The bill amends Louisiana law to enhance health insurance coverage for prosthetic and orthotic devices and services. It modifies R.S. 22:1049 to require health coverage plans to include coverage for a range of devices, materials, components, repairs, and replacements, while establishing criteria for medical necessity determinations. Key provisions include prior authorization, cost-sharing, nondiscrimination, and network adequacy standards. Importantly, the bill ensures that coverage cannot exclude devices intended for physical activity or bathing, and mandates that any denial of coverage based on medical necessity must be communicated in writing.

Furthermore, the bill introduces Part IX of Chapter 5-E of Title 40, which requires the Louisiana Medicaid program to cover medically necessary prosthetic and custom orthotic devices and services. It outlines the responsibilities of health coverage plans to provide access to accredited facilities and specifies that coverage for repairs and replacements must meet medical necessity standards. The legislation also sets an annual benefit limit of no less than $50,000 per limb and requires health plans to report claims data starting July 1, 2029. Coverage requirements will take effect for new health plans on January 1, 2027, and for existing plans upon renewal by January 1, 2028.

Statutes affected:
HB1235 Original:
HB1235 Engrossed:
HB1235 Reengrossed: