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Committee reports substitute for prosthetic and orthotic coverage bill after personal testimony
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Summary
HB 477, revised by substitute, aims to clarify insurance coverage, medical necessity criteria and prior authorization for prosthetic and orthotic devices; lawmakers heard multiple personal accounts about denials and high out-of-pocket costs and reported the substitute bill favorably.
Representative Abare introduced the substitute for House Bill 477, which would require health insurance and Medicaid to cover prosthetic and custom orthotic devices and associated services under clearer medical‑necessity criteria, prior‑authorization standards, nondiscrimination provisions and network adequacy rules. The sponsor said the substitute reflects weeks of negotiation with health plans and providers and preserves existing safeguards like prior authorization.
Representative Abare and members emphasized the bill does not create a new benefit but clarifies how existing benefits should apply. The substitute identifies that more than one device may be medically necessary for someone with limb loss and aligns state coverage standards with Medicare where appropriate.
Three witnesses described lived experience and clinical practice. Katie Guillory, a below‑the‑knee amputee and LSU strength coach, spoke about being denied coverage for activity‑specific and job‑related devices and the financial burden of paying "thousands" out of pocket. Guillory said, "When we deny people access to activity specific prosthetics, we are effectively denying them access to long term health and any possibility of a higher quality of life." Jacob Terrebonne, a prosthetist and para-athlete, described equipment costs and the importance of sports‑capable devices for health and participation. Susan Decody, a physical therapist, described decades of clinical experience showing that basic walking devices can be insufficient for activity, safety and quality of life.
Sponsor and proponents noted that similar statutes exist in other states (the sponsor said the count reached 13 states after a recent signing in Kentucky). After testimony and no objections to adopting the substitute, the committee reported HB 477 by substitute.
Ending: The committee adopted the substitute and reported HB 477 out of committee; supporters said the change clarifies coverage standards so patients who need activity‑specific or replacement devices can access them without catastrophic out‑of‑pocket costs.
