RD21 - Mandated Coverage for Artificial Limbs


Executive Summary:
House Bill 2552 was referred to the Advisory Commission for review by the House Committee on Commerce and Labor during the 2003 Session of the General Assembly of Virginia. House Bill 2552 was patroned by Delegate R. Steven Landes. The bill, as introduced, would add § 38.2-3418.14 to the Code of Virginia to require insurers to provide coverage for artificial limbs (arms and legs). These provisions would apply to all insurers proposing to issue individual or group accident and sickness policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; corporations providing subscription contracts; and health maintenance organizations (HMOs) providing health care plans.

Subsection B defined “artificial limb” as a medically necessary prosthetic appliance prescribed as the result of the amputation of an arm or leg. The benefit must include coverage for the replacement of an artificial limb when medically appropriate, including, but not limited to, replacements required as a result of the insured’s growth and normal wear and tear on an artificial limb. The benefit does not include replacement more frequently than once in a 12-month period. Subsection C required that artificial limbs are not to be considered durable medical equipment for the purpose of coverage limits, coinsurance, or co-payments and deductibles.

The Advisory Commission held a public hearing on August 4, 2003 in Richmond, Virginia to receive public comments on House Bill 2552. In addition to the bill’s patron, seven speakers addressed the proposal. A Medicaid Reviewer from the Virginia Department of Medical Assistance (DMAS), a prosthetist from the W.E. Hanger Company, a prosthetist from the Thomas G. Powell Orthopedic Company, and an eighteen-year-old amputee and college student at William and Mary, spoke in favor of House Bill 2552. Also, written comments in support of the legislation were received. A representative of the VAHP, VCC, and HIAA spoke in opposition to the bill and provided written comments.

At the September 15, 2003 hearing Delegate Landes amended House Bill 2552 to limit coverage to prostheses for artificial legs. “Artificial leg” is defined in the amended bill as a medically necessary prosthetic appliance prescribed as the result of an above-the-knee amputation of a leg. The frequency with which an artificial leg could be replaced remained the same at one replacement in a 12-month period and the requirement that artificial limbs not be considered durable medical equipment for the purpose of coverage limits, coinsurance, or co-payments and deductibles did not change.

The Advisory Commission voted unanimously (11 to 0) on September 15, 2003 against the enactment of House Bill 2552. The Advisory Commission discussed the disparity of mandating coverage for a specific limb. The Advisory Commission concluded that coverage for artificial legs would impact a very small population and that a mandate is not warranted at this time.