This bill introduces a new section to chapter 48.43 RCW, mandating that health plans in the large and small group markets provide coverage for prosthetic limbs and custom orthotic braces when deemed medically necessary. Effective January 1, 2026, the coverage must include one or more prostheses and braces per limb, along with necessary materials, components, related services, and instruction for use. Additionally, the bill stipulates that coverage for replacement or repair of these devices cannot be denied based on continuous use or useful lifetime restrictions if medically necessary due to changes in the patient's condition or the device's condition.

The legislation also prohibits health plans from denying coverage for individuals with disabilities if similar services would be covered for nondisabled individuals. It allows for normal utilization management practices and requires written explanations for any denials of coverage. Furthermore, health plans must ensure that their payment for these services aligns with federal laws for the aged and disabled. By July 1, 2028, health carriers must report claims data related to these services to the insurance commissioner, who will compile and submit a report to the legislature by December 1, 2028. Notably, this section does not apply to individual market health plans or self-insured large group plans for public and school employees.