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HB0272b -1- CSHB 272(HSS)
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CS FOR HOUSE BILL NO. 272(HSS)
IN THE LEGISLATURE OF THE STATE OF ALASKA
THIRTY-FOURTH LEGISLATURE - SECOND SESSION
BY THE HOUSE HEALTH AND SOCIAL SERVICES COMMITTEE
Offered: 4/8/26
Referred: Finance
Sponsor(s): REPRESENTATIVES JOSEPHSON, Schrage, Fields
A BILL
FOR AN ACT ENTITLED
"An Act relating to insurance coverage for prosthetic and orthotic devices; relating to 1
medical assistance for prosthetic and orthotic devices; and providing for an effective 2
date." 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 4
* Section 1. AS 21.42 is amended by adding a new section to read: 5
Sec. 21.42.445. Coverage for prosthetic and orthotic devices. (a) A health 6
care insurer that offers, issues for delivery, delivers, or renews in the state a health 7
care insurance plan in the group or individual market shall provide coverage for 8
prosthetic and orthotic devices at a level that is at least equal to the coverage required 9
under 42 U.S.C. 1395k - 1395m. 10
(b) The coverage for prosthetic and orthotic devices required under this 11
section must include all prosthetic or orthotic devices that the covered person's health 12
care provider determines are the most appropriate models to meet the medical needs of 13
the covered person to complete activities of daily living or essential job-related 14
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CSHB 272(HSS) -2- HB0272b
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activities, shower or bathe, perform applicable physical activities, including running, 1
biking, swimming, and strength training, and maximize whole-body health and limb 2
function. The coverage must also include all device materials and components and 3
instruction to the covered person on use of the devices. 4
(c) Coverage under this section must include coverage for repair or 5
replacement of a prosthetic or orthotic device as needed. The health care insurer shall 6
provide for the replacement of the device, or the repair or replacement of a part of the 7
device, without regard to continuous use or useful lifetime restrictions, if a health care 8
provider determines that the repair or replacement of the device or a part the device is 9
necessary because a change has occurred in the physiological condition of the covered 10
person or a change has occurred in the condition of the device or in a part of the 11
device that affects its functionality. 12
(d) A health care insurer shall classify the benefits provided under this section 13
as habilitative or rehabilitative benefits to meet state or federal requirements for 14
coverage of essential health benefits. 15
(e) A health care insurer may not deny coverage for a benefit to a covered 16
person with limb loss or absence that would otherwise be covered for a nondisabled 17
covered person seeking medical or surgical intervention to restore or maintain the 18
ability to perform the same physical activity. A health care insurer shall provide 19
replacement coverage when the condition of the prosthetic or orthotic device or a part 20
of the device requires repair and the cost of repair would be more than 60 percent of 21
the cost of replacement of the device or the part of the device needing repair. A health 22
care insurer may require confirmation from a health care provider before providing 23
repair or replacement coverage under this section if the device, or the part of the 24
device needing repair or replacement, is less than three years old. 25
(f) A health care insurer shall ensure at least two distinct providers of 26
prosthetics and orthotics are included within the health care insurer's network in the 27
state. If medically necessary covered prosthetics or orthotics are not available from an 28
in-network provider, the health care insurer shall provide the covered person with a 29
referral to an out-of-network provider and shall fully reimburse the out-of-network 30
provider at a mutually agreed upon rate, less the portion that is the responsibility of the 31
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covered person. The copayment of the covered person is determined on an in-network 1
basis. 2
(g) A health care insurer may not require that a person covered under the 3
health care insurer's plan be subject to financial requirements that are applicable only 4
to prosthetic and orthotic coverage. A health care provider may not impose more 5
restrictive cost-sharing requirements for prosthetic or orthotic services than the plan's 6
cost-sharing requirements for inpatient physician and surgical services. 7
(h) A health care insurer shall provide a covered person with a description of 8
the covered person's rights under this section in evidence of coverage and any benefit 9
denial letter. A denial letter must be in writing and explain in detail the reason for the 10
denial, including an explanation as to how the request or claim does not meet the 11
medical necessity standards of the insurer, if applicable. 12
* Sec. 2. AS 47.07.030(b) is amended to read: 13
(b) In addition to the mandatory services specified in (a) of this section and the 14
services provided under (d) of this section, the department may offer only the 15
following optional services: case management services for traumatic or acquired brain 16
injury; case management and nutrition services for pregnant women; personal care 17
services in a recipient's home; emergency hospital services; long-term care 18
noninstitutional services; medical supplies and equipment; advanced practice 19
registered nurse services; clinic services; rehabilitative services for children eligible 20
for services under AS 47.07.063, substance abusers, and emotionally disturbed or 21
chronically mentally ill adults; targeted case management services; inpatient 22
psychiatric facility services for individuals 65 years of age or older and individuals 23
under 21 years of age; psychologists' services; clinical social workers' services; marital 24
and family therapy services; professional counseling services; midwife services; 25
prescribed drugs; physical therapy; occupational therapy; chiropractic services; low-26
dose mammography screening, as defined in AS 21.42.375(e); hospice care; treatment 27
of speech, hearing, and language disorders; adult dental and dental hygiene services; 28
prosthetic and orthotic devices or replacements as covered in AS 21.42.445(b) and 29
(c); [AND] eyeglasses; optometrists' services; intermediate care facility services, 30
including intermediate care facility services for persons with intellectual and 31
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developmental disabilities; skilled nursing facility services for individuals under 21 1
years of age; and reasonable transportation to and from the point of medical care. 2
* Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to 3
read: 4
REPORTING. (a) Not later than October 1, 2028, a health care insurer subject to 5
AS 21.42.445, added by sec. 1 of this Act, shall submit a report to the director of the division 6
of insurance, Department of Commerce, Community, and Economic Development, on a form 7
determined by the director, that contains the total number of claims and the total amount of 8
claims paid for services required under AS 21.42.445 for the preceding two fiscal years. 9
(b) Before the first day of the First Regular Session of the Thirty-Sixth Alaska State 10
Legislature, the director of the division of insurance, Department of Commerce, Community, 11
and Economic Development, shall prepare a report that contains the information reported 12
under (a) of this section aggregated by fiscal year, and shall deliver the report to the senate 13
secretary and the chief clerk of the house of representatives and notify the legislature that the 14
report is available. 15
(c) Before the first day of the First Regular Session of the Thirty-Sixth Alaska State 16
Legislature, the commissioner of health shall prepare a report aggregated by fiscal year of the 17
total number of claims and the total amount of claims paid for prosthetic and orthotic services 18
provided through medical assistance under AS 47.07.030(b), as amended by sec. 2 of this Act, 19
and shall deliver the report to the senate secretary and the chief clerk of the house of 20
representatives and notify the legislature that the report is available. 21
* Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 22
read: 23
APPLICABILITY. AS 21.42.445, added by sec. 1 of this Act, applies to a health care 24
insurance plan or contract issued, delivered, or renewed on or after the effective date of sec. 1 25
of this Act. 26
* Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 27
read: 28
MEDICAID STATE PLAN FEDERAL APPROVAL. To the extent necessary to 29
implement this Act, the Department of Health shall amend and submit to the United States 30
Department of Health and Human Services for approval the state plan for medical assistance 31
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coverage consistent with AS 47.07.030(b), as amended by sec. 2 of this Act. 1
* Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to 2
read: 3
CONDITIONAL EFFECT; NOTIFICATION. (a) Section 2 of this Act takes effect 4
only if, on or before January 1, 2027, the United States Department of Health and Human 5
Services 6
(1) approves the amendment to the state plan for medical assistance coverage 7
under AS 47.07.030(b); or 8
(2) determines that approval of the amendment to the state plan for medical 9
assistance coverage under AS 47.07.030(b) is not necessary. 10
(b) The commissioner of health shall notify the revisor of statutes in writing within 30 11
days after the United States Department of Health and Human Services approves the 12
amendment to the state plan or determines that approval is not necessary under this section. 13
* Sec. 7. Section 1 of this Act takes effect January 1, 2027. 14
* Sec. 8. If sec. 2 of this Act takes effect, it takes effect on the day after the United States 15
Department of Health and Human Services approves the amendment submitted under sec. 6 16
of this Act or determines that approval of the amendment is not necessary. 17