Massachusetts H 4549: An Act to improve outcomes for persons with limb loss and limb difference

Bill Text

HOUSE . . . . . . . . No. 4549

The Commonwealth of Massachusetts

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HOUSE OF REPRESENTATIVES, September 29, 2025.
The committee on Financial Services, to whom was referred the
petition (accompanied by bill, House, No. 1178) of Carlos González,
Joanne M. Comerford and Jacob R. Oliveira for legislation to authorize
insurance coverage for prosthetic devices and orthotic devices, reports
recommending that the accompanying bill (House, No. 4549) ought to
pass.

For the committee,

JAMES M. MURPHY.

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FILED ON: 9/19/2025
HOUSE . . . . . . . . . . . . . . . No. 4549

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-Fourth General Court
(2025-2026)
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An Act to improve outcomes for persons with limb loss and limb difference.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:

1 SECTION 1. Section 17I of chapter 32A of the General Laws, as appearing in the 2022
2 Official Edition, is hereby amended by striking out subsection (b) and inserting in place thereof
3 the following subsection:-
4 (b) For the purposes of this section the following words shall, unless the context clearly
5 requires otherwise, have the following meanings:
6 “Orthosis”, a device: (i) used to support, align, correct or prevent deformities of the body,
7 which may be used to eliminate, control or assist motion at a joint or body part; and (ii)
8 appropriately used in a person’s home or any setting in which normal life activities take place in
9 the community.
10 “Prosthetic device”, an artificial limb device to replace, in whole or in part, an arm or leg
11 including a device that is designed specifically for physical activities.

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12 SECTION 2. Subsection (f) of said section 17I of said chapter 32A, as so appearing, is
13 hereby amended by inserting after the word “devices” the following words:-
14 but must do so in a nondiscriminatory manner and shall not deny coverage for habilitative
15 or rehabilitative benefits, including prosthetics or orthotics, solely on the basis of an insured’s
16 actual or perceived disability.
17 SECTION 3. Section 17I of chapter 32A of the General Laws, as appearing in the 2022
18 Official Edition, is hereby further amended by adding the following subsections:-
19 (g) In addition to primary prosthetic and orthotic devices for daily use, the commission
20 shall provide coverage for prosthetic devices and orthotic devices designed, custom-built or
21 fitted for a specific enrollee for the performance of physical activities, including devices
22 specifically designed for showering and bathing, as applicable, to maximize the enrollee’s ability
23 to ambulate, run, bike and swim and to maximize upper limb function. The coverage required
24 pursuant to this subsection shall include the repair or replacement of a prosthetic or orthotic
25 device for the performance of physical activities.
26 (h)(1) The division shall consider these benefits habilitative or rehabilitative for purposes
27 of any state or federal requirement for coverage of essential health benefits.
28 (2) An insurer shall render utilization determinations in a nondiscriminatory manner and
29 shall not deny coverage for habilitative or rehabilitative benefits, including prosthetics or
30 orthotics, solely on the basis of an insured’s actual or perceived disability.

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31 (3) An insurer shall not deny a prosthetic or orthotic benefit for an individual with limb
32 loss or absence that would otherwise be covered for a non-disabled person seeking medical or
33 surgical intervention to restore or maintain the ability to perform the same physical activity.
34 (4) Prosthetic and custom orthotic device coverage shall not be subject to separate
35 financial requirements that are applicable only with respect to that coverage, An individual
36 health plan may impose cost-sharing on prosthetic or custom orthotic devices provided that any
37 cost-sharing requirements shall not be more restrictive than the cost-sharing requirements
38 applicable to the plan’s coverage for inpatient physician and surgical services.
39 (5) A health plan that provides coverage for prosthetic or orthotic services shall ensure
40 access to medically necessary clinical care and to prosthetic and custom orthotic devices and
41 technology from not less than two distinct prosthetic and custom orthotic providers in the
42 managed care plan’s provider network located in the state. In the event that medically necessary
43 covered orthotics and prosthetics are not available from an in-network provider, the insurer shall
44 provide processes to refer a member to an out-of-network provider and shall fully reimburse the
45 out-of-network provider at a mutually agreed upon rate less member cost-sharing determined on
46 an in-network basis.
47 (6) If coverage for prosthetic or custom orthotic devices is provided, payment