SF 2139

2nd Engrossment - 86th Legislature (2009 - 2010) Posted on 03/11/2010 02:15pm

A bill for an act
relating to health; requiring coverage for orthotic and 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 ORTHOTIC AND 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 external 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, and is deemed medically necessary by a
prescribing physician or licensed health care prescriber who has authority in this state to
prescribe orthotic and prosthetic devices, supplies, and services. For purposes of this
section, prosthesis includes any repair or replacement of the device and may be furnished
only by an accredited facility in comprehensive prosthetic services, or a credentialed
clinician who is certified or licensed.
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 anatomical appearance,
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) "Orthosis" means:
new text end

new text begin (1) an external medical device that is custom-fabricated or custom-fitted to a specific
patient based on the patient's unique physical condition and is applied to a part of the body
to correct a deformity, provide support and protection, restrict motion, improve function,
or relieve symptoms of a disease, syndrome, injury, or postoperative condition and is
deemed medically necessary by a prescribing physician or licensed health care prescriber
who has authority in this state to prescribe orthotic and prosthetic devices, supplies, and
services; and
new text end

new text begin (2) any repair or replacement of the device that is furnished by an accredited facility
in comprehensive orthotic services, or by a credentialed clinician who is certified or
licensed.
new text end

new text begin (d) "Orthotics" means:
new text end

new text begin (1) the science and practice of evaluating, measuring, designing, fabricating,
assembling, fitting, adjusting, or servicing and providing the initial training necessary to
accomplish the fitting of an orthotic device for the support, correction, or alleviation of a
neuromuscular or musculoskeletal dysfunction, disease, injury, or deformity;
new text end

new text begin (2) evaluation, treatment, and consultation;
new text end

new text begin (3) basic observation of gait and postural analysis;
new text end

new text begin (4) assessing and designing orthosis to maximize function and provide support
and alignment necessary to prevent or correct a deformity or to improve the safety and
efficiency of mobility and locomotion;
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new text begin (5) continuing patient care to assess the effect on the patient's tissues; and
new text end

new text begin (6) proper fit and function of the orthotic device by periodic evaluation.
new text end

new text begin (e) "Accredited facility" means any entity that is accredited by the American
Board for Certification in Orthotics Prosthetics and Pedorthics (ABC), by the Board
for Orthotist/Prosthetist Certification (BOC), by the Joint Commission (JC), or by the
Commission on Accreditation of Rehabilitation Facilities (CARF) and that provides
comprehensive orthotic and prosthetic devices or 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 plan shall provide coverage for orthotic and
prosthetic devices, supplies, and services to the extent that coverage is provided under
federal laws for health insurance for the aged and disabled under sections 1832, 1833,
1834, Social Security Act (United States Code, title 42, sections 1395k, 1395l, and
1395m), but only to the extent consistent with this section. Coverage may be limited to
the orthotic or prosthetic devices, supplies, and services that are the most appropriate
model that is determined medically necessary by the prescribing physician or licensed
health care prescriber who has authority in this state to prescribe orthotic and prosthetic
devices, supplies, and services, and includes the design, fabrication, material and
component selection, and measurements, fittings, static and dynamic alignments and
device maintenance, including repair of the device to restore or maintain the ability to
complete activities of daily living and essential job-related activities and that is not solely
for comfort, convenience, or recreation.
new text end

new text begin (b) Orthotic and prosthetic device coverage under this section may only be subject
to the annual or lifetime dollar maximum that applies generally to all terms and services
covered under the plan.
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new text begin (c) Reimbursement for orthotic and prosthetic devices, supplies, and services must
be equal to the reimbursement of other contracted medical services between an accredited
provider and a health plan or state-funded medical insurance plan.
new text end

new text begin (d) Coverage for orthotic and prosthetic devices, supplies, and services must not
be subject to any limitations for preexisting conditions.
new text end

new text begin (e) Coverage for orthotic and prosthetic devices, supplies, and services must include
complex and emerging technologies as well as standards of care, as deemed medically
necessary and acceptable to the covered individual, pursuant to the prescribing provider's
professional judgment provided that the technology and standards of care comply with
accepted treatment modalities.
new text end

new text begin Subd. 3. new text end

new text begin Prior authorization. new text end

new text begin A health plan may require prior authorization for
orthotic and prosthetic devices, supplies, and services 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
repair or replacement of an orthotic or prosthetic device that is medically necessary by a
prescribing physician or licensed health care provider who has the authority in this state
to prescribe orthotic and prosthetic devices, supplies, and services to restore or maintain
the ability to complete activities of daily living or essential job-related activities and that
is not solely for comfort, convenience, or recreation. Repair or replacement due to the
covered individual's neglect, misuse, or abuse is not covered.
new text end

new text begin Subd. 5. new text end

new text begin Accredited provider. new text end

new text begin Orthotic and prosthetic devices, supplies, and
services must be provided by an accredited provider in comprehensive orthotic or
prosthetic services and prescribed by a licensed physician or licensed health care provider
who has the authority in this state to prescribe orthotic and prosthetic devices, supplies,
and services.
new text end

Sec. 2. new text begin EFFECTIVE DATE.
new text end

new text begin This act is effective August 1, 2010, and applies to all health plans issued or renewed
to provide coverage for Minnesota residents on or after that date.
new text end