Read the full stored bill text
Florida Senate
-
2026
CS for SB 1110
By
the Committee on Banking and Insurance; and Senators Truenow
and Smith
597-02756-26 20261110c1
1 A bill to be entitled
2 An act relating to coverage for orthotics and
3 prosthetics services; amending s. 409.906, F.S.;
4 defining the term “eligible individual”; authorizing
5 the Agency for Health Care Administration to authorize
6 and pay for specified orthotics and prosthetics
7 services for Medicaid recipients who are eligible
8 individuals; providing construction; requiring the
9 agency to seek federal approval and amend contracts as
10 necessary to implement the act; creating ss.
11 627.64085, 627.6614, and 641.31079, F.S.; defining the
12 term “eligible individual”; requiring individual
13 health insurance policies; group, blanket, and
14 franchise health insurance policies; and health
15 maintenance contracts, respectively, to provide
16 coverage for specified orthotics and prosthetics
17 services for eligible individuals; authorizing health
18 insurers and health maintenance organizations to
19 require certain supporting documentation; prohibiting
20 health insurers and health maintenance organizations
21 from denying claims under certain circumstances;
22 requiring health insurers and health maintenance
23 organizations to submit annual reports of specified
24 information to the Office of Insurance Regulation;
25 providing construction; providing an effective date.
26
27 Be It Enacted by the Legislature of the State of Florida:
28
29 Section 1. Subsection (10) of section 409.906, Florida
30 Statutes, is amended to read:
31 409.906 Optional Medicaid services.—Subject to specific
32 appropriations, the agency may make payments for services which
33 are optional to the state under Title XIX of the Social Security
34 Act and are furnished by Medicaid providers to recipients who
35 are determined to be eligible on the dates on which the services
36 were provided. Any optional service that is provided shall be
37 provided only when medically necessary and in accordance with
38 state and federal law. Optional services rendered by providers
39 in mobile units to Medicaid recipients may be restricted or
40 prohibited by the agency. Nothing in this section shall be
41 construed to prevent or limit the agency from adjusting fees,
42 reimbursement rates, lengths of stay, number of visits, or
43 number of services, or making any other adjustments necessary to
44 comply with the availability of moneys and any limitations or
45 directions provided for in the General Appropriations Act or
46 chapter 216. If necessary to safeguard the state’s systems of
47 providing services to elderly and disabled persons and subject
48 to the notice and review provisions of s. 216.177, the Governor
49 may direct the Agency for Health Care Administration to amend
50 the Medicaid state plan to delete the optional Medicaid service
51 known as “Intermediate Care Facilities for the Developmentally
52 Disabled.” Optional services may include:
53 (10) DURABLE MEDICAL EQUIPMENT.—
54
(a)
The agency may authorize and pay for certain durable
55 medical equipment and supplies provided to a Medicaid recipient
56 as medically necessary.
57
(b)1.
As used in this
paragraph
, the term “eligible
58
individual” means
a Medicaid recipient who is
:
59
a
.
A child younger than 18 years of age
;
60
b
.
A dependent child as
specifi
ed in s. 627.6562
;
61
c
.
An
i
ndividual 26 years of age or younger who remains
62
covered under a parent’s health insurance policy pursuant to s.
63
627.6562; or
64
d.
An individual with a
developmental
disability as defined
65
in s. 393.063.
66
2.
The agency may authorize and pay for all of the
67
following orthotics and prosthetics services for eligible
68
individuals:
69
a.
Orthoses and prostheses as those terms are defined in s.
70
468.80. Coverage must include payment for:
71
(I)
The model of an orthosis or a prosthesis which is
72
deemed by the eligible individual’s provider to be the most
73
appropriate to meet the medical needs of the eligible individual
74
to perform activities of daily living and essential job-related
75
activities; and
76
(II)
When medically necessary, an orthosis or a prosthesis
77
designed for physical or recreational activities that maximize
78
the eligible individual’s full body health and lower and upper
79
limb function.
80
b.
All materials and components necessary to use the
81
orthosis or prosthesis.
82
c.
Instruction on the use of the orthosis or prosthesis.
83
d.
Any necessary repairs or replacement of the orthosis or
84
prosthesis.
85
3.
This paragraph may not be construed to require Medicaid
86
coverage of
orthotics and prosthetics services
specified herein
87
for a Medicaid recipient who is not an eligible individual.
88 Section 2.
The Agency for Health Care Administration shall
89
seek federal
approval and amend contracts as necessary
to
90
implement the changes made to s. 409.90
6
, Florida Statutes, by
91
this act.
92 Section 3. Section 627.64085, Florida Statutes, is created
93 to read:
94
627.64085
Orthotics and prosthetics services
.—
95
(1)
As used in this
section
, the term “eligible individual”
96
means
an insured who is
:
97
a.
A child younger than 18 years of age;
98
b.
A dependent child as
specified
in s. 627.6562;
99
c.
An individual 26 years of age or younger who remains
100
covered under a parent’s health insurance policy pursuant to s.
101
627.6562; or
102
d.
An individual with a developmental disability as defined
103
in s. 393.063.
104
(2)
A health insurance policy
issued, amended, delivered,
105
or renewed in this state
on or
after July 1, 202
6
,
must provide
106
coverage of
all
of the following for eligible individuals:
107
(a)
Orthoses and prostheses as those terms are defined in
108
s. 468.80 if the eligible individual’s provider determines that
109
an orthosis or a prosthesis is medically necessary for the
110
eligible individual to perform activities of daily living,
111
essential job-related activities, and physical recreational
112
activities, such as running, biking, swimming, strength
113
training, and other activities that maximize the
eligible
114
individual
’s full body health and lower and upper limb function.
115
(b)
Any replacement of the orthosis or prosthesis, or part
116
thereof, without regard to continuous use or useful lifetime
117
restrictions, if the
eligible individual
’s provider determines
118
that it is medically necessary due to any of the following:
119
1.
A change in the physiological condition of the
eligible
120
individual
.
121
2.
An irreparable change in the condition of the orthosis
122
or prosthesis, or part thereof.
123
3.
A change in the condition of the orthosis or prosthesis,
124
or part thereof, requires repairs that would cost more than 60
125
percent of the cost of a replacement orthosis or prosthesis or
126
of the part thereof requiring replacement.
127
128
A
health
insurer
may require supporting documentation from a
n
129
eligible individual
’s provider to confirm the need for a
130
replacement for an orthosis or a prosthesis that is less than 3
131
years old.
132
(3)
A health insurer may not deny a claim for an orthosis
133
or a prosthesis as a medically necessary intervention to restore
134
physical function for an
eligible individual
with a disability
135
which would otherwise be covered for a nondisabled person
136
seeking medical or surgical intervention to restore or maintain
137
the ability to perform the same type of physical function
138
affected.
139
(4)
Beginning July 1, 2027, and annually thereafter, each
140
health insurer subject to this section shall submit a report to
141
the Office of Insurance Regulation detailing the total number of
142
claims submitted for orthotics and prosthetics services in the
143
previous plan year and the total number of such claims that were
144
paid, including the amount paid.
145
(5)
This section may not be construed to require coverage
146
of orthotics or prosthetics services for an insured who is not
147
an eligible individual.
148 Section 4. Section 627.6614, Florida Statutes, is created
149 to read:
150
627.6614
Orthotics and prosthetics services
.—
151
(1)
As used in this section, the term “eligible individual”
152
means an insured who is:
153
a.
A child younger than 18 years of age;
154
b.
A dependent child as
specified
in s. 627.6562;
155
c.
An individual 26 years of age or younger who remains
156
covered under a parent’s health insurance policy pursuant to s.
157
627.6562; or
158
d.
An individual with a developmental disability as defined
159
in s. 393.063.
160
(2)
A
group, blanket, or franchise
health insurance policy
161
issued, amended, delivered, or renewed in this state
on or
after
162
July 1, 202
6
,
must provide coverage of
all
of the following for
163
eligible individuals:
164
(a)
Orthoses and prostheses as those terms are defined in
165
s. 468.80 if the
eligible individual
’s provider determines that
166
an orthosis or a prosthesis is medically necessary for the
167
eligible individual
to perform activities of daily living,
168
essential job-related activities, and physical recreational
169
activities, such as running, biking, swimming, strength
170
training, and other activities that maximize the
eligible
171
individual
’s full body health and lower and upper limb function.
172
(b)
Any replacement of the orthosis or prosthesis, or part
173
thereof, without regard to continuous use or useful lifetime
174
restrictions, if the
eligible individual
’s provider determines
175
that it is medically necessary due to any of the following:
176
1.
A change in the physiological condition of the
eligible
177
individual
.
178
2.
An irreparable change in the condition of the orthosis
179
or prosthesis, or part thereof.
180
3.
A change in the condition of the orthosis or prosthesis,
181
or part thereof, requires repairs that would cost more than 60
182
percent of the cost of a replacement orthosis or prosthesis or
183
of the part thereof requiring replacement
.
184
185
A
health
insurer
may require supporting documentation from a
n
186
eligible individual
’s provider to confirm the need for a
187
replacement for an orthosis or a prosthesis that is less than 3
188
years old.
189
(3)
A health insurer may not deny a claim for an orthosis
190
or a prosthesis
as a medically necessary intervention to restore
191
physical function for an
eligible individual
with a disability
192
which would otherwise be covered for a nondisabled person
193
seeking medical or surgical intervention to restore or maintain
194
the ability to perform the same type of physical function
195
affected.
196
(4)
Beginning July 1, 2027, and annually thereafter, each
197
health insurer subject to this section shall submit a report to
198
the Office of Insurance Regulation detailing the total number of
199
claims submitted for
orthotics and prosthetics services
in the
200
previous plan year and the total number of such claims that were
201
paid, including the amount paid.
202
(5)
This section may not be construed to require coverage
203
of orthotics or prosthetics services for an insured who is not
204
an eligible individual.
205 Section 5. Section 641.31079, Florida Statutes, is created
206 to read:
207
641.3
1
079
Orthotics and prosthetics services
.—
208
(1)
As used in this section, the term “eligible individual”
209
means
a subscriber
who is:
210
a.
A child younger than 18 years of age;
211
b.
A dependent child as
specified
in s. 627.6562;
212
c.
An individual 26 years of age or younger who remains
213
covered under a parent’s health insurance policy pursuant to s.
214
627.6562; or
215
d.
An individual with a developmental disability as defined
216
in s. 393.063.
217
(2)
A
health maintenance contract
issued, amended,
218
delivered, or renewed in this state
on or
after July 1, 202
6
,
219
must provide coverage of
all
of the following for eligible
220
individuals:
221
(a)
Orthoses and prostheses as those terms are defined in
222
s. 468.80 if the
eligible individual
’s provider determines that
223
an orthosis or a prosthesis is medically necessary for the
224
eligible individual
to perform activities of daily living,
225
essential job-related activities, and physical recreational
226
activities, such as running, biking, swimming, strength
227
training, and other activities that maximize the
eligible
228
individual
’s full body health and lower and upper limb function.
229
(b)
Any replacement of the orthosis or prosthesis, or part
230
thereof, without regard to continuous use or useful lifetime
231
restrictions, if the subscriber’s provider determines that it is
232
medically necessary due to any of the following:
233
1.
A change in the physiological condition of the
eligible
234
individual
.
235
2.
An irreparable change in the condition of the orthosis
236
or prosthesis, or part thereof.
237
3.
A change in the condition of the orthosis or prosthesis,
238
or part thereof, requires repairs that would cost more than 60
239
percent of the cost of a replacement orthosis or prosthesis or
240
of the part thereof requiring replacement
.
241
242
A health maintenance organization may
require
supporting
243
documentation from an
eligible individual
’s provider to confirm
244
the need for a replacement for an orthosis or a prosthesis that
245
is less than 3 years old.
246
(3)
A health maintenance organization may not deny a claim
247
for an orthosis or a prosthesis as a medically necessary
248
intervention to restore physical function for an
eligible
249
individual
with a disability which would otherwise be covered
250
for a nondisabled person seeking medical or surgical
251
intervention to restore or maintain the ability to perform the
252
same type of physical function affected.
253
(4)
Beginning July 1, 2027, and annually thereafter, each
254
health maintenance organization subject to this section shall
255
submit a report to the Office of Insurance Regulation detailing
256
the total number of claims submitted for
orthotics and
257
prosthetics services
in the previous plan year and the total
258
number of such claims that were paid, including the amount paid.
259
(5)
This section may not be construed to require coverage
260
of orthotics or prosthetics services for a
subscriber
who is not
261
an eligible individual.
262 Section 6. This act shall take effect July 1, 2026.