Maryland Medical Assistance Program and Health Insurance - Coverage for Orthoses (So Every Body Can Move Act)
If enacted, SB406 will align Maryland's healthcare coverage more closely with the needs of individuals requiring orthotsic devices, ensuring that they have access to necessary treatments that support their daily activities and overall quality of life. This bill explicitly prohibits insurers from imposing separate annual or lifetime dollar maximums on coverage for orthoses beyond any aggregate limits. It also specifies that coverage cannot be more restrictive than what is established in the Medicare coverage database, thereby promoting adherence to national standards.
Senate Bill 406, titled the 'So Every Body Can Move Act', proposes significant revisions to the Maryland Medical Assistance Program and health insurance policies concerning the coverage of orthoses. The bill mandates that certain insurers, including nonprofit health service plans and health maintenance organizations, must provide specified coverage relating to orthoses, which are defined as custom-designed devices for treating neuromuscular or musculoskeletal disorders. The effective date for the bill is set for January 1, 2026, which allows sufficient time for implementation and adaptation by the concerned entities.
The discussions surrounding SB406 highlight varying viewpoints regarding healthcare access and insurance regulations. While supporters advocate for the bill as a means to ensure adequate medical support for patients needing orthotic devices, there are concerns about the financial implications for insurance providers and potential impacts on premium rates. Stakeholders emphasize the need to balance coverage requirements with the sustainability of insurance programs, fearing that increased coverage mandates might lead to higher healthcare costs across the board.
Notably, SB406 stipulates that healthcare providers can recommend replacements for orthoses without concern for continuous use or useful lifetime restrictions, as long as a patient's condition warrants it. This flexibility could significantly improve patient care and ensure that individuals can maintain optimal health through appropriate orthotic treatment. Furthermore, the bill includes provisions for regular reporting on compliance to the Maryland Insurance Administration and the Maryland Department of Health, enhancing oversight of orthotic coverage across the state.