|BILL AS INTRODUCED||2007-2008|
Introduced by Senator Racine of Chittenden District and Senator Lyons of Chittenden District
Subject: Health; health insurance; prosthetic devices
Statement of purpose: This bill proposes to require health insurers to provide coverage for prosthetic devices under the same general terms and conditions applicable to other durable medical equipment.
AN ACT RELATING TO PROSTHETIC PARITY
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 8 V.S.A. § 4088f is added to read:
§ 4088f. PROSTHETIC PARITY
(a) As used in this section:
(1) “Health insurance plan” means any health insurance policy or health benefit plan offered by a health insurer, as defined in 18 V.S.A. § 9402, as well as Medicaid, the Vermont health access plan, and any other public health care assistance program offered or administered by the state or by any subdivision or instrumentality of the state.
(2) “Prosthetic device” means an artificial limb device to replace, in whole or in part, an arm or a leg.
(b) A health insurance plan shall provide coverage for prosthetic devices in all health plans that, at a minimum, equals the coverage and payment for prosthetic devices under federal laws and regulations for the aged and disabled pursuant to sections 1395k, 1395l, and 1395m of Title 42 of the United States Code and sections 414.202, 414.210, 414.228, and 410.100 of Title 42 of the Code of Federal Regulations. Coverage may be limited to the prosthetic device that the patient’s treating physician determines to be the most appropriate model to meet the patient’s medical needs.
(c) 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.
(d) A health insurance plan shall provide coverage under this section for repair or replacement of a prosthetic device if a patient’s treating physician determines repair or replacement is appropriate.
(e) A health insurance plan shall not impose any annual or lifetime dollar maximum on coverage for prosthetics other than an annual or lifetime dollar maximum that applies in the aggregate to all terms and services covered under the plan.
Sec. 2. EFFECTIVE DATE
This act shall take effect upon passage.
The Vermont General Assembly
115 State Street