HB204 Summary

• Requires health benefit plans providing hospital, medical, or surgical coverage to include benefits for custom prosthetic and orthotic devices at least equivalent to federal Medicare program coverage and no less favorable than medical and surgical benefits.

• Mandates coverage include all services and supplies necessary for prosthetic and orthotic device use, including design, fabrication, fitting, alignment, patient instruction, and all required materials and components.

• Prohibits separate financial requirements applicable only to prosthetic and orthotic benefits; any copayments or coinsurance cannot be more restrictive than medical and surgical benefits, and prohibits annual or lifetime dollar maximums specific to these devices.

• Requires managed care plans to provide access to at least two distinct prosthetic and orthotic device providers in-network within the state.

• Applies requirements to health care service plans and health maintenance organizations; becomes effective October 1, 2019, and applies to state employee and public education employee health plans beginning December 31, 2020.