Bill
S 836
Mass. bill expands prosthetic/orthotic coverage—including athletic-use devices—across state employee plans, MassHealth, and private insurers, plus repair/replacement.
Note on source documents and scope
- The materials provided contain conflicting metadata (titles referencing a "Migrant Home Rule Transfer and Transparency Act" and a "Children and Teens’ Online Privacy Protection Act"), but the full bill text included is a Massachusetts legislative draft titled "An Act to improve outcomes for persons with limb loss and limb difference" (Senate No. 836 / Senate Docket No. 1153, filed 1/15/2025). This summary focuses on the substantive provisions in that bill text (prosthetic / orthotic coverage). Verify with the official legislative website for the final enacted language and status.
Summary — purpose and intent
- Purpose: to expand and clarify insurance and public-health coverage for prosthetic and orthotic devices for people with limb loss or limb difference in Massachusetts, explicitly including devices designed or customized for athletic or physical-activity use, and to require coverage for repair or replacement of such devices.
Key provisions and changes
- Definitions (amendments to multiple statutes): The bill adds or revises definitions across several chapters to define:
- “Orthosis/orthotic device”: a device used to support, align, correct or prevent deformities; may assist or control motion; appropriate for use in home/community settings.
- “Prosthetic device”: an artificial limb to replace an arm or leg — explicitly including devices designed exclusively for athletic purposes.
- Required coverage for state employee health benefits (amends chapter 32A, section 17I):
- The state commission must provide coverage for prosthetic and orthotic devices — including custom-built or fitted devices and those intended for athletic/physical activity — to maximize ambulation, upper limb function, and ability to run, bike, swim.
- Coverage must include repair and replacement of such devices.
- MassHealth (adds section 10R to chapter 118E):
- MassHealth must provide coverage for prosthetic and orthotic devices under the same terms as durable medical equipment.
- Explicit inclusion of athletic/activity devices and their repair/replacement.
- Requires a written prescription from a licensed physician or independent nurse practitioner with specified elements (member name/address; MassHealth ID; item identification; medical justification including diagnosis; prescriber's contact; date signed).
- Private insurance / group policies (amends chapter 175, section 47Z and chapter 176A, section 8AA):
- Group and individual policies/contracts regulated by these chapters must provide coverage for prosthetic and orthotic devices, including custom and activity-specific devices, and coverage for repair/replacement to support ambulation and upper-limb function.
Who would be affected
- Primary beneficiaries: Massachusetts residents with limb loss or limb difference who are state employees (state health plans), MassHealth members, and persons covered by insurers subject to the cited state insurance statutes.
- Payers: State health benefit commission, MassHealth, private insurers and managed-care entities that must adjust benefit design and claims processes to comply.
- Providers and suppliers: Prosthetists, orthotists, durable medical equipment suppliers, rehabilitation providers — may see increased authorization requests and claims for athletic/custom devices and repairs/replacements.
Procedural / timeline and legislative status (as provided)
- Filed: 1/15/2025 (Senate Docket No. 1153); sponsors include Senator John C. Velis and others (petitioners listed).
- Actions listed in provided materials include referrals to committees (Financial Services; Local Government), hearings (e.g., hearing scheduled 06/24/2025), and a committee report ordered with amendments favorably (Commerce, Science, and Transportation — 2025-06-25). Status entries in the provided data conflict (e.g., "REFERRED TO LOCAL GOVERNMENT"); consult the Massachusetts Legislature’s official site for current status and history.
- Fiscal impact: Not specified in the text. Implementation could increase short-term benefit expenditures for public and private payers but may reduce downstream costs by improving mobility, independence, and participation (not quantified in bill text).
Notes and recommendations
- The bill explicitly includes athletic and activity-specific prostheses/orthoses and mandates repair/replacement coverage — a notable expansion relative to some existing benefit limits that restrict “medically necessary” devices to basic ambulation.
- Because the provided materials contain inconsistent metadata and multiple bill titles, readers should confirm the correct bill number, title, and final language with the Massachusetts Legislature’s official docket before relying on this summary for legal or administrative action.
Compiled from official sources — confirm details with the bill’s official record.
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