HB2302 - 552R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-826.05, to read:

START_STATUTE20-826.05. Prosthetic and orthotic coverage; reimbursement rates; definitions

A. A subscription contract that is issued to a subscriber shall provide coverage for prosthetic devices and orthotic devices that is at least equivalent to the coverage currently provided under title XVIII of the social security act and rules adopted pursuant to that title, and the coverage may not be provided under less favorable terms or conditions than any other medical or surgical benefits under the contract.

B. The contract shall provide coverage for:

1. The most appropriate device that the treating physician determines is medically necessary to restore functionality at optimal levels.

2. All services and supplies that are necessary for the effective use of a prosthetic device or orthotic device, including both:

(a) Formulating the device's design, fabrication, material and component selection, measurements, fittings and static and dynamic alignments.

(b) Instructing the subscriber in the use of the device, including all materials and components that are necessary to use the device.

3. The repair or replacement of a prosthetic device or orthotic device that the treating physician determines is medically necessary to restore and maintain the subscriber's ability to complete activities of daily living or essential job-related activities and that is not solely for comfort or convenience.

C. The contract shall provide reimbursement rates that are at least equivalent to those currently provided under title XVIII of the social security act and rules adopted pursuant to that title and that are comparable to reimbursement under the contract for restorative internal devices.

D. A corporation may not impose deductibles, copayments, coinsurance, benefit maximums, waiting periods or other limitations on coverage, including in-network and out-of-network coverage, annual coverage maximums or lifetime coverage maximums, for prosthetic devices or orthotic devices that are different from those imposed on benefits or services not related to prosthetic devices or orthotic devices.

E. this section does not apply to limited benefit coverage as defined in section 20-1137.

F. For the purposes of this section:

1. "Orthotic device" means a rigid or semirigid device that supports a weak or deformed leg, foot, arm, hand, back or neck or that restricts or eliminates motion in a diseased or injured leg, foot, arm, hand, back or neck.

2. "Prosthetic device" means an artificial limb device or appliance that is designed to replace in whole or in part an arm or a leg. END_STATUTE

Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.19, to read:

START_STATUTE20-1057.19. Prosthetic and orthotic coverage; reimbursement rates; definitions

A. An evidence of coverage that is issued to an enrollee shall provide coverage for prosthetic devices and orthotic devices that is at least equivalent to the coverage currently provided under title XVIII of the social security act and rules adopted pursuant to that title, and the coverage may not be provided under less favorable terms or conditions than any other medical or surgical benefits under the evidence of coverage.

B. The evidence of coverage shall provide coverage for:

1. The most appropriate device that the treating physician determines is medically necessary to restore functionality at optimal levels.

2. All services and supplies that are necessary for the effective use of a prosthetic device or orthotic device, including both:

(a) Formulating the device's design, fabrication, material and component selection, measurements, fittings and static and dynamic alignments.

(b) Instructing the enrollee in the use of the device, including all materials and components necessary to use the device.

3. The repair or replacement of a prosthetic device or orthotic device that the treating physician determines is medically necessary to restore and maintain the enrollee's ability to complete activities of daily living or essential job-related activities and that is not solely for comfort or convenience.

C. The evidence of coverage shall provide reimbursement rates that are at least equivalent to those currently provided under title XVIII of the social security act and rules adopted pursuant to that title and that are comparable to reimbursement under the evidence of coverage for restorative internal devices.

D. A health care services organization may not impose deductibles, copayments, coinsurance, benefit maximums, waiting periods or other limitations on coverage, including in-network and out-of-network coverage, annual coverage maximums or lifetime coverage maximums, for prosthetic devices or orthotic devices that are different from those imposed on benefits or services not related to prosthetic devices or orthotic devices.

E. this section does not apply to limited benefit coverage as defined in section 20-1137.

F. For the purposes of this section:

2. "Prosthetic device" means an artificial limb device or appliance that is designed to replace in whole or in part an arm or a leg. END_STATUTE

Sec. 3. Title 20, chapter 6, article 4, Arizona Revised Statutes, is amended by adding section 20-1342.08, to read:

START_STATUTE20-1342.08. Prosthetic and orthotic coverage; reimbursement rates; definitions

A. A disability insurance policy that is issued to an insured shall provide coverage for prosthetic devices and orthotic devices that is at least equivalent to the coverage currently provided under title XVIII of the social security act and rules adopted pursuant to that title, and the coverage may not be provided under less favorable terms or conditions than any other medical or surgical benefits under the policy.

B. The policy shall provide coverage for:

1. The most appropriate device that the treating physician determines is medically necessary to restore functionality at optimal levels.

2. All services and supplies that are necessary for the effective use of a prosthetic device or orthotic device, including both:

(a) Formulating the device's design, fabrication, material and component selection, measurements, fittings and static and dynamic alignments.

(b) Instructing the insured in the use of the device, including all materials and components necessary to use the device.

3. The repair or replacement of a prosthetic device or orthotic device that the treating physician determines is medically necessary to restore and maintain the insured's ability to complete activities of daily living or essential job-related activities and that is not solely for comfort or convenience.

C. The disability insurance policy shall provide reimbursement rates that are at least equivalent to those currently provided under title XVIII of the social security act and rules adopted pursuant to that title and that are comparable to reimbursement under the policy for restorative internal devices.

D. A disability insurer may not impose deductibles, copayments, coinsurance, benefit maximums, waiting periods or other limitations on coverage, including in-network and out-of-network coverage, annual coverage maximums or lifetime coverage maximums, for prosthetic devices or orthotic devices that are different from those imposed on benefits or services not related to prosthetic devices or orthotic devices.

E. this section does not apply to limited benefit coverage as defined in section 20-1137.

F. For the purposes of this section:

2. "Prosthetic device" means an artificial limb device or appliance that is designed to replace in whole or in part an arm or a leg.END_STATUTE

Sec. 4. Title 20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding section 20-1406.10, to read:

START_STATUTE20-1406.10. Prosthetic and orthotic coverage; reimbursement rates; definitions

A. A group or blanket disability insurance policy that is issued to an insured shall provide coverage for prosthetic devices and orthotic devices that is at least equivalent to the coverage currently provided under title XVIII of the social security act and rules adopted pursuant to that title, and the coverage may not be provided under less favorable terms or conditions than any other medical or surgical benefits under the policy.

B. The policy shall provide coverage for:

1. The most appropriate device that the treating physician determines is medically necessary to restore functionality at optimal levels.

2. All services and supplies that are necessary for the effective use of a prosthetic device or orthotic device, including both:

(a) Formulating the device's design, fabrication, material and component selection, measurements, fittings and static and dynamic alignments.

(b) Instructing the insured in the use of the device, including all materials and components necessary to use the device.

C. The group or blanket disability insurance policy shall provide reimbursement rates that are at least equivalent to those currently provided under title XVIII of the social security act and rules adopted pursuant to that title and that are comparable to reimbursement under the policy for restorative internal devices.

D. A group or blanket disability insurer may not impose deductibles, copayments, coinsurance, benefit maximums, waiting periods or other limitations on coverage, including in-network and out-of-network coverage, annual coverage maximums or lifetime coverage maximums, for prosthetic devices or orthotic devices that are different from those imposed on benefits or services not related to prosthetic devices or orthotic devices.

E. this section does not apply to limited benefit coverage as defined in section 20-1137.

F. For the purposes of this section:

2. "Prosthetic device" means an artificial limb device or appliance that is designed to replace in whole or in part an arm or a leg. END_STATUTE