The bill establishes new coverage requirements for prosthetic limbs and custom orthotic braces under health plans in Washington State, effective January 1, 2026. It mandates that health plans must provide coverage for one or more prostheses and custom orthotic braces per limb when deemed medically necessary for enrollees to engage in daily living activities, job-related tasks, and physical activities. The coverage must include necessary materials, components, related services, and instruction on device usage, as well as reasonable repair or replacement of the devices without restrictions based on continuous use or useful lifetime, provided there is a medical necessity. Additionally, the bill prohibits health plans from denying coverage for individuals with disabilities if similar services would be covered for nondisabled individuals.

The bill also includes provisions for health plans to apply standard utilization management and prior authorization practices, requiring written explanations for any coverage denials. It ensures that payment for these services aligns with federal laws regarding coverage for the aged and disabled. Furthermore, by July 1, 2028, health carriers must report the number and total amount of claims paid for these services for the years 2026 and 2027 to the insurance commissioner, who will compile and submit this data to the legislature. The bill amends existing law by incorporating the new section on prosthetic and orthotic coverage into RCW 41.05.017.