74th OREGON LEGISLATIVE ASSEMBLY--2007 Regular Session
 
NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .
 
LC 1610
 
                         House Bill 2517
 
Sponsored by Representative BUCKLEY, Senator BATES;
  Representative ESQUIVEL
 
 
                             SUMMARY
 
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
 
  Requires coverage under health insurance policy for prosthetic
and orthotic devices.
 
                        A BILL FOR AN ACT
Relating to medical devices.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + (1) All individual and group health insurance
policies providing coverage for hospital, medical or surgical
expenses shall include coverage for prosthetic and orthotic
devices considered necessary for adjunctive treatment.
  (2) As used in this section:
  (a) 'Orthotic device' includes, but is not limited to:
  (A) Leg, arm, back and neck braces; and
  (B) Other orthopedic devices that support or align, prevent or
correct deformities of, or improve functioning of movable parts
of the body.
  (b) 'Prosthetic device' means any artificial device or
appliance designed to support or take the place of a part of the
body or to increase the acuity of a sense organ.
  (3) The coverage required by subsection (1) of this section may
be made subject to provisions of a health insurance policy that
apply to other benefits under the policy, including, but not
limited to, provisions relating to deductibles, coinsurance and
prior authorization.
  (4) A health benefit plan may impose a copayment or coinsurance
amount on a prosthetic or orthotic device that does not exceed
the copayment or coinsurance limit set by the Director of the
Department of Consumer and Business Services or the director's
designee.
  (5) The director shall set by rule the maximum copayment or
coinsurance amount a health benefit plan may impose on prosthetic
and orthotic devices. The maximum amount established by the
director may not exceed the copayment or coinsurance amounts
established under applicable federal law or rule set by the
United States Secretary of Health and Human Services.
  (6) The coverage required by subsection (1) of this section
shall include any repair or replacement of prosthetic and
orthotic devices that is determined appropriate by the
beneficiary's treating physician in consultation with the
prosthetist or orthotist.
  (7) The reasonable useful lifetime of prosthetic and orthotic
devices is determined by instructions developed by either the
manufacturer or the beneficiary's treating physician in
consultation with the prosthetist or orthotist.
  (8) A health benefit plan may not impose any annual or lifetime
maximum on benefits for prosthetic or orthotic devices other than
an annual or lifetime maximum that applies in the aggregate to
all terms and services covered under the policy.
  (9) If coverage under subsection (1) of this section is
provided through a managed care plan, the insured shall have
access to medically necessary clinical care and to prosthetic and
orthotic devices and technology from any prosthetist or orthotist
to whom the insured is referred by the insured's primary care
physician, if such physician has a contract with the managed care
plan. Fees for such services may not be less than the fee
schedule amount for prosthetics and orthotics under the Medicare
Physician Fee Schedule.
  (10) The Department of Consumer and Business Services may adopt
rules for the purpose of setting fee and payment schedules under
this section that are not inconsistent with the Medicare
Physician Fee Schedule. + }
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