Florida House Bill H1003

Florida 2024 Regular Session

• Introduced: 12/22/23
• Refer: 1/8/24
• Failed: 3/8/24

Caption

Coverage for Orthotics and Prosthetics Services

Impact

If passed, H1003 will significantly enhance access to essential medical devices for those in need under both private and public health plans, thereby promoting better quality of life and reducing health disparities among populations requiring such services. The bill mandates that health insurers and health maintenance organizations submit annual reports detailing the claims submitted and paid for orthotic and prosthetic services. This transparency aims to ensure compliance and adequate performance by insurers in fulfilling the coverage provisions required under the bill.

Summary

House Bill H1003 addresses the coverage for orthotic and prosthetic services, making it mandatory for health insurance policies, including those under Medicaid, to provide coverage for these services. The bill amends existing Florida Statutes by introducing specific definitions and requirements for coverage related to orthoses and prostheses, ensuring that they are classified as medically necessary for individuals to perform daily activities and engage in recreational pursuits. Moreover, it prohibits health insurers from denying claims for these devices based on the client’s current physical status, particularly for those with limb loss or limb absence.

Contention

There may be points of contention surrounding the fiscal implications of funding these expanded benefits, particularly in the context of Medicaid appropriations. Some stakeholders might express concerns about the potential for increased insurance premiums or budgetary impacts on the state’s Medicaid program. Additionally, discussions on the documentation required to validate the medical necessity of replacements or new devices, especially within set timeframes, could also elicit debates among healthcare providers and insurers regarding accessibility and administrative burdens.