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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
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HB 2333: insurance; prosthetics; orthotics; reporting requirements
Sponsor: Representative Heap, LD 10
Committee on Health & Human Services
Overview
Requires health care insurers to provide coverage for prosthetic and orthotic devices that are equivalent to the coverage provided under Medicare Part B and contains reporting requirements.
History
Health care insurers include disability insurers, group disability insurers, blanket disability insurers, health care services organizations, hospital service corporations and medical service corporations. The Department of Insurance and Financial Institutions (DIFI) regulates policies, certificates, evidence of coverage and contracts of insurance (insurance policies) that are issued or delivered by health care insurers (A.R.S. § 20-1379).
Medicare Part B helps cover medical services like doctors' services, outpatient care and other medical services that Part A doesn't cover. Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary. Part B also covers some preventive services like exams, lab tests and screening shots to help prevent, find or manage a medical problem (U.S. Dept. of Health and Human Services).
Provisions
Prosthetic Devices and Orthotic Devices Coverage
1. Requires a health care insurer, for policies or contracts issued, amended, delivered or renewed on or after January 1, 2027, to provide coverage for prosthetic devices and orthotic devices that are equivalent to the coverage that is currently provided under Medicare Part B. (Sec. 1-4)
2. Prohibits the prosthetic and orthotic device coverage from being under less favorable terms or conditions than any other medical or surgical benefits under the contract or policy. (Sec. 1-4)
3. Specifies that the prosthetic and orthotic device coverage includes:
a. the purchasing, fitting, adjustment, repair and replacement of one or more prosthetic or orthotic devices as needed to accomplish certain activities and functions, as outlined;
b. all materials and components that are necessary to use the device, including instructions on how to use the device; and
c. habilitative or rehabilitative coverage benefits. (Sec. 1-4)
4. Deems prosthetic devices and orthotic devices to be medially necessary as determined by an insured's health care provider and requires the health care provider to choose the most appropriate model of prosthetic or orthotic device that adequately meets the medical needs of the insured and allows the subscriber to perform certain activities and functions. (Sec. 1-4)
5. Requires a health care insurer to include in its policies or contracts language that describes both an insured's rights to the prosthetic and orthotic device coverage and any benefit denial letters. (Sec. 1-4)
6. Specifies that if a health care insurer denies coverage for a prosthetic device or orthotic device the insurer must issue the denial of coverage in writing. (Sec. 1-4)
7. Clarifies this does not prohibit a health care insurer from imposing cost sharing for prosthetic devices or orthotic devices if the cost sharing is not more restrictive than the cost sharing requirements for inpatient physician or surgical services. (Sec. 1-4)
8. Prohibits prosthetic and orthotic device coverage from incurring separate cost sharing requirements that are applicable only to coverage for prosthetic devices or orthotic devices. (Sec. 1-4)
9. Requires a health care insurer to ensure that an insured has access to medically necessary clinical care and to prosthetic devices and orthotic devices and technology from not less than two distinct prosthetic devices and orthotic device providers that are in Arizona. (Sec. 1-4)
10. Requires a health care insurer to provide a process to refer a subscriber to an out-of-network provider and fully reimburse the out-of-network provider at a mutually agreed on rate, less any applicable cost sharing provider as determined on an in-network basis, if a medically necessary covered prosthetic or orthotic device is not available from an in-network provider. (Sec. 1-4)
11. Requires a health care insurer to provide coverage for the replacement of a covered prosthetic or orthotic device, as applicable, without regard to continuous use or useful lifetime restrictions if an ordering health care provider determines that the device or part of the device needs to be replaced due to any of the following reasons:
a. a change in the physiological condition of the subscriber;
b. an irreparable change in the condition of the device or in a part of the device; and
c. the condition of the device or any part of the device requires repairs and the cost of the repairs is more than 60% of the cost of a replacement device or of the part that is being replaced. (Sec. 1-4)
12. Allows a health care insurer, before replacing a prosthetic or orthotic device that is less than 3 years old, to request a health care insurer confirm that the device needs to be replaced. (Sec. 1-4)
13. Prohibits a health care insurer from:
a. cancelling or changing premiums, benefits or conditions under a policy or contract on the basis of an insured's actual or perceived disability; or
b. denying prosthetic or orthotic device benefits to an insured with limb loss, limb absence or limb difference if such benefits would otherwise be covered for a person who does not have a disability and who seeks medical or surgical intervention to restore or maintain the ability to perform the same physical activity. (Sec. 1-4)
Reporting Requirements
14. Requires, by January 1, 2028, and annually thereafter, DIFI to issue a report that provides guidance on what type of medical care and prosthetic and orthotic devices are necessary to restore full physical activity to an insured with limb loss, limb difference or mobility impairment. (Sec. 1-4)
15. Requires health care insurers to submit a report to DIFI that contains:
a. the total number of claims that were made for prosthetic and orthotic devices; and
b. the total amount paid for coverage that was provided for prosthetic and orthotic devices. (Sec. 5)
16. Requires by January 1, 2028, and annually thereafter, DIFI to compile the information provided by the health care insurers and submit a report to the Legislature and provide a copy of this report to the Secretary of State. (Sec. 5)
17. Repeals the prosthetic and orthotic device reporting requirements on January 1, 2032. (Sec. 5)
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21. Initials AG HB 2333
22. 2/3/2026 Page 0 Health & Human Services
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