We will soon introduce legislation to ensure that Pennsylvanians with limb loss, limb difference, and mobility impairments may access the orthotic and prosthetic (O&P) devices they need to fully restore function.

More than 276,000 Pennsylvanians, including veterans and children, live with limb loss or limb difference yet many cannot access the O&P devices required to safely move, work, care for their families, or participate in physical activity. According to the World Health Organization, physical activity is vital to health and is not just defined as being able to get out of the house to go to work. Participation in sports, fitness, exercise and daily tasks such as cleaning and gardening are essential components as well.  For individuals with limb loss or mobility impairments, the ability to participate in these domains depends on access to appropriate prosthetic and orthotic devices. Therefore, when a physician determines that a device is necessary to regain maximum function, there should be no questions or doubts.

However, insurers in Pennsylvania often deny coverage for medically necessary devices that restore all domains of physical activity, exclude devices needed for bathing and showering which are important for hygiene and safety, and fail to cover devices that allow individuals to return to their lives as holistically as possible. Furthermore, O&P providers are currently reimbursed at unsustainably low levels by both commercial insurers and Medicaid Managed Care Organizations compared to Medicare which has created barriers in access and inequities of care. These structural issues in coverage have led many patients and their families to shoulder thousands in out-of-pocket charges, rely on unsafe and improper devices, or live sedentary and socially isolated lives that create preventable health complications such as obesity, depression, joint deterioration, and increased long-term healthcare costs.

In turn, the So Every Body Can Move Act (SEBCM) clarifies existing insurance obligations for both fully insured commercial plans and government insurance programs including Medicaid and Medicaid Managed Care plans to ensure the coverage of O&P services and devices. In order to extend O&P coverage as intended under the Affordable Care Act as an essential health benefit, our legislation:

• Covers prosthetic and orthotic devices necessary for physical activity, when deemed appropriate by the prescribing physician.
• Covers devices required for bathing and showering, ensuring safety and personal hygiene.
• Establishes insurance fairness by covering and reimbursing O&P care at levels at least equivalent to Medicare.
• Prohibits discriminatory denials, ensuring that individuals with disabilities receive the same functional restoration that would be provided to a patient without a disability.

If enacted, our legislation would align Pennsylvania with 12 other states that have already enacted similar versions of the SEBCM. Additionally, independent actuarial reviews from multiple states show that ensuring appropriate O&P coverage has a minimal impact on premiums, typically an increase of $0.08 to $0.37 per member per month. Meanwhile, O&P devices prevent joint deterioration which otherwise could lead to up to $150,000 in potential lifetime healthcare costs, reduce strain on daily‑use devices to prevent costly repairs and replacements, and provide people with disabilities the platform to excel physically, mentally, and in their careers.

Please join us in supporting equitable access to orthotic and prosthetic care by cosponsoring this legislation. Together, we can ensure that every Pennsylvanian – regardless of disability, income, or insurance type – has the opportunity to move, work, play, and live with dignity.