New York S 10292: Requires certain health insurance coverage for prostheses and custom orthoses

Bill Text

Bill Search and Legislative Information | New York State Assembly 

• 

• 

• 

• 

• 

• 

• 

• 

 Skip to main content 

 New York State Assembly

 Speaker Carl E. Heastie

 --> 
 --> 

 --> 

• 
 Assembly Members 

• 
 Legislative Info 

• 
 Public Hearings 

• 
 Speaker's Press 

• 
 Assembly Reports 

• 
 Committees & More 

• Bill Search Home
• Laws
• Legislative Calendar
• Public Hearing Schedule
• Assembly Calendars
• Assembly Committee Agenda 

 Javascript must be enabled to properly view this page. 

 Bill No.: 

• Summary 
• Actions 
• Committee&nbspVotes 
• Floor&nbspVotes 
• Memo 
• Text 
• LFIN 
• Chamber&nbspVideo/Transcript 
S10292 Summary:

BILL NOS10292 

&nbsp

SAME ASNo Same As

&nbsp

SPONSORWEBB

&nbsp

COSPNSRROLISON

&nbsp

MLTSPNSR

&nbsp

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 that equals the coverage and payment provided for by federal laws and regulations for the aged and disabled.

Go to top S10292 Actions:

BILL NOS10292 

&nbsp

05/11/2026REFERRED TO INSURANCE

Go to topS10292 Committee&nbspVotes:

Go to topS10292 Floor&nbspVotes:

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

Go to topS10292 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 10292

 IN SENATE

 May 11, 2026
 ___________

 Introduced by Sen. WEBB -- read twice and ordered printed, and when
 printed to be committed to the Committee on Insurance

 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 that equals the coverage and payment provided for by federal
 6 laws and regulations for the aged and disabled pursuant to 42 U.S.C.,
 7 sections 1395k, 1395l and 1395m and 42 C.F.R., sections 414.202,
 8 414.210, 414.228 and 410.100, and any successor regulations, including
 9 payment at a rate no less than the current quarter's medicare durable
 10 medical equipment, prosthetics, orthotics and supplies fee schedule
 11 established by the centers for medicare and medicaid services for pros-
 12 thetic and orthotic devices and services.
 13 (B) Coverage provided under this paragraph shall include:
 14 (i) a prosthetic or orthotic device determined by the enrollee's
 15 health care provider to be the most appropriate model that adequately
 16 meets the medical needs of such enrollee;
 17 (ii) a prosthetic or custom orthotic device determined by the
 18 enrollee's health care provider to be the most appropriate model that
 19 meets the medical needs of such enrollee for purposes of performing
 20 physical activities, including, but not limited to, running, biking,
 21 swimming, strength training, and to maximize such enrollee's whole-body
 22 health and lower and/or upper limb function;
 23 (iii) a prosthetic or custom orthotic device determined by the
 24 enrollee's health care provider to be the most appropriate model that
 25 meets the medical needs of such enrollee for purposes of showering or
 26 bathing;

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD15475-02-6

 S. 10292 2

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