SB 269-1_ Filed 01/23/2008, 16:26

COMMITTEE REPORT




MADAM PRESIDENT:

    The Senate Committee on Health and Provider Services, to which was referred Senate Bill No. 269, has had the same under consideration and begs leave to report the same back to the Senate with the recommendation that said bill be AMENDED as follows:

SOURCE: Page 1, line 6; (08)AM026902.1. -->     Page 1, line 6, after "(b)" insert " As used in this section, "orthotic device" means a custom fabricated brace or support that is designed based on medical necessity.
    (c)
".
    Page 1, line 7, delete "medical device that is not surgically implanted and that" and insert " leg or arm.".
    Page 1, delete lines 8 through 15.
    Page 1, line 16, delete "(c)" and insert " (d)".
    Page 2, line 6, delete (d)" and insert " (e)".
    Page 2, line 6, delete "the" and insert " coverage for orthotic devices and prosthetic devices, including repair or replacement of an orthotic device or a prosthetic device that:
         (1) is performed by a licensed orthotist or prosthetist or a certified pedorthist;
         (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 this section:
        (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 this section may be subject to utilization review, including periodic review, of the continued medical necessity of the benefit.
".
    Page 2, delete lines 7 through 19.
    Page 3, line 2, after "(a)" insert " As used in this chapter, "orthotic device" means a custom fabricated brace or support that is designed based on medical necessity.
    (b)
".
    Page 3, line 3, delete "medical device that is not surgically implanted and that" and insert " leg or arm.".
    Page 3, delete lines 4 through 12.
    Page 3, line 13, after "provide" insert " coverage for orthotic devices and prosthetic devices, including repair or replacement of an orthotic device or a prosthetic device that:
        (1) is performed by a licensed orthotist or prosthetist or a certified pedorthist;
        (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. 5. The coverage required under section 4 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. 6. Except as provided in section 7 of this chapter, the coverage required under section 4 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. 7. The coverage required under section 4 of this chapter may be subject to utilization review, including periodic review, of the continued medical necessity of the benefit.".
    Page 3, delete lines 14 through 25.
    Page 3, line 28, after "(a)" insert " As used in this section, "orthotic device" means a custom fabricated brace or support that is designed based on medical necessity.
    (b)
".
    Page 3, line 29, delete "medical device that is not surgically implanted" and insert " leg or arm.".
    Page 3, delete lines 30 through 38.
    Page 3, line 39, delete "the" and insert " coverage for orthotic devices and prosthetic devices, including repair or replacement of an orthotic device or a prosthetic device that:
        (1) is performed by a licensed orthotist or prosthetist or a certified pedorthist;
        (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) Except as provided in subsection (e), 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.

     (e) The coverage required under this section may be subject to utilization review, including periodic review, of the continued


medical necessity of the benefit.".
    Page 3, delete lines 40 through 42.
    Page 4, delete lines 1 through 9.
    (Reference is to SB 269 as introduced.)

and when so amended that said bill do pass .

Committee Vote: Yeas 11, Nays 0.

____________________________________

Senator Miller, Chairperson


AM 026902/DI 104    2008