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Bill Summary · HB 906

Summary — HB 906 (“Reagan’s Law”) — North Carolina (2025)

Purpose / Intent

HB 906, titled “Reagan’s Law,” is designed to improve access to prosthetic and orthotic devices and related care for North Carolinians with limb loss or limb difference. The bill standardizes insurer coverage requirements to ensure people with limb differences can obtain medically appropriate devices (including custom devices), maintenance, repair, and replacements without arbitrary lifetime limits, and to treat such coverage as habilitative/rehabilitative care.

Note: Earlier drafts of HB 906 included provisions repealing certain state emergency‑care coverage rules that duplicate federal law. The committee substitute and later editions focus on prosthetic/orthotic coverage; confirm the enacted text for any retained repeal language.

Key provisions

  • Adds a new statutory section (G.S. 58‑3‑286) applicable to most health benefit plans in the State (excludes plans regulated under the Small Employer Group Health Insurance Reform and Multiple Employer Welfare Arrangements provisions).
  • Requires coverage consistent with federal Medicare Part B rules (42 U.S.C. § 1395 et seq.; 42 C.F.R. Part 414 Subpart D) for prosthetic and orthotic devices, including:
    • All materials/components necessary for device use.
    • Instruction on device use.
    • Repair and replacement (including custom devices).
  • Coverage rules:
    • Insurers must cover the prosthetic/orthotic device determined by the insured’s healthcare provider to be the most appropriate to meet medical needs for activities of daily living or essential job functions.
    • Coverage is not limited to a single device; additional devices (including custom ones) may be covered for (a) performing physical activities (e.g., running, biking, swimming, strength training) and (b) maximizing whole‑body health and limb function.
    • Coverage for prosthetic/orthotic devices (including custom devices) counts as habilitative or rehabilitative benefits (relevant to essential health benefits).
    • Insurers may not deny claims for prosthetic/orthotic devices for an insured with limb loss solely because a similar intervention would be provided to a non‑disabled insured for restoration/maintenance of function.
  • Replacement criteria:
    • Replacements (or replacement parts) must be covered without regard to continuous‑use or “useful lifetime” restrictions when the prescribing provider determines replacement is necessary due to: physiological change, irreparable damage, or when repair cost(s) would exceed 60% of replacement cost.
    • An insurer may require provider confirmation before replacement only if the device/part is less than 3 years old.
  • Reporting and oversight:
    • By Feb 1, 2028, issuers offering plans subject to the new section must report to the Commissioner of Insurance the number and total amount of claims paid under G.S. 58‑3‑286 (form to be prescribed by the Commissioner).
    • By March 1, 2028, the Commissioner must aggregate that data by plan year and report to the Joint Legislative Oversight Committees on General Government and on Health and Human Services.

Who is affected

  • Primary beneficiaries: North Carolinians with limb loss or limb difference who obtain coverage through private health benefit plans subject to state insurance law.
  • Affected payers: Insurers/plan issuers offering applicable health benefit plans (subject to the statutory exclusions).
  • Providers: Prosthetists, orthotists, rehabilitation clinicians and suppliers who prescribe, fit, supply, repair, or replace devices.
  • Regulators: NC Commissioner of Insurance and legislative oversight committees (for reporting).

Effective date / Implementation timeline

  • Effective Oct 1, 2025.
  • Applies to insurance contracts issued, renewed, or amended on or after Oct 1, 2025, or to the next yearly anniversary of the contract occurring after Oct 1, 2025 (that anniversary is treated as a renewal).

Potential impacts / considerations

  • Access: Expected to expand access to medically appropriate prosthetic and orthotic devices and reduce denials based on lifetime/age restrictions.
  • Costs: Insurers may see increased utilization and replacement claims (including custom devices and coverage for activity‑specific devices); fiscal impacts on premiums or plan costs are possible but not specified in the bill text.
  • Administrative: Issuers will have a reporting obligation (data collection and submission). Insurers retain limited ability to require confirmation for recent devices (<3 years).
  • Legal / benefit classification: Explicitly treats prosthetic/orthotic coverage as habilitative/rehabilitative and ties standards to existing federal Medicare Part B rules to promote consistency.

For questions about the bill’s final enacted language or whether any earlier repeal/conforming provisions remain, consult the official enrolled bill or the Legislative Services office.

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

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