Assembly Bill 1121 mandates that health insurance policies and self-insured governmental health plans provide coverage for prosthetic limbs and custom orthotic braces when deemed medically necessary. The bill outlines that coverage must include all necessary materials, components, and related services for the effective use of these devices, as well as instruction on their use and reasonable repair costs. Additionally, it stipulates that significant repairs or replacements must be covered without restrictions related to continuous use or the device's useful lifetime, particularly when necessitated by changes in the individual's physiological condition or if repair costs exceed 60% of the replacement cost. The coverage must align with the standards set by the federal Medicare program.

Furthermore, the bill requires managed care plans to ensure access to these devices from at least two in-network providers and to facilitate referrals to out-of-network providers when necessary, with full reimbursement at mutually agreed rates. The coverage may only be subject to cost-sharing provisions that apply to inpatient physician and surgical services. The bill also includes provisions for the denial of coverage, requiring written explanations for any denials based on medical necessity. This legislation aims to enhance access to essential medical devices for individuals with disabilities, ensuring they can participate in daily activities and maintain their quality of life.