HB0445, the “So Every Body Can Move Act,” expands coverage requirements for orthoses and prostheses under Maryland’s Medicaid program and under certain private health plans, nonprofit health service plans, and health maintenance organizations. Beginning January 1, 2027, the Maryland Medical Assistance Program must cover orthoses in the same general manner that the bill requires private carriers to do. The bill defines orthosis broadly to include rigid or semi-rigid devices used to support, align, improve function, or relieve symptoms, and it includes custom-designed, fabricated, molded, fitted, or modified devices for neuromuscular, musculoskeletal, acquired, or congenital conditions.
For private insurance and Medicaid managed care, the bill requires annual coverage for orthoses, orthosis components, repairs, and replacements. It also limits insurers’ ability to deny replacements based on continuous-use or useful-life restrictions when a provider determines a replacement is medically necessary because of a change in the patient’s condition or an irreparable change in the device, unless the need is due to misuse. The bill further bars higher copayments or coinsurance than those applied to comparable medical or surgical benefits, prohibits separate annual or lifetime dollar caps on the mandated coverage, and restricts medical-necessity standards to no more restrictive than the Medicare Coverage Database. It also requires provider-panel plans to comply with existing network rules.
The bill also clarifies and broadens prosthesis coverage under Maryland insurance law. It states that mandated prosthesis benefits include all prostheses determined by a treating provider to be medically necessary for daily living, essential job-related activities, and physical activities such as running, biking, swimming, and strength training. Like the orthosis provisions, prosthesis coverage is subject to limits on restrictive medical-necessity standards and cost-sharing treatment relative to other similar benefits.
The overall sentiment reflected in the bill’s enactment is strongly supportive, as it passed and was approved by the Governor. No committee transcripts or recorded votes were provided, so there is no documented floor or committee debate in the supplied materials. The structure and title of the act suggest a policy goal of improving mobility, independence, and access to assistive devices for people with disabilities, limb loss, or other conditions requiring orthotic or prosthetic care.
The main points of potential contention are the cost and scope of the mandate. The bill expands what must be covered, limits insurers’ ability to apply utilization controls, and requires coverage for medically necessary devices even when they support activities beyond basic function, which could increase claims costs. To address implementation concerns, the bill includes a legislative intent statement clarifying that it should not be read to require Medicaid managed care organizations to add new HCPCS L-code coverage beyond what they covered as of December 31, 2026, and it requires later reporting to state agencies and legislative committees on compliance and claims experience.
HB0445 amends Maryland Health – General and Insurance law to create a new Medicaid coverage requirement for orthoses and to expand and clarify mandated insurance coverage for orthoses and prostheses. It applies to insurers, nonprofit health service plans, and HMOs issued or delivered in the state, and it adds a new Medicaid provision effective January 1, 2027. The bill also imposes reporting obligations on carriers and managed care organizations, with state agencies required to compile and submit a joint report to the legislature in 2032. The practical effect is to broaden access to assistive devices and related repairs/replacements while limiting insurers’ ability to impose restrictive medical-necessity standards, cost-sharing differentials, and separate dollar caps.
The bill’s final status indicates favorable sentiment overall: it was enacted and signed into law as Chapter 628. In the materials provided, there are no committee transcripts, recorded votes, or other debate excerpts showing organized opposition or support, so the public record here does not reveal detailed partisan or stakeholder positions. Based on the bill’s purpose and title, the measure appears to have been framed as a disability-access and mobility-expansion bill, which typically draws supportive sentiment from patient advocates and health access proponents.
The likely areas of contention are the breadth of the mandated benefit and the resulting cost exposure for insurers and Medicaid managed care organizations. The bill requires coverage for replacements without strict continuous-use or useful-life limits when medically necessary, includes devices used for a wide range of activities, and prevents more restrictive medical-necessity rules than those in Medicare’s coverage database. Insurers may view these provisions as limiting utilization management and increasing claims costs, while supporters would emphasize medical necessity, functional independence, and access to modern orthotic and prosthetic care. The bill’s intent language limiting new HCPCS L-code obligations for Medicaid managed care suggests lawmakers were attentive to implementation concerns.