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HB2333 - 572R - I Ver
REFERENCE TITLE:
insurance; prosthetics; orthotics; reporting requirements
State of Arizona
House of Representatives
Fifty-seventh Legislature
Second Regular Session
2026
HB 2333
Introduced by
Representative
Heap
AN
ACT
Amending Title
20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-826.06;
amending Title 20, chapter 4, article 9, Arizona Revised Statutes, by adding
section 20-1057.21; amending Title 20, chapter 6, article 4, Arizona
Revised Statutes, by adding section 20-1342.09; amending Title 20,
chapter 6, article 5, Arizona Revised Statutes, by adding section 20-1404.07;
relating to health insurance.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section
1. Title
20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding
section 20-826.06, to read:
START_STATUTE
20-826.06.
Prosthetic devices and orthotic devices; coverage; reimbursement
rates; annual report
A. A hospital service corporation or
medical service corporation that issues, amends, delivers or renews a
subscription contract on or after January 1, 2027 shall provide coverage for
prosthetic devices and orthotic devices that is at least equivalent to the
coverage that is currently provided under Medicare Part B, and the coverage may
not be provided under less favorable terms or conditions than any other medical
or surgical benefits under the subscription contract.
B. Coverage under a subscription
contract for prosthetic devices and orthotic devices shall include all of the
following:
1. The purchase, fitting, adjustment,
repair and replacement of one or more prosthetic devices or orthotic devices as
needed to accomplish both of the following, as applicable:
(
a
) The
replacement of all or part of a missing body part and its adjoining tissues.
(
b
) The
replacement of all of the function of a permanently useless or malfunctioning
body part as necessary to allow the subscriber to do all of the following:
(
i
) Complete
activities of daily living or essential job-related activities.
(
ii
) Perform
physical activities, including running, biking, swimming or strength training,
to maximize the covered person's whole body health and lower and upper limb
function.
(
iii
) Shower or
bathe.
2. All materials and components that
are necessary to use the device, including instructions on how to use the
device.
3. Habilitative or rehabilitative
coverage benefits.
C. A prosthetic device or orthotic
device shall be medically necessary as determined by a subscriber's health care
provider, and the health care provider shall choose the most appropriate model
of prosthetic device or orthotic device that adequately meets the medical needs
of the subscriber and that allows the subscriber to perform activities as
provided in subsection B, paragraph 1 of this SECTION.
D. A hospital service corporation or
medical service corporation shall include in the subscription contract language
that describes both a subscriber's rights under this section and any benefit
denial letters.� If a hospital service corporation or medical service
corporation denies coverage for a prosthetic device or orthotic device, the
hospital service corporation or medical service corporation shall issue the
denial of coverage in writing.
E. This section does not prohibit a
hospital service corporation or medical service corporation from imposing cost
sharing for prosthetic devices or orthotic devices if the cost sharing is not
more restrictive than the cost sharing requirements for inpatient physician or
surgical services.� prosthetic device and orthotic device coverage may not
incur separate cost sharing requirements that are applicable only to coverage
for prosthetic devices or orthotic devices.
F. A hospital service corporation or
medical service corporation shall ensure that a subscriber has access to
medically necessary clinical care and to prosthetic devices and orthotic
devices and technology from not less than two distinct prosthetic device and
orthotic device providers that are located in this state.
G. If medically necessary covered
prosthetic devices and orthotic devices are not available from an in-network
provider, a hospital service corporation or medical service corporation shall
provide a process to refer a subscriber to an out-of-network
provider and shall fully reimburse the out-of-network provider at a
mutually agreed on rate, less any applicable cost sharing as determined on an
in-network basis.
H. A hospital service corporation or
medical service corporation shall provide coverage for the replacement of a
covered prosthetic device or orthotic device or for the replacement of any part
of the device, as applicable, without regard to CONTINUOUS use or useful
lifetime restrictions if an ordering health care provider determines that the
device or part of the device needs to be replaced due to any of the following:
1. A change in the physiological
condition of the subscriber.
2. An irreparable change in the
condition of the device or in a part of the device.
3. The condition of the device or any
part of the device requires repairs and the cost of the repairs is more than
sixty percent of the cost of a replacement device or of the part that is being
replaced.
I. Before a hospital service
corporation or medical service corporation replaces a prosthetic device or
orthotic device that is less than three years old, the hospital service
corporation or medical service corporation may request that the health care
provider confirm that the device needs to be replaced.
J. A hospital service corporation or
medical service corporation may not:
1. Cancel or change premiums,
benefits or conditions under a subscription contract on the basis of a
subscriber's actual or perceived disability.
2. Deny prosthetic device or orthotic
device benefits to a subscriber with limb loss, limb absence or limb difference
if such benefits would otherwise be covered for a person who does not have a
disability and who seekS medical or surgical intervention to restore or
maintain the ability to perform the same physical activity.
K. On or before January 1, 2028 and
each year thereafter, the department shall issue a report that provides
guidance on what type of medical care and prosthetic devices and orthotic
devices are necessary to restore full physical activity to a subscriber with
limb loss, limb difference or mobility impairment.
END_STATUTE
Sec. 2. Title 20, chapter 4, article 9, Arizona
Revised Statutes, is amended by adding section 20-1057.21, to read:
START_STATUTE
20-1057.21.
Prosthetic devices and orthotic devices; coverage; reimbursement
rates; annual report
A. A health care services
organization that issues, amends, delivers or renews an evidence of coverage on
or after January 1, 2027 shall provide coverage for prosthetic devices and
orthotic devices that is at least equivalent to the coverage that is currently
provided under Medicare Part B, and the coverage may not be provided under less
favorable terms or conditions than any other medical or surgical benefits under
the evidence of coverage.
B. Coverage under an evidence of
coverage for prosthetic devices and orthotic devices shall include all of the
following:
1. The purchase, fitting, adjustment,
repair and replacement of one or more prosthetic devices or orthotic devices as
needed to accomplish both of the following, as applicable:
(
a
) The
replacement of all or part of a missing body part and its adjoining tissues.
(
b
) The
replacement of all of the function of a permanently useless or malfunctioning
body part as necessary to allow the enrollee to do all of the following:
(
i
) Complete
activities of daily living or essential job-related activities.
(
ii
) Perform
physical activities, including running, biking, swimming or strength training,
to maximize the covered person's whole body health and lower and upper limb
function.
(
iii
) Shower or
bathe.
2. All materials and components that
are necessary to use the device, including instructions on how to use the
device.
3. Habilitative or rehabilitative
coverage benefits.
C. A prosthetic device or orthotic
device shall be medically necessary as determined by an enrollee's health care
provider, and the health care provider shall choose the most appropriate model
of prosthetic device or orthotic device that adequately meets the medical needs
of the enrollee and that allows the enrollee to perform activities as provided
in subsection B, paragraph 1 of this SECTION.
D. A health care services
organization shall include in the evidence of coverage language that describes
both an enrollee's rights under this section and any benefit denial
letters. If a health care services organization denies coverage for
a prosthetic device or orthotic device, the health care services organization
shall issue the denial of coverage in writing.
E. This section does not prohibit a
health care services organization from imposing cost sharing for prosthetic
devices or orthotic devices if the cost sharing is not more restrictive than
the cost sharing requirements for inpatient physician or surgical services.�
prosthetic device and orthotic device coverage may not incur separate cost
sharing requirements that are applicable only to coverage for prosthetic
devices or orthotic devices.
F. A health care services
organization shall ensure that an enrollee has access to medically necessary
clinical care and to prosthetic devices and orthotic devices and technology
from not less than two distinct prosthetic device and orthotic device providers
that are located in this state.
G. If medically necessary covered
prosthetic devices and orthotic devices are not available from an in-network
provider, a health care services organization shall provide a process to refer
an enrollee to an out-of-network provider and shall fully reimburse
the out-of-network provider at a mutually agreed on rate, less any
applicable cost sharing as determined on an in-network basis.
H. A health care services
organization shall provide coverage for the replacement of a covered prosthetic
device or orthotic device or for the replacement of any part of the device, as
applicable, without regard to CONTINUOUS use or useful lifetime restrictions if
an ordering health care provider determines that the device or part of the
device needs to be replaced due to any of the following:
1. A change in the physiological
condition of the enrollee.
2. An irreparable change in the
condition of the device or in a part of the device.
3. The condition of the device or any
part of the device requires repairs and the cost of the repairs is more than
sixty percent of the cost of a replacement device or of the part that is being
replaced.
I. Before a health care services
organization replaces a prosthetic device or orthotic device that is less than
three years old, the health care services organization may request that the
health care provider confirm that the device needs to be replaced.
J. A health care services
organization may not:
1. Cancel or change premiums,
benefits or conditions under an evidence of coverage on the basis of an
enrollee's actual or perceived disability.
2. Deny prosthetic device or orthotic
device benefits to an enrollee with limb loss, limb absence or limb difference
if such benefits would otherwise be covered for a person who does not have a
disability and who seekS medical or surgical intervention to restore or
maintain the ability to perform the same physical activity.
K. On or before January 1, 2028 and
each year thereafter, the department shall issuer a report that provides
guidance on what type of medical care and prosthetic devices and orthotic
devices are necessary to restore full physical activity to an enrollee with
limb loss, limb difference or mobility impairment.
END_STATUTE
Sec. 3.
Title 20,
chapter 6, article 4, Arizona Revised Statutes, is amended by adding section
20-1342.0
9, to read:
START_STATUTE
20-1342.09.
Prosthetic devices and orthotic devices; coverage; reimbursement
rates; annual report
A. A disability insurer that issues,
amends, delivers or renews a policy on or after January 1, 2027 shall provide
coverage for prosthetic devices and orthotic devices that is at least
equivalent to the coverage that is currently provided under Medicare Part B,
and the coverage may not be provided under less favorable terms or conditions
than any other medical or surgical benefits under the policy.
B. Policy coverage for prosthetic
devices and orthotic devices shall include all of the following:
1. The purchase, fitting, adjustment,
repair and replacement of one or more prosthetic devices or orthotic devices as
needed to accomplish both of the following, as applicable:
(
a
) The
replacement of all or part of a missing body part and its adjoining tissues.
(
b
) The
replacement of all of the function of a permanently useless or malfunctioning
body part as necessary to allow the insured to do all of the following:
(
i
) Complete
activities of daily living or essential job-related activities.
(
ii
) Perform
physical activities, including running, biking, swimming or strength training,
to maximize the covered person's whole body health and lower and upper limb
function.
(
iii
) Shower or
bathe.
2. All materials and components that
are necessary to use the device, including instructions on how to use the
device.
3. Habilitative or rehabilitative
coverage benefits.
C. A prosthetic device or orthotic
device shall be medically necessary as determined by an insured's health care
provider, and the health care provider shall choose the most appropriate model
of prosthetic device or orthotic device that adequately meets the medical needs
of the insured and that allows the insured to perform activities as provided in
subsection B, paragraph 1 of this SECTION.
D. A disability insurer shall include
in the policy language that describes both an insured's rights under this
section and any benefit denial letters.� If a disability insurer denies
coverage for a prosthetic device or orthotic device, the disability insurer
shall issue the denial of coverage in writing.
E. This section does not prohibit a
disability insurer from imposing cost sharing for prosthetic devices or
orthotic devices if the cost sharing is not more restrictive than the cost
sharing requirements for inpatient physician or surgical services.� prosthetic
device and orthotic device coverage may not incur separate cost sharing
requirements that are applicable only to coverage for prosthetic devices or
orthotic devices.
F. A disability insurer shall ensure
that an insured has access to medically necessary clinical care and to
prosthetic devices and orthotic devices and technology from not less than two
distinct prosthetic device and orthotic device providers that are located in
this state.
G. If medically necessary covered
prosthetic devices and orthotic devices are not available from an in-network
provider, a disability insurer shall provide a process to refer an insured to
an out-of-network provider and shall fully reimburse the out-of-network
provider at a mutually agreed on rate, less any applicable cost sharing as
determined on an in-network basis.
H. A disability insurer shall provide
coverage for the replacement of a covered prosthetic device or orthotic device
or for the replacement of any part of the device, as applicable, without regard
to CONTINUOUS use or useful lifetime restrictions if an ordering health care
provider determines that the device or part of the device needs to be replaced
due to any of the following:
1. A change in the physiological
condition of the insured.
2. An irreparable change in the
condition of the device or in a part of the device.
3. The condition of the device or any
part of the device requires repairs and the cost of the repairs is more than
sixty percent of the cost of a replacement device or of the part that is being
replaced.
I. Before a disability insurer
replaces a prosthetic device or orthotic device that is less than three years
old, the disability insurer may request that the health care provider confirm
that the device needs to be replaced.
J. A disability insurer may not:
1. Cancel or change premiums,
benefits or conditions under a policy on the basis of an insured's actual or
perceived disability.
2. Deny prosthetic device or orthotic
device benefits to an insured with limb loss, limb absence or limb difference
if such benefits would otherwise be covered for a person who does not have a
disability and who seekS medical or surgical intervention to restore or
maintain the ability to perform the same physical activity.
K. On or before January 1, 2028 and
each year thereafter, the department shall issue a report that provides
guidance on what type of medical care and prosthetic devices and orthotic
devices are necessary to restore full physical activity to an insured with limb
loss, limb difference or mobility impairment.
END_STATUTE
Sec. 4.
Title 20,
chapter 6, article 5, Arizona Revised Statutes, is amended by adding section 20-1404.
07,
to read:
START_STATUTE
20-1404.07.
Prosthetic devices and orthotic devices; coverage; reimbursement
rates; annual report
A. A group or blanket disability
insurer that issues, amends, delivers or renews a policy on or after January 1,
2027 shall provide coverage for prosthetic devices and orthotic devices that is
at least equivalent to the coverage that is currently provided under Medicare
Part B, and the coverage may not be provided under less favorable terms or
conditions than any other medical or surgical benefits under the policy.
B. Policy coverage for prosthetic
devices and orthotic devices shall include all of the following:
1. The purchase, fitting, adjustment,
repair and replacement of one or more prosthetic devices or orthotic devices as
needed to accomplish both of the following, as applicable:
(
a
) The
replacement of all or part of a missing body part and its adjoining tissues.
(
b
) The
replacement of all of the function of a permanently useless or malfunctioning
body part as necessary to allow the insured to do all of the following:
(
i
) Complete
activities of daily living or essential job-related activities.
(
ii
) Perform
physical activities, including running, biking, swimming or strength training,
to maximize the covered person's whole body health and lower and upper limb
function.
(
iii
) Shower or
bathe.
2. All materials and components that
are necessary to use the device, including instructions on how to use the
device.
3. Habilitative or rehabilitative
coverage benefits.
C. A prosthetic device or orthotic
device shall be medically necessary as determined by an insured's health care
provider, and the health care provider shall choose the most appropriate model
of prosthetic device or orthotic device that adequately meets the medical needs
of the insured and that allows the insured to perform activities as provided in
subsection B, paragraph 1 of this SECTION.
D. A group or blanket disability
insurer shall include in the policy language that describes both an insured's
rights under this section and any benefit denial letters.� If a group or
blanket disability insurer denies coverage for a prosthetic device or orthotic
device, the group or blanket disability insurer shall issue the denial of
coverage in writing.
E. This section does not prohibit a
group or blanket disability insurer from imposing cost sharing for prosthetic
devices or orthotic devices if the cost sharing is not more restrictive than
the cost sharing requirements for inpatient physician or surgical services.�
prosthetic device and orthotic device coverage may not incur separate cost
sharing requirements that are applicable only to coverage for prosthetic
devices or orthotic devices.
F. A group or blanket disability
insurer shall ensure that an insured has access to medically necessary clinical
care and to prosthetic devices and orthotic devices and technology from not
less than two distinct prosthetic device and orthotic device providers that are
located in this state.
G. If medically necessary covered
prosthetic devices and orthotic devices are not available from an in-network
provider, a group or blanket disability insurer shall provide a process to
refer an insured to an out-of-network provider and shall fully
reimburse the out-of-network provider at a mutually agreed on rate,
less any applicable cost sharing as determined on an in-network basis.
H. A group or blanket disability
insurer shall provide coverage for the replacement of a covered prosthetic
device or orthotic device or for the replacement of any part of the device, as
applicable, without regard to CONTINUOUS use or useful lifetime restrictions if
an ordering health care provider determines that the device or part of the
device needs to be replaced due to any of the following:
1. A change in the physiological
condition of the insured.
2. An irreparable change in the
condition of the device or in a part of the device.
3. The condition of the device or any
part of the device requires repairs and the cost of the repairs is more than
sixty percent of the cost of a replacement device or of the part that is being
replaced.
I. Before a group or blanket
disability insurer replaces a prosthetic device or orthotic device that is less
than three years old, the group or blanket disability insurer may request that
the health care provider confirm that the device needs to be replaced.
J. A group or blanket disability
insurer may not:
1. Cancel or change premiums,
benefits or conditions under a policy on the basis of an insured's actual or
perceived disability.
2. Deny prosthetic device or orthotic
device benefits to an insured with limb loss, limb absence or limb difference
if such benefits would otherwise be covered for a person who does not have a
disability and who seekS medical or surgical intervention to restore or
maintain the ability to perform the same physical activity.
K. On or before January 1, 2028 and
each year thereafter, the department shall issue a report that provides
guidance on what type of medical care and prosthetic devices and orthotic
devices are necessary to restore full physical activity to an insured with limb
loss, limb difference or mobility impairment.
END_STATUTE
Sec. 5.
Prosthetic
devices and orthotic devices; annual reports; delayed repeal
A. On or before January 1,
2028 and each year thereafter through January 1, 2032, the following entities
shall submit a report to the department of insurance and financial institutions
as follows:
1. A hospital service
corporation and medical service corporation shall submit a report that contains
both of the following:
(a) The total number of
claims that were made for prosthetic devices and orthotic devices as prescribed
in section 20-826.06, Arizona Revised Statutes, as added by this act.
(b) The total amount paid
for coverage that was provided for prosthetic devices and orthotic devices as
prescribed in section 20-826.06, Arizona Revised Statutes, as added by
this act.
2. A health care services
organization shall submit a report that contains both of the following:
(a) The total number of
claims that were made for prosthetic devices and orthotic devices as prescribed
in section 20-1057.21, Arizona Revised Statutes, as added by this act.
(b) The total amount paid
for coverage that was provided for prosthetic devices and orthotic devices as
prescribed in section 20-1057.21, Arizona Revised Statutes, as added by
this act.
3. A disability insurer
shall submit a report that contains both of the following:
(a) The total number of
claims that were made for prosthetic devices and orthotic devices as prescribed
in section 20-1342.09, Arizona Revised Statutes, as added by this act.
(b) The total amount paid
for coverage that was provided for prosthetic devices and orthotic devices as
prescribed in section 20-1342.09, Arizona Revised Statutes, as added by
this act.
4. A group or blanket
disability insurer shall submit a report that contains both of the following:
(a) The total number of
claims that were made for prosthetic devices and orthotic devices as prescribed
in section 20-1404.07, Arizona Revised Statutes, as added by this act.
(b) The total amount paid
for coverage that was provided for prosthetic devices and orthotic devices as
prescribed in section 20-1404.07, Arizona Revised Statutes, as added by
this act.
B. On or before January 1,
2028 and each year thereafter through January 1, 2032, the department of
insurance and financial institutions shall compile the information provided
pursuant to subsection A of this section, shall submit a report to the
president of the senate and the speaker of the house of representatives and
shall provide a copy of this report to the secretary of state.
C. This section is repealed
from and after January 1, 2032.