HB 616 -- Health Insurance Coverage for Prosthetic Devices

Sponsor:  Cooper

Beginning January 1, 2010, this bill requires all health
insurance carriers or health benefit plans which are issued,
delivered, continued, or renewed to provide coverage for certain
prosthetic devices and related services and supplies that meet
minimum standards as provided under the federal Medicare Program.
"Prosthetic device" is defined as an artificial limb, device, or
appliance designed to replace in whole or in part an arm, leg, or
eye.

A health insurance carrier:

(1)  May require an insured to obtain prior authorization for any
prosthetic device;

(2)  May impose co-payments and co-insurance requirements in
accordance with Part B of the federal Medicare Fee-for-Service
Program; and

(3)  Must reimburse an insured for the devices at no less than
the fee schedule amount under the federal Medicare reimbursement
schedule.

The coverage benefits will:

(1)  Be limited to the most appropriate devices that adequately
meet the medical needs of the insured to perform activities of
daily living and essential job-related activities as determined
by his or her physician;

(2)  Include repair services and replacement of prosthetics
needed to restore or maintain the daily living or essential
job-related activities; and

(3)  Not impose any annual or lifetime benefit maximum for
prosthetic devices.

Certain other supplemental insurance polices are not subject to
the prosthetic devices coverage requirements.

Missouri House of Representatives
95th General Assembly, 1st Regular Session
Last Updated November 17, 2009 at 9:25 am