Advisory committee backs routine year update to prosthetic orthotic rule; public comment open through June 3

Ethan Baldwin, chair of the Prosthetic Orthotic Rulemaking Advisory Committee, told the group the only change staff propose this year is a technical annual update to set the rule’s effective date to Jan. 1, 2027. He said staff previously circulated a version that showed a summer effective date in error and clarified the agency’s intention to follow statutory timing.

The committee reviewed the statement of need and fiscal impact. Baldwin said staff do not expect the proposed amendment to create new substantive coverage requirements beyond existing statute and that the rule could help ensure equitable access for people with limb loss and limb difference who are enrolled in individual and group health insurance policies. "We don't believe that the proposed rule will result in new substantive coverage requirements beyond the underlying statutory requirements," Baldwin said.

During introductions and discussion, Antoinette Iwuachi, a senior public and regulatory affairs specialist representing plan stakeholders, raised a concern about a recent statutory change. "I think it was House Bill 4040, at section 33 amended the statute," she said, noting the bill removes the phrase "and that are not solely for comfort or convenience" from the statute and asking whether that change appears in the rule text and might require additional rulemaking.

Baldwin and agency counsel Pramila Reddy said staff had reviewed the rule and did not find that wording in the prosthetic orthotic rule. Reddy, who identified herself as counsel for the Division of Financial Regulation, confirmed the division's review and the agency's view that the statutory amendment should not require changes to this rule. Baldwin thanked Iwuachi for raising the point and said staff had already consulted counsel to ensure the rule text is consistent with the underlying statute.

A Kaiser Permanente representative signaled support for keeping the annual change limited to updating the date. "This annual rule is very, generic by nature, and I think that it makes sense to just update the year and keep it simple as it currently is," the representative said.

On fiscal effects, staff said the primary cost of complying with the rules would fall on licensed health insurers and that, based on available information, no insurer meets the small-business definition for regulatory impact purposes. Staff stated they do not expect additional fiscal or economic impacts on state agencies or local governments beyond those imposed by statute.

Baldwin opened the meeting for public comment; no members of the public spoke. He said written comments will be accepted through close of business on June 3 and that if the division receives no substantive objections it will likely move forward with the rule as drafted and aim for an effective date of Jan. 1, 2027.

The committee adjourned after brief closing remarks.