Arkansas health plans must provide coverage for orthotics, prosthetics

A new law in Arkansas will require health benefit plans to cover costs associated with orthotic devices, orthotic services, prosthetic devices, and prosthetic services. Limits on coverage may not be less than 80 percent of Medicare allowables as defined by the Center for Medicare and Medicaid Service's common procedure coding system as of January 1, 2009.

Eligible charges and coverage limits must be based on medical necessity or the health plan's coverage criteria for other medical services. Plans may require prior authorization for the devices and services in the same manner as required for other covered benefits. They may also impose copayments, deductibles or coinsurance if the amounts are no greater than those applicable to other plan benefits. Plans need not cover replacement devices more frequently than once every three years, unless medically necessary or indicated by other coverage criteria.

The law will take effect 91 days after adjournment of the state's legislature (Sec. 23-99-417, as amended by Act 950 (H. 2244), L. 2009, enacted April 6, 2009).

Reprinted with permission. © CCH





 

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