This bill amends Louisiana law to mandate comprehensive health coverage for prosthetic and orthotic devices and associated services. It establishes criteria for medical necessity determinations, coverage standards for multiple devices, and requirements for prior authorization and cost-sharing. The legislation ensures that coverage does not discriminate based on disability and sets network adequacy standards to guarantee access to necessary care. Additionally, it outlines an appeals process for denied claims based on medical necessity and specifies that coverage for repairs and replacements of these devices must also meet medical necessity requirements.

Moreover, the bill introduces a new section in the Louisiana Revised Statutes requiring the Louisiana Medicaid program to cover medically necessary prosthetic and custom orthotic devices and services. This includes coverage for devices, services, materials, and repairs essential for daily living activities and job functions. The definitions and standards established in the amended law will apply to Medicaid coverage, ensuring consistency across health plans. The new coverage requirements will take effect for plans initiated on or after January 1, 2027, with existing policies needing to conform upon renewal by January 1, 2028. The bill will become effective upon the governor's signature or after the designated period for bills to become law without a signature.

Statutes affected:
HB1235 Original:
HB1235 Engrossed:
HB1235 Reengrossed:
HB1235 Enrolled:
HB1235 Act 719: