FL S0828

Individual, group, blanket, franchise health insurance policies and health maintenance contracts issued or renewed on or after July 1, 2024, must cover orthoses and prostheses deemed medically necessary by a provider for activities of daily living, job-related activities, and physical recreational activities such as running, biking, and swimming.

Replacements of orthotic and prosthetic devices must be covered without continuous use or useful lifetime restrictions when medically necessary due to a change in the patient's condition, irreparable device damage, or when repair costs exceed 60 percent of the replacement cost; insurers may require supporting documentation for replacements of devices less than 3 years old.

Health insurers and HMOs are prohibited from denying orthotic or prosthetic claims for individuals with limb loss or limb absence if equivalent medical or surgical intervention would be covered for a nondisabled person seeking to restore the same physical function.

The Agency for Health Care Administration is authorized to pay for orthotics and prosthetics services under Medicaid, including devices, materials, usage instruction, and repairs or replacements, and must seek federal approval and amend contracts as necessary to implement these changes.

Beginning July 1, 2025, health insurers and HMOs must annually report to the Office of Insurance Regulation the total number of orthotic and prosthetic claims submitted, paid, and the amounts paid.