House Bill No. 477, introduced by Representative Hebert, seeks to improve health insurance coverage for prosthetic and custom orthotic devices in Louisiana by enacting new provisions under R.S. 22:1049.1. The bill mandates that health coverage plans provide comprehensive coverage for these devices, including various options, materials, and necessary repairs or replacements deemed medically necessary. It establishes criteria for medical necessity determinations, outlines prior authorization processes, and includes nondiscrimination provisions to ensure equitable access for individuals with disabilities. The legislation also sets network adequacy standards and reporting requirements for health coverage plans, ensuring that individuals receive the necessary medical devices.

Additionally, the bill repeals the existing R.S. 22:1049 and replaces it with the new coverage requirements effective January 1, 2027. It specifies that coverage must include instructional support for the proper use of devices and allows for cost-sharing that is not more restrictive than other benefits. The bill emphasizes that prosthetic and custom orthotic devices must be provided by accredited facilities and that coverage must be treated as rehabilitative and habilitative services. Furthermore, it requires the Louisiana Medicaid program to provide similar coverage and establishes reporting requirements for health coverage plans regarding claims experience, ensuring that individuals have access to necessary services and clear communication about their coverage rights.

Statutes affected:
HB477 Original: