The bill amends section 409.906 of the Florida Statutes to authorize the Agency for Health Care Administration to provide coverage for specific orthotics and prosthetics services for Medicaid recipients, contingent upon federal approval and necessary contract amendments. It introduces new sections (627.64085, 627.6614, and 641.31079) that require individual health insurance policies, group health insurance policies, and health maintenance contracts to cover orthotics and prosthetics services. The bill specifies that coverage must include medically necessary orthoses and prostheses, as well as related materials, instructions, and repairs. Additionally, it prohibits health insurers and health maintenance organizations from denying claims for these services under certain conditions.

Furthermore, the bill mandates that health insurers and health maintenance organizations submit annual reports detailing the number of claims submitted and paid for orthotics and prosthetics services. It also establishes that claims for orthoses or prostheses cannot be denied for individuals with limb loss or absence if they would otherwise be covered for nondisabled individuals. The act is set to take effect on July 1, 2026.

Statutes affected:
H 1301 Filed: 409.906