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MA S811
Bill
Status
Introduced
2/27/2025
Primary Sponsor
Jacob Oliveira
Click for details
AI Summary
- Requires health insurers, MassHealth, and state employee plans to cover prosthetic and orthotic devices for both daily use and physical activities such as running, biking, swimming, and showering
- Prohibits insurers from denying coverage for prosthetics or orthotics solely based on an individual's actual or perceived disability, and bars denial of benefits that would be covered for non-disabled persons seeking equivalent medical interventions
- Mandates coverage for repair and replacement of devices without continuous use or lifetime restrictions when a provider determines replacement is necessary due to patient condition changes, irreparable device damage, or when repair costs exceed 60% of replacement cost
- Requires health plans to include at least two in-network prosthetic/orthotic providers in Massachusetts, with full reimbursement for out-of-network providers when in-network options are unavailable
- Prohibits separate financial requirements for prosthetic/orthotic coverage and limits cost-sharing to no more than what applies to inpatient physician and surgical services
Legislative Description
To improve outcomes for those with limb loss and limb difference
Last Action
Bill reported favorably by committee and referred to the committee on Senate Ways and Means
11/17/2025
Committee Referrals
Ways and Means11/17/2025
Health Care Financing8/28/2025
Financial Services2/27/2025
Full Bill Text
No bill text available