Chapter 374
AN ACT
HB 2517
Relating to medical devices.
Be It Enacted by the People of
the State of
SECTION 1. Section 2 of this 2007 Act is added to and
made a part of the Insurance Code.
SECTION 2. (1) All individual and group health
insurance policies providing coverage for hospital, medical or surgical
expenses shall include coverage for prosthetic and orthotic devices that are
medically necessary to restore or maintain the ability to complete activities
of daily living or essential job-related activities and that are not solely for
comfort or convenience. The coverage required by this subsection includes all
services and supplies medically necessary for the effective use of a prosthetic
or orthotic device, including formulating its design, fabrication, material and
component selection, measurements, fittings, static and dynamic alignments, and
instructing the patient in the use of the device.
(2) As used in this
section:
(a) “Orthotic device”
means a rigid or semirigid device supporting a weak or deformed leg, foot, arm,
hand, back or neck, or restricting or eliminating motion in a diseased or
injured leg, foot, arm, hand, back or neck.
(b) “Prosthetic device”
means an artificial limb device or appliance designed to replace in whole or in
part an arm or a leg.
(3) The Director of the
Department of Consumer and Business Services shall adopt and annually update
rules listing the prosthetic and orthotic devices covered under this section.
The list shall be no more restrictive than the list of prosthetic and orthotic
devices and supplies in the Medicare fee schedule for Durable Medical
Equipment, Prosthetics, Orthotics and Supplies, but only to the extent
consistent with this section.
(4) The coverage
required by subsection (1) of this section may be made subject to, and no more
restrictive than, the provisions of a health insurance policy that apply to
other benefits under the policy.
(5) The coverage
required by subsection (1) of this section shall include any repair or replacement
of a prosthetic or orthotic device that is determined medically necessary to
restore or maintain the ability to complete activities of daily living or
essential job-related activities and that is not solely for comfort or
convenience.
(6) If coverage under
subsection (1) of this section is provided through a managed care plan, the
insured shall have access to medically necessary clinical care and to
prosthetic and orthotic devices and technology from not less than two distinct
Oregon prosthetic and orthotic providers in the
managed care plan’s provider network.
Approved by the Governor June 12, 2007
Filed in the office of Secretary of State June 13, 2007
Effective date January 1, 2008
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