SB100 Alabama 2019 Session

Summary

Primary Sponsor

William “Bill” M. BeasleySenator

Democrat

Session

Regular Session 2019

Title

Prosthetic and orthotic devices, health benefit plans, coverage the same as Medicare, coverage under health care service plans and health maint. organizations, Secs. 10A-20-6.16, 27-21A-23 am'd.

Summary

SB 100 would require Alabama health benefit plans to cover custom prosthetic and orthotic devices with Medicare-like terms and necessary services.

What This Bill Does

If passed, the bill would require health plans to cover custom prosthetic and orthotic devices that are medically necessary, at least equal to Medicare terms and not less favorable than other medical benefits. It would require coverage of all services and supplies needed to use the device, including design, fabrication, fitting, measurements, alignments, and patient instruction. Reimbursement would be Medicare-equivalent, with repairs or replacements covered when medically necessary, and it would not impose separate or more restrictive financial rules than those for medical benefits. The bill also limits annual or lifetime dollar maximums on these devices (allowing only an aggregate maximum for the policy) and sets network access rules, such as requiring in managed care plans access to at least two in-state providers.

Who It Affects

• Health plan enrollees and patients who need prosthetic or orthotic devices, who would gain Medicare-equivalent coverage and required access to necessary services.
• Health benefit plan sponsors and insurers (including HMOs and other managed care plans), who would need to provide this coverage, align reimbursements with Medicare, and ensure network access requirements.

Key Provisions

• Coverage for custom prosthetic and orthotic devices must be at least equivalent to Medicare and no less favorable than medical/surgical benefits, including medically necessary devices identified by the treating physician.
• All related services and supplies needed to use the device must be covered, such as design, fabrication, materials, measurements, fittings, alignments, and patient instruction.
• Reimbursement for these devices must be Medicare-equivalent and not more restrictive than other plan benefits, including coverage of repairs or replacements when medically necessary.
• No separate or more restrictive financial requirements may be imposed specifically on prosthetic/orthotic benefits; copayments or coinsurance are allowed but cannot be more restrictive than those for medical benefits.
• Out-of-network coverage may be limited, but restrictions cannot be more restrictive than those for out-of-network medical/surgical benefits.
• No annual or lifetime dollar maximums for prosthetic/orthotic devices, except an aggregate maximum across all covered terms and services.
• In managed care plans, beneficiaries must have access to at least two in-state prosthetic/orthotic providers within the network.
• The bill would amend Sections 10A-20-6.16 and 27-21A-23 to implement these changes, with an effective date for certain provisions starting October 1, 2019.

AI-generated summary using openai/gpt-5-nano on Feb 24, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health