H.B. 108

1

PROSTHETIC LIMB HEALTH INSURANCE
2 PARITY
3 2008 GENERAL SESSION
4 STATE OF UTAH
5 Chief Sponsor: David Litvack
6 Senate Sponsor: ____________
7
8 LONG TITLE
9 General Description:
10 This bill amends the Insurance Code to require accident and health insurers to provide
11 coverage for prosthetic and orthotic devices.
12 Highlighted Provisions:
13 This bill:
14 . defines terms;
15 . requires accident and health insurers to provide coverage for prosthetic and orthotic
16 devices; and
17 . establishes:
18 . the terms of coverage; and
19 . minimum requirements for access to providers.
20 Monies Appropriated in this Bill:
21 None
22 Other Special Clauses:
23 None
24 Utah Code Sections Affected:
25 ENACTS:
26 31A-22-635, Utah Code Annotated 1953
27

28 Be it enacted by the Legislature of the state of Utah:
29 Section 1. Section 31A-22-635 is enacted to read:
30 31A-22-635. Coverage for prosthetic device.
31 (1) For purposes of this section:
32 (a) "Orthotic device" means a rigid or semirigid device supporting a weak or deformed
33 leg, foot, arm, hand, back, or neck, or restricting or eliminating motion in a diseased or injured
34 leg, foot, arm, hand, back, or neck.
35 (b) "Prosthetic device" means an artificial limb device or appliance designed to replace
36 in whole or in part an arm or a leg.
37 (2) Beginning July 1, 2008, an accident and health insurance policy that provides
38 coverage for hospital, medical, or surgical expenses shall provide coverage for benefits for
39 prosthetics and orthotics that:
40 (a) at a minimum, equals the coverage provided for under the federal Medicare
41 program pursuant to 42 U.S.C. Secs. 1395k, 1395l, and 1395m and 42 C.F.R 414.202, 414.210,
42 and 414.228 as applicable to this section; and
43 (b) includes:
44 (i) all services and supplies necessary for the effective use of a prosthetic or orthotic
45 device, including:
46 (A) formulating its design;
47 (B) fabrication;
48 (C) material and component selection;
49 (D) measurements and fittings;
50 (E) static and dynamic alignments; and
51 (F) instructing the patient in the use of the device;
52 (ii) all materials and components necessary to use the device; and
53 (iii) any repair or replacement of a prosthetic or orthotic device that is determined
54 medically necessary to restore or maintain the ability to complete activities of daily living or
55 essential job-related activities and that is not solely for comfort or convenience.
56 (3) The coverage required by this section:
57 (a) may be made subject to, and no more restrictive than, the provisions of an accident
58 and health insurance policy that apply to other benefits under the policy;

59 (b) may impose a copayment and coinsurance amounts on a prosthetic or orthotic
60 device, not to exceed the copayment or coinsurance amounts imposed under Part B of the
61 Medicare fee-for-service program;
62 (c) shall reimburse for a prosthetic or orthotic device at no less than the fee schedule
63 amount for the prosthetic or orthotic device under the federal Medicare reimbursement
64 schedule; and
65 (d) may not impose any annual or lifetime dollar maximum on coverage for prosthetic
66 or orthotic devices other than an annual or lifetime dollar maximum that applies in the
67 aggregate to all terms and services covered under the policy.
68 (4) If coverage is provided through a managed care plan, offered under Chapter (8),
69 Health Maintenance Organizations and Limited Health Plans, or under a preferred provider
70 plan under this chapter, the insured shall have access to medically necessary clinical care and to
71 prosthetic and orthotic devices and technology from not less than two distinct Utah prosthetic
72 and orthotic providers in the managed care plan's provider network.




Legislative Review Note
as of 12-4-07 11:28 AM

Office of Legislative Research and General Counsel