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MA H1178
Bill
Status
Introduced
2/27/2025
Primary Sponsor
Carlos Gonzalez
Click for details
AI Summary
- Requires all health insurers, MassHealth, and the Group Insurance Commission to cover prosthetic and orthotic devices for both daily use and physical activities including running, biking, swimming, and showering
- Prohibits insurers from denying coverage for prosthetics or orthotics based on an individual's actual or perceived disability, and bars denial of benefits that would be covered for non-disabled persons seeking surgical intervention for the same physical activity
- Mandates health plans include at least two distinct prosthetic and orthotic providers in their network, with full reimbursement to out-of-network providers when in-network services are unavailable
- Requires coverage for device replacement when a provider determines it necessary due to physiological changes, irreparable device damage, or when repair costs exceed 60% of replacement cost, eliminating "useful lifetime" restrictions
- Cost-sharing for prosthetic and orthotic devices cannot be more restrictive than cost-sharing for inpatient physician and surgical services
Legislative Description
To improve outcomes for persons with limb loss and limb difference
Last Action
Accompanied a new draft, see H4549
9/29/2025
Committee Referrals
Financial Services2/27/2025
Full Bill Text
No bill text available