This bill amends Florida Statutes to enhance coverage for orthotics and prosthetics services for eligible individuals under Medicaid and private health insurance policies. It defines "eligible individual" as a child under 18, a dependent child, an individual up to 26 years old covered under a parent's policy, or an individual with a developmental disability. The Agency for Health Care Administration is authorized to provide and pay for specific orthotics and prosthetics services for Medicaid recipients who meet these criteria. Additionally, the bill mandates that individual health insurance policies, group, blanket, and franchise health insurance policies, and health maintenance contracts must cover these services for eligible individuals starting July 1, 2026.

The bill outlines the specific services covered, including orthoses and prostheses deemed medically necessary, as well as necessary repairs and replacements. Health insurers and health maintenance organizations are prohibited from denying claims for medically necessary interventions for eligible individuals with disabilities that would otherwise be covered for non-disabled individuals. Furthermore, insurers are required to submit annual reports detailing claims for orthotics and prosthetics services. The bill also stipulates that the Agency for Health Care Administration must seek federal approval to implement these changes. The act is set to take effect on July 1, 2026.

Statutes affected:
S 1110 Filed: 409.906