This bill seeks to improve coverage and access to prosthetic and orthotic devices for individuals with limb loss or differences by amending various sections of the General Laws, including Chapter 32A, Chapter 118E, and Chapter 175. It ensures that coverage for these devices is provided under the same terms as other durable medical equipment, mandates nondiscriminatory review of prior authorizations, and includes custom-designed devices for physical activities. The bill also stipulates that coverage cannot be denied based on an enrollee's actual or perceived disability and requires health plans to refer enrollees to out-of-network providers with full reimbursement if medically necessary devices are unavailable from in-network providers.

Additionally, the legislation emphasizes that coverage for prosthetic and orthotic devices must not be subject to more restrictive financial requirements than those for other medical services. It introduces specific definitions for custom orthotic and prosthetic devices and allows for their replacement without regard to continuous use or lifetime restrictions, based on a healthcare provider's determination. Overall, the bill aims to ensure equitable access to necessary medical devices and services, thereby enhancing the quality of life for individuals with limb loss or differences.

Statutes affected:
Bill Text: 32A-17I, 175-47Z, 176A-8AA, 176B-4AA, 176G-4S