February 12, 2008





ENGROSSED

SENATE BILL No. 269

_____


DIGEST OF SB 269 (Updated February 6, 2008 5:13 pm - DI 92)



Citations Affected: IC 5-10; IC 27-8; IC 27-13; noncode.

Synopsis: Coverage for prosthetic devices. Requires a state employee health benefit plan, a policy of accident and sickness insurance, and a health maintenance organization contract to provide prosthetic device coverage. (The introduced version of this bill was prepared by the health finance commission.)

Effective: July 1, 2008.





Dillon , Simpson
(HOUSE SPONSORS _ FRY, MURPHY, GOODIN, TYLER)




    January 10, 2008, read first time and referred to Committee on Health and Provider Services.
    January 24, 2008, amended, reported favorably _ Do Pass.
    January 28, 2008, read second time, ordered engrossed. Engrossed.
    January 29, 2008, read third time, passed. Yeas 43, nays 5.

HOUSE ACTION

    February 4, 2008, read first time and referred to Committee on Ways and Means.
    February 12, 2008, amended, reported _ Do Pass.






February 12, 2008

Second Regular Session 115th General Assembly (2008)


PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts between statutes enacted by the 2007 Regular Session of the General Assembly.


ENGROSSED

SENATE BILL No. 269



    A BILL FOR AN ACT to amend the Indiana Code concerning insurance.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 5-10-8-14; (08)ES0269.1.1. -->     SECTION 1. IC 5-10-8-14 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2008]: Sec. 14. (a) As used in this section, "covered individual" means an individual who is entitled to coverage under a state employee health benefit plan.
    (b) As used in this section, "orthotic device" means a custom fabricated brace or support that is designed based on medical necessity.
    (c) As used in this section, "prosthetic device" means an artificial leg or arm.
    (d) As used in this section, "state employee health benefit plan" means a:
        (1) self-insurance program established under section 7(b) of this chapter; or
        (2) contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter;
to provide group health coverage.
    (e) A state employee health benefit plan must provide coverage for orthotic devices and prosthetic devices, including repair or replacement of an orthotic device or a prosthetic device that:
        (1) is performed by an orthotist, a prosthetist, or a pedorthist certified by:
            (A) the American Board for Certification in Orthotics, Prosthetics and Pedorthics, or its successor; or
            (B) the Board for Orthotist or Prosthetist Certification, or its successor;

         (2) is determined by the covered individual's physician to be medically necessary to restore or maintain the covered individual's ability to perform activities of daily living or essential job related activities; and
        (3) is not solely for comfort or convenience.

     (f) The coverage required under subsection (e) must be equal to the coverage that is provided for the same device, repair, or replacement under the federal Medicare reimbursement schedule, unless:
        (1) otherwise limited by this section; or
        (2) a different reimbursement rate is negotiated.
    (g) Except as provided in subsection (h), the coverage required under subsection (e):
        (1) may be subject to; and
        (2) may not be more restrictive than;
the provisions that apply to other benefits under the state employee health plan.
    (h) The coverage required under subsection (e) may be subject to utilization review, including periodic review, of the continued medical necessity of the benefit.

     (i) Coverage under a state employee health benefit plan may not be changed in an attempt to cause a covered individual to elect Medicare as the covered individual's primary coverage.
SOURCE: IC 27-8-24.2; (08)ES0269.1.2. -->     SECTION 2. IC 27-8-24.2 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2008]:
    Chapter 24.2. Coverage for Prosthetic Devices
    Sec. 1. As used in this chapter, "insured" means an individual who is entitled to coverage under a policy of accident and sickness insurance.
    Sec. 2. (a) As used in this chapter, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1.
    (b) The term does not include the following:
        (1) Accident only, credit, dental, vision, Medicare, Medicare supplement, long term care, or disability income insurance.
        (2) Coverage issued as a supplement to liability insurance.
        (3) Automobile medical payment insurance.
        (4) A specified disease policy.
        (5) A limited benefit health insurance policy.
        (6) A short term insurance plan that:
            (A) may not be renewed; and
            (B) has a duration of not more than six (6) months.
        (7) A policy that provides a stipulated daily, weekly, or monthly payment to an insured during hospital confinement, without regard to the actual expense of the confinement.
        (8) Worker's compensation or similar insurance.
        (9) A student health insurance policy.
    Sec. 3. As used in this chapter, "orthotic device" means a custom fabricated brace or support that is designed based on medical necessity.
    Sec. 4. As used in this chapter, "prosthetic device" means an artificial leg or arm.
    Sec. 5. A policy of accident and sickness insurance must provide coverage for orthotic devices and prosthetic devices, including repair or replacement of an orthotic device or a prosthetic device that:
        (1) is performed by an orthotist, a prosthetist, or a pedorthist certified by:
            (A) the American Board for Certification in Orthotics, Prosthetics and Pedorthics, or its successor; or
            (B) the Board for Orthotist or Prosthetist Certification, or its successor;
        (2) is determined by the insured's physician to be medically necessary to restore or maintain the insured's ability to perform activities of daily living or essential job related activities; and
        (3) is not solely for comfort or convenience.

     Sec. 6. The coverage required under section 5 of this chapter must be equal to the coverage that is provided for the same device, repair, or replacement under the federal Medicare reimbursement schedule, unless:
        (1) otherwise limited by this chapter; or
        (2) a different reimbursement rate is negotiated.
    Sec. 7. Except as provided in section 8 of this chapter, the coverage required under section 5 of this chapter:

         (1) may be subject to; and
        (2) may not be more restrictive than;
the provisions that apply to other benefits under the policy of accident and sickness insurance.

     Sec. 8. The coverage required under section 5 of this chapter may be subject to utilization review, including periodic review, of the continued medical necessity of the benefit.
     Sec. 9. Coverage under a policy of accident and sickness insurance may not be changed in an attempt to cause an insured to elect Medicare as the insured's primary coverage.
SOURCE: IC 27-13-7-19; (08)ES0269.1.3. -->     SECTION 3. IC 27-13-7-19 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2008]: Sec. 19. (a) As used in this section, "orthotic device" means a custom fabricated brace or support that is designed based on medical necessity.
    (b) As used in this section, "prosthetic device" means an artificial leg or arm.
    (c) An individual contract or a group contract must provide coverage for orthotic devices and prosthetic devices, including repair or replacement of an orthotic device or a prosthetic device that:
        (1) is performed by an orthotist, a prosthetist, or a pedorthist certified by:
            (A) the American Board for Certification in Orthotics, Prosthetics and Pedorthics, or its successor; or
            (B) the Board for Orthotist or Prosthetist Certification, or its successor;
        (2) is determined by the enrollee's physician to be medically necessary to restore or maintain the enrollee's ability to perform activities of daily living or essential job related activities; and
        (3) is not solely for comfort or convenience.
    (d) The coverage required under subsection (c) must be equal to the coverage that is provided for the same device, repair, or replacement under the federal Medicare reimbursement schedule, unless:
        (1) otherwise limited by this section; or
        (2) a different reimbursement rate is negotiated.
    (e) Except as provided in subsection (f), the coverage required under subsection (c):
        (1) may be subject to; and
        (2) may not be more restrictive than;
the provisions that apply to other benefits under the group contract or individual contract.

    (f) The coverage required under subsection (c) may be subject to utilization review, including periodic review, of the continued medical necessity of the benefit.
     (g) Coverage under an individual contract or a group contract may not be changed in an attempt to cause an enrollee to elect Medicare as the enrollee's primary coverage.
SOURCE: ; (08)ES0269.1.4. -->     SECTION 4. [EFFECTIVE JULY 1, 2008] (a) IC 5-10-8-14, as added by this act, applies to a state employee health benefit plan that is established, entered into, delivered, amended, or renewed after June 30, 2008.
    (b) IC 27-8-24.2, as added by this act, applies to a policy of accident and sickness insurance that is issued, delivered, amended, or renewed after June 30, 2008.
    (c) IC 27-13-7-19, as added by this act, applies to an individual contract or a group contract that is entered into, delivered, amended, or renewed after June 30, 2008.