AN ACT to amend Tennessee Code Annotated, Title 56, relative to prosthetic devices.
Impact
The bill impacts state laws by specifying that health benefit plans not only cover prosthetic devices but also necessary repairs and replacements, subject to typical copayments and deductibles. There is a provision allowing health benefit plans to require prior authorization for prosthetic devices. This requirement aligns the treatment of prosthetics with other healthcare services, enabling insurers to manage and monitor the provision of such devices effectively.
Summary
House Bill 626 amends Tennessee Code Annotated, Title 56, with a specific focus on health benefit plans and their coverage of prosthetic devices. This legislation mandates that health benefit plans must provide coverage for prosthetic devices, ensuring that such benefits equal those stipulated under federal laws for insurance for the aged and disabled. The primary goal is to enhance the availability and accessibility of prosthetic devices for individuals in need, particularly those with physical disabilities or injuries.
Contention
Notably, some points of contention may arise from the predetermined limits on coverage for prosthetic devices, which may be restricted to the most appropriate model for an individual’s medical needs. This could potentially lead to disputes regarding what constitutes the 'most appropriate' model and the decisions of treating physicians when it comes to patient care. Further, while the bill allows health insurance entities to dictate some terms of coverage based on managed care agreements, it raises questions about access to different standards of care across various network providers.