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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
SENATE AMENDMENTS TO
SENATE BILL 699
By COMMITTEE ON HEALTH CARE
April 15
On page 1 of the printed bill, line 2, after the second semicolon delete the rest of the line and
line 3 and insert “and amending ORS 743A.145.”.
Delete lines 5 through 28 and delete page 2 and insert:
“SECTION 1. ORS 743A.145 is amended to read:
“743A.145. (1) As used in this section:
“(a) ‘Device’ means:
“(A) An orthotic device.
“(B) A prosthetic device.
“[(a)] (b) ‘Orthotic device’ means a rigid or semirigid device supporting a weak or deformed leg,
foot, arm, hand, back or neck, or restricting or eliminating motion in a diseased or injured leg, foot,
arm, hand, back or neck.
“[(b)] (c) ‘Prosthetic device’ means an artificial limb device or appliance designed to replace in
whole or in part an arm or a leg.
“(2) All individual and group health insurance policies providing coverage for the expenses of
hospital, medical or surgical services or supplies shall provide coverage for [prosthetic and orthotic]
devices. [that are medically necessary to restore or maintain the ability to complete activities of daily
living or essential job-related activities and that are not solely for comfort or convenience.] The cover-
age required by this subsection includes:
“(a) Devices that are determined to be medically necessary to restore or maintain the
ability to complete activities of daily living or essential job-related activities and that are not
solely for comfort or convenience.
“(b) All services and supplies medically necessary for the effective use of a [prosthetic or
orthotic] device, including design formulation, fabrication, material and component selection, meas-
urements, fittings, static and dynamic alignments and patient instruction in the use of the device.
“(c) Replacement of a device or any part of a device, if the replacement is determined to
be medically necessary, based on:
“(A) A change in the physiological condition of the insured;
“(B) An irreparable change in the condition of the device or part of the device; or
“(C) The device, or a part of the device, requiring repair and the cost of the repair would
be more than 60 percent of the cost of the replacement device or replacement part of the
device.
“(d) Repair of a device or any part of a device, if the repair is determined to be medically
necessary, based on:
“(A) A change in the physiological condition of the insured; or
“(B) A change in the condition of the device or part of the device.
LC 1089/SB 699-5 1
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“(e) Devices that are determined to be medically necessary and the most appropriate
model that meets the medical needs of the insured for purposes of performing physical ac-
tivities, including but not limited to running, biking, swimming and strength training, and
that maximizes the insured’s whole-body health, including lower and upper limb function.
“(3) The Director of the Department of Consumer and Business Services shall adopt and annu-
ally update rules listing the [prosthetic and orthotic] devices covered under this section. The list shall
be no more restrictive than the list of [prosthetic and orthotic] devices and supplies in the Medicare
fee schedule for Durable Medical Equipment, Prosthetics, Orthotics and Supplies, but only to the
extent consistent with this section.
“(4) The coverage required by subsection (2) of this section may be made subject to, and no more
restrictive than, the provisions of a health insurance policy that apply to other benefits under the
policy.
“[(5) The coverage required by subsection (2) of this section shall include any repair or replacement
of a prosthetic or orthotic device that is determined medically necessary to restore or maintain the
ability to complete activities of daily living or essential job-related activities and that is not solely for
comfort or convenience.]
“[(6)] (5) If the coverage under subsection (2) of this section is provided through a managed care
organization, the insured shall have access to medically necessary clinical care and to [prosthetic
and orthotic] devices and technology from not fewer than two distinct Oregon prosthetic and
orthotic providers in the managed care organization’s provider network.
“(6) An individual or group health plan may not deny coverage for a prosthetic or
orthotic benefit for an insured with limb loss, impairment or absence to restore or maintain
the ability to perform a physical activity if a benefit would be covered for medical or surgical
intervention for a person without limb loss, impairment or absence to restore or maintain
the ability to perform the same physical activity.
“(7) For coverage described in subsection (2)(c) of this section, an insurer may require
confirmation from the prescribing health care provider that the coverage is medically nec-
essary if the device, or any part of the device, requires replacement and is less than three
yearsold.
“[(7)] (8) This section is exempt from ORS 743A.001.
“(9) The coverage requirements described in subsections (2)(e), (6) and (7) of this section
do not apply to a health benefit plan offered by the Public Employees’ Benefit Board or the
Oregon Educators Benefit Board, unless the plans offered by the Public Employees’ Benefit
Board or the Oregon Educators Benefit Board elect to provide the coverage and provide no-
tice to the Department of Consumer and Business Services in the form and manner described
by the department by rule.
“SECTION 2. The amendments to ORS 743A.145 by section 1 of this 2025 Act apply to
policies or certificates of health insurance issued, renewed or extended on or after January
1, 2026.”.
SA to SB 699 Page 2