Coverage for Orthotics and Prosthetics Services

HB 1301 2026

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A bill to be entitled 1
An act relating to coverage for orthotics and 2
prosthetics services; amending s. 409.906, F.S.; 3
authorizing the Agency for Health Care Administration 4
to authorize and pay for specified orthotics and 5
prosthetics services for Medicaid recipients; 6
requiring the agency to seek federal approval and 7
amend contracts as necessary to implement the act; 8
creating ss. 627.64085, 627.6614, and 641.31079, F.S.; 9
requiring individual health insurance policies; group, 10
blanket, and franchise health insurance policies; and 11
health maintenance contracts, respectively, to provide 12
coverage for specified orthotics and prosthetics 13
services; prohibiting health insurers and health 14
maintenance organizations from denying claims under 15
certain circumstances; requiring health insurers and 16
health maintenance organizations to submit annual 17
reports of specified information to the Office of 18
Insurance Regulation; providing an effective date. 19
20
Be It Enacted by the Legislature of the State of Florida: 21
22
Section 1. Subsection (10) of section 409.906, Florida 23
Statutes, is amended to read: 24
409.906 Optional Medicaid services.—Subject to specific 25

HB 1301 2026

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appropriations, the agency may make payments for services which 26
are optional to the state under Title XIX of the Social Security 27
Act and are furnished by Medicaid providers to recipients who 28
are determined to be eligible on the dates on which the services 29
were provided. Any optional service that is provided shall be 30
provided only when medically necessary and in accordance with 31
state and federal law. Optional services rendered by providers 32
in mobile units to Medicaid recipients may be restricted or 33
prohibited by the agency. Nothing in this section shall be 34
construed to prevent or limit the agency from adjusting fees, 35
reimbursement rates, lengths of stay, number of visits, or 36
number of services, or making any other adjustments necessary to 37
comply with the availability of moneys and any limitations or 38
directions provided for in the General Appropriations Act or 39
chapter 216. If necessary to safeguard the state's systems of 40
providing services to elderly and disabled persons and subject 41
to the notice and review provisions of s. 216.177, the Governor 42
may direct the Agency for Health Care Administration to amend 43
the Medicaid state plan to delete the optional Medicaid service 44
known as "Intermediate Care Facilities for the Developmentally 45
Disabled." Optional services may include: 46
(10) DURABLE MEDICAL EQUIPMENT.— 47
(a) The agency may authorize and pay for certain durable 48
medical equipment and supplies provided to a Medicaid recipient 49
as medically necessary. 50

HB 1301 2026

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(b) The agency may authorize and pay for all of the 51
following orthotics and prosthetics services: 52
1. Orthoses and prostheses as those terms are defined in 53
s. 468.80. Coverage must include payment for the model of an 54
orthosis or a prosthesis which is deemed by the recipient's 55
provider to be the most appropriate to meet the medical needs of 56
the recipient to perform activities of daily living, essential 57
job-related activities, and physical recreational activities, 58
such as running, biking, swimming, strength training, and other 59
activities that maximize the recipient's full body health and 60
lower and upper limb function. 61
2. All materials and components necessary to use the 62
orthosis or prosthesis. 63
3. Instruction on the use of the orthosis or prosthesis. 64
4. Any necessary repairs or replacement of the orthosis or 65
prosthesis. 66
Section 2. The Agency for Health Care Administration shall 67
seek federal approval and amend contracts as necessary to 68
implement the changes made to s. 409.906, Florida Statutes, by 69
this act. 70
Section 3. Section 627.64085, Florida Statutes, is created 71
to read: 72
627.64085 Orthotics and prosthetics services.— 73
(1) A health insurance policy issued, amended, delivered, 74
or renewed in this state on or after July 1, 2026, must provide 75

HB 1301 2026

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coverage for all of the following: 76
(a) Orthoses and prostheses as those terms are defined in 77
s. 468.80 if the insured's provider determines that an orthosis 78
or a prosthesis is medically necessary for the insured to 79
perform activities of daily living, essential job-related 80
activities, and physical recreational activities, such as 81
running, biking, swimming, strength training, and other 82
activities that maximize the insured's full body health and 83
lower and upper limb function. 84
(b) Any replacement of the orthosis or prosthesis, or part 85
thereof, without regard to continuous use or useful lifetime 86
restrictions, if the insured's provider determines that it is 87
medically necessary due to any of the following: 88
1. A change in the physiological condition of the insured. 89
2. An irreparable change in the condition of the orthosis 90
or prosthesis, or part thereof. 91
3. A change in the condition of the orthosis or 92
prosthesis, or part thereof, requires repairs that would cost 93
more than 60 percent of the cost of a replacement orthosis or 94
prosthesis or of the part thereof requiring replacement. 95
96
A health insurer may require supporting documentation from an 97
insured's provider to confirm the need for a replacement for an 98
orthosis or a prosthesis that is less than 3 years old. 99
(2) A health insurer may not deny a claim for an orthosis 100

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or a prosthesis for an insured with limb loss or limb absence 101
which would otherwise be covered for a nondisabled person 102
seeking medical or surgical intervention to restore or maintain 103
the ability to perform the same type of physical function 104
affected. 105
(3) Beginning July 1, 2027, and annually thereafter, each 106
health insurer subject to this section shall submit a report to 107
the office of the total number of claims submitted for orthotics 108
and prosthetics services in the previous plan year and the total 109
number of such claims that were paid, including the amount paid. 110
Section 4. Section 627.6614, Florida Statutes, is created 111
to read: 112
627.6614 Orthotics and prosthetics services.— 113
(1) A group, blanket, or franchise health insurance policy 114
issued, amended, delivered, or renewed in this state on or after 115
July 1, 2026, must provide coverage for all of the following: 116
(a) Orthoses and prostheses as those terms are defined in 117
s. 468.80 if the insured's provider determines that an orthosis 118
or a prosthesis is medically necessary for the insured to 119
perform activities of daily living, essential job-related 120
activities, and physical recreational activities, such as 121
running, biking, swimming, strength training, and other 122
activities that maximize the insured's full body health and 123
lower and upper limb function. 124
(b) Any replacement of the orthosis or prosthesis, or part 125

HB 1301 2026

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thereof, without regard to continuous use or useful lifetime 126
restrictions, if the insured's provider determines that it is 127
medically necessary due to any of the following: 128
1. A change in the physiological condition of the insured. 129
2. An irreparable change in the condition of the orthosis 130
or prosthesis, or part thereof. 131
3. A change in the condition of the orthosis or 132
prosthesis, or part thereof, requires repairs that would cost 133
more than 60 percent of the cost of a replacement orthosis or 134
prosthesis or of the part thereof requiring replacement. 135
136
A health insurer may require supporting documentation from an 137
insured's provider to confirm the need for a replacement for an 138
orthosis or a prosthesis that is less than 3 years old. 139
(2) A health insurer may not deny a claim for an orthosis 140
or a prosthesis for an insured with limb loss or limb absence 141
which would otherwise be covered for a nondisabled person 142
seeking medical or surgical intervention to restore or maintain 143
the ability to perform the same type of physical function 144
affected. 145
(3) Beginning July 1, 2027, and annually thereafter, each 146
health insurer subject to this section shall submit a report to 147
the office of the total number of claims submitted for orthotics 148
and prosthetics services in the previous plan year and the total 149
number of such claims that were paid, including the amount paid. 150

HB 1301 2026

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Section 5. Section 641.31079, Florida Statutes, is created 151
to read: 152
641.31079 Orthotics and prosthetics services.— 153
(1) A health maintenance contract issued, amended, 154
delivered, or renewed in this state on or after July 1, 2026, 155
must provide coverage for all of the following: 156
(a) Orthoses and prostheses as those terms are defined in 157
s. 468.80 if the subscriber's provider determines that an 158
orthosis or a prosthesis is medically necessary for the 159
subscriber to perform activities of daily living, essential job-160
related activities, and physical recreational activities, such 161
as running, biking, swimming, strength training, and other 162
activities that maximize the subscriber's full body health and 163
lower and upper limb function. 164
(b) Any replacement of the orthosis or prosthesis, or part 165
thereof, without regard to continuous use or useful lifetime 166
restrictions, if the subscriber's provider determines that it is 167
medically necessary due to any of the following: 168
1. A change in the physiological condition of the 169
subscriber. 170
2. An irreparable change in the condition of the orthosis 171
or prosthesis, or part thereof. 172
3. A change in the condition of the orthosis or 173
prosthesis, or part thereof, requires repairs that would cost 174
more than 60 percent of the cost of a replacement orthosis or 175

HB 1301 2026

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prosthesis or of the part thereof requiring replacement. 176
177
A health maintenance organization may require supporting 178
documentation from a subscriber's provider to confirm the need 179
for a replacement for an orthosis or a prosthesis that is less 180
than 3 years old. 181
(2) A health maintenance organization may not deny a claim 182
for an orthosis or a prosthesis for a subscriber with limb loss 183
or limb absence which would otherwise be covered for a 184
nondisabled person seeking medical or surgical intervention to 185
restore or maintain the ability to perform the same type of 186
physical function affected. 187
(3) Beginning July 1, 2027, and annually thereafter, each 188
health maintenance organization subject to this section shall 189
submit a report to the office of the total number of claims 190
submitted for orthotics and prosthetics services in the previous 191
plan year and the total number of such claims that were paid, 192
including the amount paid. 193
Section 6. This act shall take effect July 1, 2026. 194