Florida Senate - 2012                                    SB 1320
       By Senator Sobel
       31-01287-12                                           20121320__
    1                        A bill to be entitled                      
    2         An act relating to orthoses and prostheses; requiring
    3         the Agency for Health Care Administration to conduct a
    4         study concerning the medical necessity, costs, and
    5         efficacy of mandating coverage for certain orthoses
    6         and prostheses; requiring that the agency report its
    7         findings and recommendations to the Legislature;
    8         requiring the Office of Insurance Regulation and the
    9         Department of Health to provide certain assistance;
   10         providing an appropriation; providing an effective
   11         date.
   13  Be It Enacted by the Legislature of the State of Florida:
   15         Section 1. (1) The Agency for Health Care Administration,
   16  in consultation with the Office of Insurance Regulation, shall
   17  conduct a study evaluating the medical necessity, efficacy, and
   18  costs of requiring health insurers and health maintenance
   19  organizations to provide coverage for benefits for orthoses and
   20  prostheses and orthotics and prosthetics as defined in s.
   21  468.80, Florida Statutes, that equal those benefits provided for
   22  under federal laws for health insurance for the aged and
   23  disabled pursuant to 42 U.S.C. ss. 1395k and 1395m and 42 C.F.R.
   24  ss. 414.202, 414.210, 414.228, and 410.100 as applicable to this
   25  act. The agency and office shall evaluate whether gaps in
   26  coverage currently exist in the small and large group insurance
   27  markets for such orthoses and prostheses. The agency shall
   28  provide information concerning the types of benefits, including
   29  the cost of such benefits, provided to Medicaid recipients for
   30  orthoses and prostheses.
   31         (2) The Department of Health shall coordinate with the
   32  agency to provide such information concerning coverage and the
   33  costs of providing such coverage to children requiring orthoses
   34  and prostheses who are enrolled in the Children’s Medical
   35  Services Program. The agency, in consultation with the office,
   36  may contract with an actuary who is a member of the American
   37  Academy of Actuaries and other persons who have an extensive
   38  background in health insurance for the purpose of assisting the
   39  agency in evaluating the medical necessity, efficacy, and costs
   40  of such coverage. The agency shall report its findings and
   41  recommendations related to mandating insurance coverage for the
   42  orthoses and prostheses to the President of the Senate and the
   43  Speaker of the House of Representatives by January 1, 2013.
   44         Section 2. For the 2012-2013 fiscal year, the sum of
   45  $25,000 is appropriated in nonrecurring funds from the Insurance
   46  Regulatory Trust Fund to the Office of Insurance Regulation for
   47  the purpose of funding the study conducted by the Agency for
   48  Health Care Administration as provided in this act.
   49         Section 3. This act shall take effect July 1, 2012.