New York A 11406: Requires certain health insurance coverage for prostheses and custom orthoses

Bill Text

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A11406 Summary:

BILL NOA11406A

&nbsp

SAME ASNo Same As

&nbsp

SPONSORRules (Ramos)

&nbsp

COSPNSR

&nbsp

MLTSPNSR

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Amd §§345, 3216, 3221, 4303 & 4902, Ins L; amd §364-j, Soc Serv L; add §4406-j, Pub Health L

&nbsp

Requires health insurance coverage for prosthetic and orthotic devices at a rate no less than the current quarter's Medicare durable medical equipment, prosthetics, orthotics and supplies fee schedule established by the Centers for Medicare and Medicaid services for prosthetic and orthotic devices and services.

Go to top A11406 Actions:

BILL NOA11406A

&nbsp

05/15/2026referred to insurance

06/03/2026amend and recommit to insurance

06/03/2026print number 11406a

Go to topA11406 Committee&nbspVotes:

Go to topA11406 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topA11406 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 11406--A

 IN ASSEMBLY

 May 15, 2026
 ___________

 Introduced by COMMITTEE ON RULES -- (at request of M. of A. Ramos) --
 read once and referred to the Committee on Insurance -- committee
 discharged, bill amended, ordered reprinted as amended and recommitted
 to said committee

 AN ACT to amend the insurance law, the social services law and the
 public health law, in relation to requiring certain health insurance
 coverage for prostheses and custom orthoses

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Subsection (i) of section 3216 of the insurance law is
 2 amended by adding a new paragraph 42 to read as follows:
 3 (42) (A) Every policy that provides coverage for hospital, medical or
 4 surgical expenses shall include coverage for prosthetic and orthotic
 5 devices at a rate no less than the current quarter's medicare durable
 6 medical equipment, prosthetics, orthotics and supplies fee schedule
 7 established by the centers for medicare and medicaid services for pros-
 8 thetic and orthotic devices and services.
 9 (B) Coverage provided under this paragraph shall include:
 10 (i) a prosthetic or orthotic device determined by the enrollee's
 11 health care provider to be the most appropriate model that adequately
 12 meets the medical needs of such enrollee;
 13 (ii) a prosthetic or custom orthotic device determined by the
 14 enrollee's health care provider to be the most appropriate model that
 15 meets the medical needs of such enrollee for purposes of performing
 16 physical activities, including, but not limited to, running, biking,
 17 swimming, strength training, and to maximize such enrollee's whole-body
 18 health and lower and/or upper limb function;
 19 (iii) a prosthetic or custom orthotic device determined by the
 20 enrollee's health care provider to be the most appropriate model that
 21 meets the medical needs of such enrollee for purposes of showering or
 22 bathing;
 23 (iv) all materials and components necessary for the use of the
 24 prostheses and orthoses;
 25 (v) instruction to the enrollee on using the device; and

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD15475-04-6

 A. 11406--A 2

 1 (vi) with respect to the prostheses and orthoses covered under items
 2 (i), (ii), and (iii) of this subparagraph, the medically necessary
 3 repair or replacement of such prosthetic or orthotic device.
 4 (C) For an enrollee to receive a prosthesis or orthosis under items
 5 (i), (ii), and (iii) of subparagraph (B) of this paragraph, the treating
 6 health care provider shall be required to determine whether the addi-
 7 tional prosthetic or custom orthotic device is necessary to enable such
 8 enrollee to engage in physical activities, as applicable, including, but
 9 not limited to, running, biking, swimming, strength training, showering,
 10 bathing, and to maximize enrollee's whole-body health and lower and/or
 11 upper limb function.
 12 (D) Every policy that is delivered, issued for delivery or renewed in
 13 this state that provides coverage for prosthetic and custom orthotic
 14 devices shall consider such devices habilitative or rehabilitative bene-
 15 fits for the purposes of any state or federal requirement for coverage
 16 of essential health benefit