Advocates urge coverage for active prosthetics and orthotics; insurers largely neutral or concerned about language

The House Committee on Behavioral Health and Health Care held a public hearing May 8 on Senate Bill 699, a measure that would expand insurance coverage for medically necessary prosthetic and orthotic devices, including devices that enable physical activity and exercise.

Sen. Lisa Reynolds, a physician and sponsor, told the committee the bill would extend coverage beyond devices that enable activities of daily living to those "which are needed to perform kind of exertional physical activities in service of whole body health." She said devices would still require a determination of medical necessity by the patient’s health care provider.

Representative Hai Pham described the bill as reducing financial barriers to activity-specific devices and said some active prosthetics can cost "upwards of $15,000 out of pocket." Testimony from multiple amputees and clinicians framed the issue as a health and equity matter: access to sport- or activity-specific devices can prevent secondary injuries and support physical and mental well-being.

Sarah Hollandsworth, co-lead for So Everybody Can Move Oregon, and Nicole Verkheilen of the Amputee Coalition described personal and community impacts. Hollandsworth said her running blades cost $15,000 each and recounted relying on grants to participate in events. Verkheilen recounted waiting years for an appropriate running blade and said, after receiving one, "my insurance has not had to pay for a new foot in over 7 years. More importantly, I can run without pain." Charlotte Ness, a 13-year-old athlete who uses running blades and receives support from Shriners Children’s Portland and Challenge Athletes Foundation, said she worries about losing coverage at age 21.

Clinicians and prosthetists supported the bill. Taylor Wyatt, a certified prosthetist-orthotist, said restrictive insurance policies that limit devices to basic walking function prevent many patients from obtaining the device that matches their activity needs. Tristan Thomas, an adaptive athlete and veteran, compared private insurance limitations unfavorably to the Department of Veterans Affairs, which covers activity-specific devices.

Insurer representatives described negotiations on the Senate side and a current neutral position for at least one carrier. Leah Navarro, representing Regence Blue Cross Blue Shield of Oregon, said Regence is neutral after changes made in the Senate and noted the mandate does not cover Oregon Health Plan (OHP) or public employees under the state plan, limiting reach to about one-third of Oregonians. Fawn Berry of Moda Health said her company opposed the bill as written, raising concerns about ambiguous language in subsection cross-references and how the Department of Consumer and Business Services might interpret the mandate.

Supporters said the bill mirrors recent action in other states. Representative Pham said passage would put Oregon among the states that have enacted similar laws; transcript testimony counted about nine states already enacted and roughly 40 states actively pursuing similar measures. The sponsors also noted a posted A6 amendment that removes outdated language from statutes.

Ending: The committee closed the public hearing with a mix of personal testimony, clinical support and insurer concerns; no committee vote was taken. Sponsors and stakeholders signaled continued work to refine statutory language and align coverage across market segments.