out-of-network referrals and reimbursement if in-network options are unavailable. Coverage for replacement devices or parts is required without strict usage or lifetime limits if a healthcare provider determines replacement is necessary due to changes in the patient's condition, irreparable damage to the device, or if repair costs exceed sixty percent of a replacement. Insurers are prohibited from altering premiums or benefits based on a patient's disability or denying coverage for limb loss, absence, or difference if similar benefits would be provided to someone without a disability seeking to restore or maintain physical activity. The bill also requires the Department of Insurance and Financial Institutions to issue an annual report starting January 1, 2028, providing guidance on necessary medical care and devices for restoring full physical activity for individuals with limb loss, difference, or mobility impairments, and mandates that the specified insurance entities submit annual reports on claims and payments for these devices to the department until January 1, 2032, when this reporting requirement is set to expire.

Budget and Finance, Health and Social Services

https://apps.azleg.gov/BillStatus/BillOverview/84077