Bill > HB272

This bill mandates that health care insurers in Alaska must provide coverage for prosthetic and orthotic devices, which are artificial limbs or braces used to improve function and mobility, at a level at least equal to federal standards, ensuring coverage for the most appropriate devices to meet a person's medical needs for daily living, work, physical activities, and overall health. This coverage must include all necessary materials and components, as well as instructions for use, and must also cover repairs or replacements of these devices when a person's physical condition changes or the device itself becomes non-functional, without imposing arbitrary limits based on continuous use or a device's "useful lifetime." Furthermore, the bill requires insurers to classify these benefits as either habilitative (helping someone achieve a skill or ability they never had) or rehabilitative (helping someone regain a skill or ability they lost) to meet essential health benefit requirements, and prohibits denying coverage for individuals with limb loss or absence if the same service would be covered for a non-disabled person. Insurers must also provide replacement coverage if repair costs exceed 60% of the replacement cost, and while they can require confirmation from a healthcare provider for devices less than three years old, they cannot impose financial requirements solely on prosthetic and orthotic coverage that are more restrictive than those for inpatient physician and surgical services. The bill also ensures that health insurance networks include at least two prosthetic and orthotic providers, and if medically necessary devices aren't available in-network, the insurer must refer the patient to an out-of-network provider and fully reimburse them. Additionally, the bill amends the state's medical assistance program (Medicaid) to include prosthetic and orthotic devices and replacements as covered services, contingent on federal approval, and requires insurers and the Department of Health to report on claims and costs related to these devices.

Health and Social Services

https://www.akleg.gov/basis/Bill/Detail/34?Root=HB272