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A 3856

Requires the Triborough bridge and tunnel authority reimburse certain individuals from transit deserts

2025 Regular Session Introduced by Judy Griffin and 3 co-sponsors

Requires health plans to cover orthotic/prosthetic devices, including an extra device for sports/rec use, reimbursed at Medicare rates; allows licensed podiatrists to provide them.

REFERRED TO CORPORATIONS, AUTHORITIES AND COMMISSIONS
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Bill Summary · A 3856

Note: the bill title you supplied (about the Triborough Bridge and Tunnel Authority) does not match the bill text and analyses provided. This summary is based on the bill documents you included for Assembly Bill A3856 (as introduced and amended), which concern health insurance coverage for orthotic and prosthetic appliances.

Purpose

A3856 requires health insurance plans to cover additional orthotic and prosthetic appliances in certain circumstances and to permit coverage for orthotic and prosthetic appliances obtained through podiatrists. The intent is to ensure medically necessary devices — including an extra device used specifically for physical and recreational activities — are covered by insurers and certain public employee health plans.

Key provisions

  • Requires coverage for:
    • An orthotic or prosthetic appliance when medically necessary, consistent with current law; and
    • An additional orthotic or prosthetic appliance if the covered person’s physician determines the extra device is necessary to enable participation in physical and recreational activities (explicit examples include running, bicycling, swimming, climbing, skiing, snowboarding, and team and individual sports).
  • Expands the providers through whom covered appliances may be obtained to include licensed podiatrists (in addition to licensed orthotists/prosthetists and certified pedorthists).
  • Sets reimbursement for orthotic and prosthetic appliances at the same rate used under the federal Medicare reimbursement schedule.
  • Benefits are to be provided to the same extent as for other medical conditions under the contract.
  • Applies to hospital/medical/health service corporations, individual and group insurers (small and large employer markets), health maintenance organizations, and the State Health Benefits Program and School Employees’ Health Benefits Program.

Fiscal impact

Office of Legislative Services (OLS) estimates an annual increase in State and local government health plan expenditures:
- First reprint (Dec. 19, 2024): total increase $461,000 – $577,000.
- Second reprint (Mar. 28, 2025): total increase $496,000 – $621,000.
These estimates derive from prior analyses of similar mandates (NJ advisory commission and a Maine study) and OLS assumptions (e.g., that roughly half of current prosthetic recipients might be approved for an additional recreational-use device). OLS cites a small projected premium impact on insured markets (reports referenced 0.01%–0.025% increases in projected medical claim costs).

Who is affected

  • Insured individuals who require orthotic or prosthetic devices (including those who seek an additional device for recreational activities).
  • Providers: licensed orthotists, prosthetists, certified pedorthists, and licensed podiatrists.
  • Private insurers, HMOs, and publicly funded plans (State Health Benefits Program, School Employees’ Health Benefits Program).
  • State and local government budgets via increased plan costs.

Procedural status (selected)

  • Introduced in the Assembly: Feb 22, 2024.
  • Reported with committee amendments by the Assembly Financial Institutions and Insurance Committee (Dec 9, 2024) and by Assembly Appropriations (Mar 20, 2025).
  • Reported out and on 2nd reading as of Mar 20, 2025.
  • Substituted by S1439 (1R) on May 22, 2025.
  • Referred to Corporations, Authorities and Commissions (record shows referral entries 1/30/2025).

Sponsors and related bills

  • Primary sponsor(s): Jaime R. Williams (and co-sponsors listed in documents).
  • Companion/related: S1439 (companion), A8413 (prior-session).

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

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