Vermont H 432: An act relating to establishing the Task Force to Study and Develop Reparation Proposals for the Institution of Chattel Slavery

Bill Text

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VT LEG #380733 v.1
H.432 1
Introduced by Representatives Burke of Brattleboro, Cina of Burlington, 2
Howard of Rutland City, Lalley of Shelburne, Masland of 3
Thetford, Morgan, L. of Milton, and Ode of Burlington 4
Referred to Committee on 5
Date: 6
Subject: Health; health insurance; prosthetics; orthotics 7
Statement of purpose of bill as introduced: This bill proposes to expand health 8
insurance coverage requirements for prosthetic and orthotic devices. It would 9
also require health insurers to report their claims experience with coverage for 10
prosthetic and orthotic devices for plan years 2026, 2027, and 2028 to the 11
Department of Financial Regulation, which the Department would aggregate 12
into a report to the General Assembly. 13
An act relating to health insurance coverage for prosthetic and orthotic 14
devices 15
It is hereby enacted by the General Assembly of the State of Vermont: 16
Sec. 1. 8 V.S.A. § 4088f is amended to read: 17
§ 4088f. PROSTHETIC PARITY COVERAGE FOR PROSTHETIC AND 18
ORTHOTIC DEVICES 19
(a) As used in this section: 20

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VT LEG #380733 v.1
(1) “Health insurance plan” means any health insurance policy or health 1
benefit plan offered by a health insurer, as defined in 18 V.S.A. § 9402, as well 2
as Medicaid and any other public health care assistance program offered or 3
administered by the State or by any subdivision or instrumentality of the State. 4
The term shall not include policies or plans providing coverage for a specific 5
disease or other limited benefit coverage. 6
(2) “Prosthetic device and orthotic devices” means an artificial limb 7
device to replace, in whole or in part, an arm or a leg, arm, back, and neck 8
braces and artificial legs, arms, and eyes, whether standard or custom-made. 9
(b) A health insurance plan shall provide coverage for prosthetic and 10
orthotic devices in all health plans that is at least equivalent to that the 11
coverage provided by the federal Medicare program pursuant to 42 U.S.C. 12
§§ 1395k, 1395l, and 1395m and 42 C.F.R. §§ 414.202, 414.210, 414.228, and 13
140.100. Coverage may be limited to the shall be provided for all of the 14
following: 15
(1) a prosthetic or orthotic device that is determined by the covered 16
individual’s treating health care provider to be the most appropriate model that 17
is medically necessary to meet the patient’s adequately meets the covered 18
individual’s medical needs; 19
(2) a prosthetic or orthotic device that is determined by the covered 20
individual’s treating health care provider to be the most appropriate model that 21

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VT LEG #380733 v.1
meets the covered individual’s medical needs for purposes of performing 1
physical activities, such as running, biking, swimming, and strength training, 2
as applicable, and that maximizes the covered individual’s whole-body health 3
and the functions of the individual’s lower or upper limbs, or both; 4
(3) a prosthetic or orthotic device that is determined by the covered 5
individual’s treating health care provider to be the most appropriate model that 6
meets the covered individual’s medical needs for purposes of showering or 7
bathing; 8
(4) all materials and components necessary for the covered individual’s 9
use of the prostheses and orthoses described in subdivisions (1)–(3) of this 10
subsection; 11
(5) instruction to the covered individual on using the device or devices, 12
materials, and components described in subdivisions (1)–(4) of this subsection; 13
and 14
(6) the medically necessary repair or replacement of a prosthetic or 15
orthotic device, material, or component described in subdivisions (1)–(4) of 16
this subsection, as further described in subsection (f) of this section. 17
(c)(1) A health insurance plan shall consider coverage for prosthetic and 18
orthotic devices to be habilitative or rehabilitative benefits for purposes of any 19
federal or State requirement regarding coverage of essential health benefits. 20

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VT LEG #380733 v.1
(2) For purposes of the coverage required by subdivisions (b)(2) and (3) 1
of this section, a health plan may require the covered individual’s treating 2
health care provider to determine that the additional prosthetic or orthotic 3
device is necessary to enable the person to engage in physical activities, such 4
as running, biking, swimming, strength training, showering, and bathing, as 5
applicable, and to maximize the covered individual’s whole-body health and 6
the functions of the individual’s lower or upper limbs, or both. 7
(3) A health plan shall make its utilization review determinations in a 8
nondiscriminatory manner and shall not deny coverage for a prosthetic or 9
orthotic device solely on the basis of a covered individual’s actual or perceived 10
disability. 11
(4) A health insurance plan shall not deny coverage for a prosthe