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SB 1360

An Act providing for insurance coverage for prostheses and orthoses; and imposing duties on the Insurance Department and the Department of Human Services.

2025-2026 Regular Session Introduced by Lisa Boscola and 18 co-sponsors

The bill requires insurance coverage for prostheses and orthoses, expanding access and reducing out-of-pocket costs for devices needed medically.

Referred to Institutional Sustainability & Innovation
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WeVote Research Nonpartisan
Bill Summary · SB 1360

Summary of Bill: SB 1360 (2025-2026, Pennsylvania)

Purpose and Intent

  • SB 1360 is titled An Act providing for insurance coverage for prostheses and orthoses; and imposing duties on the Insurance Department and the Department of Human Services.
  • The bill is associated with the “So Every Body Can Move Act” and aims to ensure coverage for prosthetic devices (prostheses) and orthotic devices (orthoses) under certain insurance programs or requirements, affecting individuals who require such devices for medical reasons, mobility, and daily functioning.

Key Provisions (What the Bill Would Change or Establish)

  • Establishes or expands insurance coverage requirements for:
    • Prostheses (artificial limbs and related devices)
    • Orthoses (orthopedic devices such as braces, supports, and similar equipment)
  • Assigns duties to state agencies:
    • Insurance Department: likely to regulate, implement, or enforce the new coverage requirements, including standards for what must be covered, exclusions, and compliance by insurers.
    • Department of Human Services: potentially responsible for coordinating with Medicaid/MA programs, implementing coverage rules for public programs, and ensuring access to prosthetic and orthotic services for program beneficiaries.
  • The bill may specify:
    • Types of devices covered (e.g., replacements, repairs, and accessories) and limits on coverage.
    • Medical necessity criteria to qualify for coverage.
    • Timelines, prior authorization processes, and documentation requirements.
    • Exclusions or caps (e.g., non-durable devices, cosmetic devices, or experimental/prosthetic technologies not covered).
    • Provider qualifications and network requirements for durable medical equipment (DME) suppliers.
  • Administrative and enforcement mechanisms:
    • Rules for insurer compliance, consumer protections, and potential remedies for denial of coverage.
    • Possible coordination between private insurers and public programs to avoid dual coverage gaps.

Affected Parties and Impacts

  • Individuals requiring prosthetic or orthotic devices:
    • Potentially broader or mandated insurance coverage, reducing out-of-pocket costs and expanding access.
  • Insurance companies and issuers:
    • Would need to align policies with the new coverage requirements, adjust benefits, prior authorization, and reimbursement methodologies.
  • Public programs (e.g., Pennsylvania Department of Human Services, Medicaid):
    • May see changes in coverage rules, eligibility determinations, and reimbursement for prosthetics and orthotics.
  • Healthcare providers and DME suppliers:
    • May face new documentation, eligibility checks, and billing procedures to qualify devices under the mandated coverage.

Procedural and Timeline Considerations

  • Status: Referred to the Senate Committee on Institutional Sustainability & Innovation on June 8, 2026.
  • Action path:
    • The bill would progress through committee review, potential amendments, and then floor consideration within the Pennsylvania Senate.
    • If advanced, it would move to the House for consideration (and potentially a conference if there are differences).
  • Effective dates:
    • Not specified in the provided text; typically, bills specify an effective date (e.g., a date after enactment or upon regulatory implementation). Absent explicit language here, the bill would likely include an effective date in the final enrolled version.

Additional Information

  • Primary sponsor: Senator Christine Tartaglione (and numerous co-sponsors from both parties).
  • Committee: Institutional Sustainability & Innovation (initial referral).
  • Related memo: So Every Body Can Move Act, indicating a public health or accessibility focus.

If you’d like, I can pull and summarize the exact statutory language, any fiscal notes, and potential cost implications once the bill’s text and fiscal impact statements are available.

Compiled from official sources — confirm details with the bill’s official record.

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