Senate bill would require insurers to cover medically necessary activity‑specific orthoses
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Summary
SB276 would expand insurance coverage to include medically necessary custom orthoses for physical activity. Clinicians and patients told the Senate Finance Committee the change clarifies benefits and could increase participation in exercise with little fiscal impact cited by witnesses.
Senate Bill 276, presented to the Senate Finance Committee on Feb. 4, would require health insurers to cover medically necessary custom orthoses when prescribed to enable physical activity, rehabilitation, or essential job‑related tasks. Sponsor testimony and multiple patient and clinician witnesses said the change is intended to align orthotic coverage with earlier prosthetics legislation and to remove financial barriers to devices that advocates describe as rehabilitative, not recreational.
Supporters told concrete stories. John Singer described recurring equipment failures and the out‑of‑pocket cost to replace ankle‑foot orthoses: "I could pay $1,100 for my own pocket for each AFO replacement" after insurers set replacement intervals, he said, arguing the bill would prevent financial hardship. Jonas Young, a certified orthotist‑prosthetist, described designing a wrist‑hand orthosis that allowed a patient with cerebral palsy to paddle a kayak and participate fully. Leila Tice, a University of Maryland senior and amputee, said access to orthotics affects long‑term prevention and quality of life. Krishna Gaurav, a rehabilitation physician and chief medical officer at the University of Maryland Rehab and Orthopedic Institute, described a patient with an incomplete spinal cord injury whose mobility and outdoor activity were restored by a custom orthosis.
Clinical witnesses emphasized that activity‑specific orthoses differ in design and coding from everyday devices and said the bill clarifies billing and coverage for devices already in clinical use. Cheryl Sachs, a certified prosthetics and orthotics practitioner, noted the fiscal note indicates no material impact on Medicaid or state employee health plans. Charlie Kelly, an orthotist practicing in Annapolis, summarized the clinical rationale: activity‑specific devices are often necessary to complete therapy and prevent secondary injury.
No formal action was taken during the hearing; committee members asked clarifying questions about how the bill interacts with current Medicaid billing codes. Witnesses and the sponsor said the aim is clarification and coverage parity rather than creating a wholly new benefit.
The committee hearing concluded with the sponsor asking for a favorable report and no vote recorded at that time.
