HF 2379

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:03am

A bill for an act
relating to health; requiring coverage for prosthetic devices; proposing coding
for new law in Minnesota Statutes, chapter 62A.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62A.251] COVERAGE FOR PROSTHETIC DEVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin The following definitions have the meanings given for
purposes of this section.
new text end

new text begin (a) "Prosthesis" means an artificial medical device that is not surgically implanted
and that is used to replace a missing limb, appendage, or other external human body part
including an artificial limb, hand, or foot. The term does not include artificial eyes, ears,
noses, dental appliances, ostomy products, or devices such as eyelashes or wigs.
new text end

new text begin (b) "Prosthetics" means the science and practice of evaluation, measuring, designing,
fabricating, assembling, fitting, aligning, adjusting, or servicing, as well as providing the
initial training necessary to accomplish the fitting of, a prosthesis through the replacement
of external parts of a human body lost due to amputation or congenital deformities or
absences. The practice of prosthetics also includes the generation of an image, form,
or mold that replicates the patient's body segment and that requires rectification of
dimensions, contours, and volumes for use in the design and fabrication of a socket
to accept a residual anatomic limb to, in turn, create an artificial appendage that is
designed either to support body weight or to improve or restore function or cosmesis, or
both. Involved in the practice of prosthetics is observational gait analysis and clinical
assessment of the requirements necessary to refine and mechanically fix the relative
position of various parts of the prosthesis to maximize function, stability, and safety of the
patient. The practice of prosthetics includes providing and continuing patient care in order
to assess the prosthetic device's effect on the patient's tissues and to assure proper fit and
function of the prosthetic device by periodic evaluation.
new text end

new text begin (c) "Private insurance company" means any insurance company, or management
company hired by an insurance company, who is based in the state of Minnesota or
provides coverage for citizens for the state of Minnesota; or allows subscribing patients
to seek prosthetic services in the state of Minnesota. Every individual or group health
insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state
on or after ......., which provides medical coverage that includes coverage for physician
services in a physician's office and every policy, which provides major medical or similar
comprehensive type coverage shall provide coverage for benefits for prosthetic devices
that equal those benefits provided for under federal laws for health insurance for the
aged and disabled.
new text end

new text begin (d) "Accredited facility" means any entity that is accredited by the American Board
for Certification in Orthotics Prosthetics and Pedorthics (ABC) or by the Board for
Orthotist/Prosthetist Certification (BOC) and that provides prosthetic devices or prosthetic
services.
new text end

new text begin Subd. 2. new text end

new text begin Coverage. new text end

new text begin (a) A health insurance plan shall provide coverage for
prosthetic devices in all health plans to the extent that coverage is provided by the federal
insurance programs, including those covering federal employees, Medicare, and Veterans
Administration programs, but only to the extent consistent with this section. Coverage
may be limited to the prosthetic device that is the most appropriate model that is medically
necessary to meet the patient's medical needs. Any dispute between the insured and
the carrier concerning coverage and the application of this section shall be subject to
independent external review.
new text end

new text begin (b) A health insurance plan shall not impose any annual or lifetime dollar maximum
on coverage for prosthetics that is less than the annual or lifetime dollar maximum that
applies generally to all terms and services covered under the plan.
new text end

new text begin (c) The coverage required may not be subject to a deductible, co-payment, or
coinsurance provision that is less favorable to a covered individual than the deductible,
co-payment, or coinsurance provisions that apply generally to other nonprimary care
items and services under the health plan.
new text end

new text begin Subd. 3. new text end

new text begin Prior authorization. new text end

new text begin A health insurance plan may require prior
authorization for prosthetic devices in the same manner and to the same extent as prior
authorization is required for any other covered benefit.
new text end

new text begin Subd. 4. new text end

new text begin Repair or replacement. new text end

new text begin The coverage under this section shall include any
repair or replacement of a prosthetic device that is determined medically necessary by
a prescribing physician to restore or maintain the ability to complete activities of daily
living or essential job-related activities and that is not solely for comfort or convenience.
new text end

new text begin Subd. 5. new text end

new text begin Accredited facility. new text end

new text begin Prosthetic devices must be provided by an accredited
facility. Prosthetic services must be prescribed by a licensed physician and provided
by an accredited facility.
new text end