The proposed bill would amend current statutes to mandate that health care insurers provide coverage for prosthetic and orthotic devices that is at least equivalent to Medicare Part B, effective January 1, 2027. This coverage would include the purchase, fitting, adjustment, repair, and replacement of devices, as well as necessary materials and components. Insurers would also be required to ensure that subscribers have access to at least two distinct providers of these devices within the state and must facilitate referrals to out-of-network providers when necessary. Additionally, the bill prohibits insurers from imposing more restrictive cost-sharing requirements for these devices compared to other medical services.

Furthermore, the bill introduces annual reporting requirements for health care insurers, starting January 1, 2028, where they must report the total number of claims and amounts paid for prosthetic and orthotic devices. The Department of Insurance and Financial Institutions (DIFI) would compile this information and submit a report to the Legislature, with the reporting requirement set to be repealed on January 1, 2032. The bill also establishes subscriber rights, including the requirement for written denial letters if coverage is denied and ensures that coverage cannot be denied based on an insured's disability. Overall, these updates aim to improve access to essential medical devices for individuals with disabilities while enhancing transparency and accountability from insurers.

Statutes affected:
Introduced Version: 20-826.06, 20-1057.21, 20-1342.09, 20-1404.07, 20-1342.0