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Senate of Pennsylvania
Session of 2019 - 2020 Regular Session


Posted: August 26, 2019 02:37 PM
From: Senator Mario M. Scavello
To: All Senate members
Subject: Legislation Further Providing for Prosthetic and Orthotic Coverage
In the near future I intend to introduce legislation which will require reimbursement for prosthetic and orthotic devices across the Commonwealth.

Currently, there are concerns about the level of coverage in that some insurance companies have restrictions on prosthetic and orthotic coverage. These restrictions range from annual caps and lifetime caps to one prosthesis per lifetime. A child who has suffered a catastrophic illness or injury which resulted in limb loss or injury should not have to worry about whether or not a new prosthesis or orthosis will be covered as they get older and progress in their prosthetic or orthotic journey.

Specifically, this legislation will require that health insurers provide health benefits coverage for expenses incurred in obtaining any orthotic or prosthetic device and/or component. The bill requires health insurers, on and after the bill's effective date, to reimburse for these benefits at the same rate as reimbursement for orthotic and prosthetic devices under the federal Medicare reimbursement schedule.

We have a responsibility to ensure that individuals living with limb loss, absence of a limb, or in need of correction to relieve pain are able to lead productive lives. Accessibility will not only improve the physical and psychological functioning of persons with amputations, injuries and congenital disabilities, but will also reduce the incidence and costs associated with secondary conditions, such as obesity, cardiovascular disease and additional amputations or further injury.

At the present time there are at least twenty-one states (Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New Jersey, Delaware, Maryland, Virginia, Oregon, Indiana, Illinois, Iowa, Missouri, Arkansas, Louisiana, Texas, Colorado, Utah, and California) that have passed similar legislation. This legislation is supported by the Amputee Coalition of Pennsylvania. Please join me in co-sponsoring this important legislation.

If you have any questions regarding this legislation, please contact Christine Zubeck in my office at 717-787-6123 or czubeck@pasen.gov. Thank you for your consideration.