1.1.................... moves to amend H.F. No. 2379 as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. [62A.251] COVERAGE FOR ORTHOTIC AND PROSTHETIC
1.4DEVICES.
1.5    Subdivision 1. Definitions. The following definitions have the meanings given for
1.6purposes of this section.
1.7(a) "Prosthesis" means an external medical device that is not surgically implanted
1.8and that is used to replace a missing limb, appendage, or other external human body
1.9part including an artificial limb, hand, or foot, and is deemed medically necessary. For
1.10purposes of this section, prosthesis includes any repair or replacement of the device and
1.11may be furnished only by an accredited provider in comprehensive prosthetic services, or
1.12a credentialed clinician who is certified or licensed.
1.13(b) "Prosthetics" means the science and practice of evaluation, measuring, designing,
1.14fabricating, assembling, fitting, aligning, adjusting, or servicing, as well as providing the
1.15initial training necessary to accomplish the fitting of, a prosthesis through the replacement
1.16of external parts of a human body lost due to amputation or congenital deformities or
1.17absences. The practice of prosthetics also includes the generation of an image, form,
1.18or mold that replicates the patient's body segment and that requires rectification of
1.19dimensions, contours, and volumes for use in the design and fabrication of a socket to
1.20accept a residual anatomic limb to, in turn, create an artificial appendage that is designed
1.21either to support body weight or to improve or restore function or anatomical appearance,
1.22or both. Involved in the practice of prosthetics is observational gait analysis and clinical
1.23assessment of the requirements necessary to refine and mechanically fix the relative
1.24position of various parts of the prosthesis to maximize function, stability, and safety of the
1.25patient. The practice of prosthetics includes providing and continuing patient care in order
1.26to assess the prosthetic device's effect on the patient's tissues and to assure proper fit and
1.27function of the prosthetic device by periodic evaluation.
2.1(c) "Orthosis" means:
2.2(1) an external medical device that is custom-fabricated or custom-fitted to a specific
2.3patient based on the patient's unique physical condition and is applied to a part of the
2.4body to correct a deformity, provide support and protection, restrict motion, improve
2.5function, or relieve symptoms of a disease, syndrome, injury, or postoperative condition
2.6and is deemed medically necessary ; and
2.7(2) any repair or replacement of the device that is furnished by an accredited facility
2.8in comprehensive orthotic services, or by a credentialed clinician who is certified or
2.9licensed.
2.10(d) "Orthotics" means:
2.11(1) the science and practice of evaluating, measuring, designing, fabricating,
2.12assembling, fitting, adjusting, or servicing and providing the initial training necessary to
2.13accomplish the fitting of an orthotic device for the support, correction, or alleviation of a
2.14neuromuscular or musculoskeletal dysfunction, disease, injury, or deformity;
2.15(2) evaluation, treatment, and consultation;
2.16(3) basic observation of gait and postural analysis;
2.17(4) assessing and designing orthosis to maximize function and provide support
2.18and alignment necessary to prevent or correct a deformity or to improve the safety and
2.19efficiency of mobility and locomotion;
2.20(5) continuing patient care to assess the effect on the patient's tissues; and
2.21(6) proper fit and function of the orthotic device by periodic evaluation.
2.22For purposes of orthotic device coverage, this section specifically excludes the
2.23following categories: items that are available over-the-counter without a prescription,
2.24such as soft goods, immobilizers, soft collars, corsets, sleeves, wraps, and other items not
2.25requiring modification or adjustment and can be fitted with minimum expertise.
2.26(e) "Accredited provider" means any provider that is accredited by the American
2.27Board for Certification in Orthotics Prosthetics and Pedorthics (ABC), by the Board
2.28for Orthotist/Prosthetist Certification (BOC), by the Joint Commission (JC), or by the
2.29Commission on Accreditation of Rehabilitation Facilities (CARF) and that provides
2.30comprehensive orthotic and prosthetic devices or services.
2.31    Subd. 2. Coverage. (a) A health plan shall provide coverage for orthotic and
2.32prosthetic devices, supplies, and services to the extent that coverage is provided under
2.33federal laws for health insurance for the aged and disabled under sections 1832, 1833,
2.341834, Social Security Act (United States Code, title 42, sections 1395k, 1395l, and
2.351395m), but only to the extent consistent with this section. Coverage may be limited to the
2.36orthotic or prosthetic devices, supplies, and services that are the most appropriate model
3.1that is determined medically necessary and includes the design, fabrication, material and
3.2component selection, and measurements, fittings, static and dynamic alignments and
3.3device maintenance, including repair of the device to restore or maintain the ability to
3.4complete activities of daily living and essential job-related activities and that is not solely
3.5for comfort, convenience, or recreation.
3.6(b) Orthotic and prosthetic device coverage under this section may only be subject to
3.7the annual or lifetime dollar maximums, deductibles and coinsurance that apply generally
3.8to all terms and services covered under the plan.
3.9(c) Reimbursement for orthotic and prosthetic devices, supplies, and services must
3.10be equal to the reimbursement of other contracted medical services between an accredited
3.11provider and a health plan or state-funded medical insurance plan.
3.12    Subd. 3. Prior authorization. A health plan may require prior authorization for
3.13orthotic and prosthetic devices, supplies, and services in the same manner and to the same
3.14extent as prior authorization is required for any other covered benefit.
3.15    Subd. 4. Repair or replacement. The coverage under this section shall include
3.16repair or replacement of an orthotic or prosthetic device that is medically necessary to
3.17restore or maintain the ability to complete activities of daily living or essential job-related
3.18activities and that is not solely for comfort, convenience, or recreation. Repair or
3.19replacement due to the covered individual's neglect, misuse, or abuse is not covered.
3.20    Subd. 5. Accredited provider. Orthotic and prosthetic devices, supplies, and
3.21services must be provided by an accredited provider in comprehensive orthotic or
3.22prosthetic services and prescribed by a licensed physician or licensed health care provider
3.23who has the authority in this state to prescribe orthotic and prosthetic devices, supplies,
3.24and services.
3.25EFFECTIVE DATE.This section is effective August 1, 2010, and applies to all
3.26health plans issued or renewed to provide coverage for Minnesota residents on or after
3.27that date."
3.28Amend the title accordingly