The bill introduced by Representative Hebert amends Louisiana law to enhance health insurance coverage for prosthetic and orthotic devices and services. It mandates that health coverage plans provide coverage for these devices and associated services, establishing criteria for medical necessity that includes recommendations from treating physicians and input from orthotists or prosthetists. The legislation ensures that coverage cannot be denied based on an individual's disability and sets standards for network adequacy, requiring access to medically necessary devices from at least two in-state providers. Additionally, it prohibits copayments and deductibles from being more restrictive than those for other benefits and establishes an annual benefit limit of no less than $50,000 per limb.

Furthermore, the bill introduces new reporting requirements, mandating health coverage plans to report claims data for prosthetic and orthotic services to the commissioner by 2029. It specifies that coverage must include medically necessary clinical care and that devices must be provided by accredited facilities. The Louisiana Medicaid program is also required to cover these devices and services when deemed medically necessary. The new coverage requirements will take effect for new plans starting January 1, 2027, and for existing plans upon renewal by January 1, 2028.

Statutes affected:
HB1235 Original: