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State hearing considers expanding insurance coverage for prosthetic and orthotic devices
Summary
The Financial Regulation Division of the Oregon Department of Consumer and Business Services held a hybrid public hearing Oct. 22, 2025, on proposed rules to update the list of covered prosthetic and orthotic devices to include items deemed medically necessary for physical activities; no one provided oral testimony and written comments are due Oct. 29, 2025.
Ethan Baldwin, a policy analyst and hearing officer for the Financial Regulation Division - DCBS, opened a hybrid public hearing Oct. 22 in Salem and by Microsoft Teams to receive comment on a proposed rule to revise the list of prosthetic and orthotic devices insurers must cover. Baldwin said the division is considering a reassertion of the existing coverage list and an expansion to require coverage for additional devices "that are determined to be medically necessary and the most appropriate model that meets the medical needs of the insured for purposes of performing physical activities, including but not limited to running, biking, swimming, and strength training, and that maximizes the insured's whole body health, including lower and upper limb function."
The hearing focused on the rulemaking's statutory framework. Baldwin said the rulemaking is being conducted under the Oregon Administrative Procedures Act and that state law requires the department to adopt an annually updated list that is no more restrictive than the Medicare fee schedule. He also cited SB 699 as having expanded the rulemaking to encompass devices necessary to support physical activities. "Notice for today's hearing was published in the Oregon bulletin on 10/01/2025," Baldwin added.
No members of the public gave oral testimony during the hearing. Several industry and advocacy representatives attended and stated their affiliations but said they would only listen: Antoinette O'Hwache, senior public and regulatory affairs specialist, Kimia Health Solutions; Scott White, director of regulatory affairs, Moda Health; Marlene Converse, government relations consultant, Kaiser Permanente; Melanie Anderson, associate general counsel, UnitedHealthcare; Joe McTernan, American Orthotic and Prosthetic Association; Nicole Verkailen, director of impact campaigns, Amputee Coalition (national campaign lead, So Everybody Can Move); Beau Wright, Providence Health Plan; Lisa Cervantes, Kaiser Permanente regulatory consultant; and Jill Schlosser, TFR.
Baldwin instructed that anyone wishing to testify should state their name and affiliation for the record and that the division does not respond to questions during the hearing. He said written comments would be accepted until 5:00 p.m. Pacific on Oct. 29, 2025, and that no other comments or exhibits would be accepted after that date and time. Those who provided oral testimony or who wish to submit written testimony were directed to send copies or summaries to Karen Winkle, division roles coordinator; her contact information is listed in the notice of proposed rulemaking.
After the close of the public comment period the hearing officer said he will prepare a report for the division administrator as part of the formal rulemaking record. The hearing concluded at approximately 10:08 a.m. Pacific with no oral testimony recorded.
