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HOUSE, No. 376
By Mr. Ruane of Salem, petition of J. Michael Ruane for legislation to
provide health insurance coverage for certain prosthetic devices. Insurance.
The Commonwealth of Massachusetts
In the Year Two Thousand and Three
AN ACT PROVIDING HEALTH CARE COVERAGE FOR CERTAIN PROSTHETIC DEVICES.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by
the authority of the same, as follows:
SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after section 17H
the following section:—
Section 17I. (a) As used in this section, “Prosthetic device” means an artificial device to replace,
in whole or in part, an arm or leg.
(b) The commission shall provide to any active or retired employee of the commonwealth who is
insured under the group insurance commission coverage for prosthetic devices that equals the
coverage provided for such devices under the federal laws providing health insurance to the aged
and disabled, 42 U.S.C. sections 1395k, 1395l and 1395m and 42 C.F.R. 414.202, 414.210,
414.228 and 410.100. Coverage for the prosthetic devices shall be provided for the most
appropriate medically necessary model that adequately meets the medical needs of such
employees as determined by the treating physician. The commission shall also provide coverage
for medically necessary repairs and replacements of prosthetic devices, subject to co-payments
and deductibles, if any, unless the repair or replacement is necessitated by misuse or loss.
(c) Nothing in this section shall prohibit the commission from offering greater coverage for
prosthetic devices than that required by this section.
SECTION 2. Chapter 175 of the General Laws is hereby amended by inserting after section 47W,
inserted by section 1 of chapter 49 of the acts of 2002, the following section:—
Section 47X. (a) As used in this section, “prosthetic device” means an artificial device to replace,
in whole or in part, and arm or leg.
(b) Any individual policy of accident and sickness insurance issued pursuant to section 108 and
any group blanket policy of accident and sickness insurance issued pursuant to section 110,
except policies providing supplemental coverage to Medicare or to other government programs,
that is delivered, issued or renewed within or without the commonwealth shall provide coverage
for prosthetic devices that equals the coverage provided for such devices under the federal laws
providing health insurance to the aged and disabled, 42 U.S.C. sections 1395k, 1395l, and 1395m
and 42 C.F.R. 414.202, 414.210, 414.228 and 410.100. Coverage for the prosthetic devices shall
be provided for the most appropriate medically necessary model that adequately meets the
medical needs of the policyholder as determined by the treating physician. Coverage shall also be
provided for medically necessary repairs and replacements of prosthetic devices, subject to copayments
and deductibles, if any, unless the repair or replacement is necessitated by misuse or
loss.
(c) Nothing in this section shall prohibit an insurer from offering greater coverage for prosthetic
devices than that required by this section.
SECTION 3. Chapter 176A of the General Laws is hereby amended by inserting after section
8W, inserted in section 2 of chapter 49 of the acts of 2002, the following section:—
Section 8X. (a) As used in this section, “prosthetic device” means an artificial device to replace,
in whole or in part and arm or leg.
(b) Any contract between a subscriber and the corporation under an individual or group hospital
service plan, except contracts providing supplemental coverage to Medicare or other
governmental programs, that is delivered, issued or renewed within or without the
commonwealth shall provide to all individual subscribers and members within the
commonwealth and to all group members having a principal place of employment within the
commonwealth coverage for prosthetic devices that equals the coverage provided for such
devices under the federal laws providing health insurance to the aged and disabled, 42 U.S.C.
sections 1395k, 1395l, and 1395m and 42 C.F.R. 414.202, 414.210, 414.228 and 410.100.
Coverage for the prosthetic devices shall be provided for the most appropriate medically
necessary model that adequately meets the medical needs of such subscribers or members as
determined by the treating physician. Coverage shall also be provided for any medically
necessary repairs and replacements of prosthetic devices, subject to co-payments and deductibles
if any, unless the repair or replacement is necessitated by misuse or loss.
(c) Nothing in this section shall prohibit the corporation from offering greater coverage for
prosthetic devices than that required by this section.
SECTION 4. Chapter 176B of the General Laws is hereby amended by inserting after section
4W, inserted by section 3 of chapter 49 of the acts of 2002, the following section:—
Section 4X. (a) As used in this section, “prosthetic device” means an artificial device to replace,
in whole or in part, an arm or leg.
(b) Any subscription certificate under an individual or group medical service agreement, except
certificates providing supplemental coverage to Medicare or other governmental programs, that is
delivered, issued or renewed within or without the commonwealth shall provide to all individual
subscribers and members within the commonwealth and to all group members having a principal
place of employment in the commonwealth coverage for prosthetic devices that equals the
coverage provided for such devices under the federal laws providing health insurance to the aged
and disabled, 42 U.S.C. sections 1395k, 1395l, and 1395m and 42 C.F.R. 414.202, 414.210,
414.228 and 410.100. Coverage for the prosthetic devices shall be provided for the most
appropriate medically necessary model that adequately meets the medical needs of such
subscribers or members as determined by the treating physician. Coverage shall also be provided
for medically necessary repairs and replacements or prosthetic devices, subject to co-payments
and deductibles, if any, unless the repair or replacement is necessitated by misuse or loss.
(c) Nothing in this section shall prohibit the corporation from offering greater coverage for
prosthetic devices than that required by this section.
SECTION 5. Chapter 176G of the General Laws is hereby amended by inserting after section 4O,
inserted by section 4 of chapter 49 of the acts of 2002, the following section:—
Section 4P. (a) As used in this section, “prosthetic device” means an artificial device to replace,
in whole or in part, an arm or leg.
(b) An individual or group health maintenance contract, except contracts providing supplemental
coverage to Medicare or to other government programs, shall provide to residents of the
commonwealth and to persons having a principal place of employment within the commonwealth
coverage for prosthetic devices that equals the coverage and benefits provided for such devices
under the federal laws providing health insurance to the aged and disabled, 42 U.S.C. sections
1395k, 1395l, and 1395m and 42 C.F.R. 414.202, 414.210, 414.228 and 410.100. Coverage for
the prosthetic devices shall be provided for the most appropriate medically necessary model that
adequately meets the medical needs of such subscribers or members as determined by the treating
physician. Coverage shall also be provided for medically necessary repairs and replacements of
prosthetic devices, subject to co-payments and deductibles, if any, unless the repair or
replacement is necessitated by misuse or loss.
(c) Nothing in this section shall prohibit a health maintenance organization from offering greater
coverage for prosthetic devices than that required by this section.
SECTION 6. This act shall apply to all policies, contracts, agreements, plans and certificates of
insurance issued or delivered within or without the commonwealth on or after January 1, 2003,
and to all policies, contracts, agreements, plans and certificates of insurance in effect before that
date upon renewal on or after January 1, 2003.
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