INSURANCE/HEALTH: Modifies provisions of law regarding health insurance coverage of prosthetic and custom orthotic devices and services (OR INCREASE EX See Note)

HB 477 requires most health insurance plans in Louisiana (effective January 2027) to cover prosthetic devices (like artificial limbs) and custom orthotic devices (like braces) for medical necessity. It mandates coverage for the devices, materials, repair, replacement (without lifetime limits), instruction, and special adaptations for bathing or physical activities like running. Insurance plans must follow federal payment standards (based on Medicare rates) and base coverage decisions on a physician’s or advanced provider’s medical necessity determination, with clear appeal processes for denials. This directly affects insured Louisianans needing these devices and insurers offering health coverage in the state.