AN ACT Relating to coverage requirements for prosthetic limbs and custom orthotic braces;
Summary
HB 1669 requires most fully insured large-group and small-group health plans issued or renewed on or after January 1, 2026, to cover medically necessary prosthetic limbs and custom orthotic braces. The bill specifies that coverage must include one or more prostheses or braces per limb when needed for daily living, essential job-related activities, or physical activities such as running, biking, swimming, and strength training. It also requires coverage for materials, components, related services, instruction on use, and reasonable repair or replacement.
The bill further provides that coverage may not be denied to a person with a disability if the same medical or surgical intervention would be covered for a nondisabled person seeking to restore or maintain the same physical activity. Plans may still use normal utilization management and prior authorization, but any denial must be in writing with an explanation. The bill also requires carriers to report claims data to the insurance commissioner, who must aggregate and report it to the Legislature. The law does not apply to individual market plans or to self-insured or fully insured public employee and school employee plans.
Impact
HB 1669 amends Washington insurance law by adding a new section to chapter 48 RCW that mandates specific prosthetic limb and custom orthotic brace benefits in large-group and small-group health plans. It expands required coverage for repair, replacement, and related services, and sets parity standards tied to coverage for nondisabled enrollees. The bill also creates reporting obligations for carriers and the insurance commissioner, which may affect plan administration, claims processing, and oversight for affected insurers and enrollees.
Sentiment
The bill appears to have broad support. It passed the House committee 16-2, the House floor 80-17, the Senate committee 9-2, and the Senate floor 41-8, indicating clear bipartisan approval despite some opposition. The voting pattern suggests general agreement with expanding access to prosthetic and orthotic coverage, with only a minority of lawmakers voting against it.
Contention
The main points of contention appear to be the scope and cost of the mandated benefit. Opponents likely focused on the requirement that plans cover multiple prostheses or braces, repair and replacement without continuous-use or useful-lifetime limits in some cases, and coverage for athletic and daily-living activities beyond basic mobility. Another likely concern is the administrative burden of prior authorization, written denial explanations, and carrier reporting requirements. Supporters, by contrast, appear to have emphasized nondiscrimination, medical necessity, and ensuring that people with disabilities have coverage comparable to that available for nondisabled enrollees.