Bill Text: MS HB896 | 2026 | Regular Session | Introduced
Bill Title: Insurance; require health insurance policies to include coverage for medically necessary orthotic and prosthetic devices.
Sponsorship: Partisan Bill (Democrat 3)
Status: (Failed) 2026-02-03 - Died In Committee [HB896 Detail]
Download: Mississippi-2026-HB896-Introduced.html
MISSISSIPPI LEGISLATURE
2026 Regular Session
To: Insurance
By: Representative Bell (65th)
House Bill 896
AN ACT TO REQUIRE CERTAIN HEALTH INSURANCE POLICIES AND CONTRACTS TO PROVIDE COVERAGE FOR MEDICALLY NECESSARY ORTHOTIC DEVICES AND PROSTHETIC DEVICES AND THEIR MATERIALS AND COMPONENTS; TO DEFINE CERTAIN TERMS; TO REQUIRE THE COMMISSIONER OF INSURANCE TO SUBMIT A REPORT TO THE HOUSE AND SENATE INSURANCE COMMITTEES REGARDING THE IMPLEMENTATION OF COVERAGE UNDER THIS ACT; TO AMEND SECTION 25-15-9, MISSISSIPPI CODE OF 1972, TO REQUIRE THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE PLAN TO INCLUDE COVERAGE FOR MEDICALLY NECESSARY ORTHOTIC DEVICES AND PROSTHETIC DEVICES AND THEIR MATERIALS AND COMPONENTS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) As used in this section, the following words and phrases have the meanings given in this subsection unless the context clearly requires otherwise:
(a) "Cost-sharing requirement" means a deductible, coinsurance or copayment and any maximum limitation on the application of the deductible, coinsurance, copayment or similar out-of-pocket expense.
(b) "Covered person" means an individual covered under a health benefit policy.
(c) "Health benefit policy" means an individual and group health insurance policy providing coverage on an expense-incurred basis, an individual and group service or indemnity type contract issued by a nonprofit corporation, an individual and group service contract issued by a health maintenance organization, a self-insured group arrangement to the extent not preempted by federal law, and a managed health care delivery entity of any type or description.
(d) "Health insurer" means a person, corporation or other entity authorized to provide health benefit policies.
(e) "Medically necessary" means healthcare services that a prudent physician or other healthcare provider would provide, in accordance with nationally recognized clinical practice guidelines, to a patient for the purpose of preventing, diagnosing or treating an illness, injury or disease or its symptoms in a manner that is:
(i) In accordance with generally accepted standards of medical or other healthcare practice;
(ii) Clinically appropriate in terms of type, frequency, extent, site and duration;
(iii) Not primarily for the economic benefit of the health insurer or for the convenience of the patient, treating physician or other healthcare provider; and
(iv) Not primarily custodial care, unless custodial care is a covered service or benefit under the covered person's healthcare plan.
(f) "Nationally recognized clinical practice guidelines" means evidence based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy; the guidelines must establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options, including recommendations intended to optimize patient care.
(g) "Orthotic device" or "orthosis" means a custom fabricated or custom fitted device that is designed, fabricated, modified or fitted to correct, support or compensate for a neuromusculoskeletal disorder or acquired condition for the purpose of stabilizing, stretching or immobilizing a body part, improving alignment, preventing deformities, protecting against injury or assisting with motion or function, and is worn on the outside of the body to help with such structural or functional problems. The term does not include fabric or elastic supports, corsets, arch supports, low-temperature plastic splints, trusses, elastic hoses, canes, crutches, soft cervical collars, dental appliances or other similar devices that are carried in stock and sold as over-the-counter items by a drug store, department store, corset shop or surgical supply facility.
(h) "Prosthetic device" or "prosthesis" means a custom designed, fabricated, fitted, modified or fitted and modified device to replace an absent external body part for purposes of restoring physiological function or cosmesis or both. The term does not include: artificial eyes or ears; dental appliances; cosmetic devices such as artificial breasts, eyelashes or wigs; or other devices that do not have a significant impact on mobility or the musculoskeletal functions of the body.
(2) A health benefit policy renewed or issued on or after July 1, 2026, must include coverage for orthotic devices and prosthetic devices that are medically necessary for:
(a) Activities of daily living;
(b) Essential job related activities;
(c) Personal hygiene related activities, including, but not limited to, showering, bathing and toileting; or
(d) Physical activities, including, but not limited to, running, biking, swimming and strength training, so as to maximize the covered person's whole body health and both upper and lower limb function.
(3) The coverage required under this section must include no more than three (3) orthotic devices or prosthetic devices per affected limb per covered person during any period of three (3) years. The coverage must include:
(a) All materials and components for the use of the orthotic device or prosthetic device, including:
(i) The orthosis or prosthesis;
(ii) Structural components such as the socket;
(iii) Suspension mechanisms such as the pin, lock, suction and elevated vacuum;
(iv) Hip joint, knee joint, foot, alignable parts and terminal device;
(v) Connective components such as pads, bands and cushions; and
(vi) Consumable items such as socks, sleeves and liners;
(b) Formulation of the device's design, fabrication, measurements and fittings;
(c) Education and training on using and maintaining the device; and
(d) The repair of the device and its components.
(4) (a) The replacement of an orthotic device or prosthetic device and its materials and components when the device is less than three (3) years old must be deemed medically necessary if there is adequate documentation of a change in the physiological condition of the covered person, an irreparable change in the condition of the device or any of its components, or the condition of the device or a component of the device requires repairs and the cost of those repairs would be more than sixty percent (60%) of the cost of the device.
(b) A socket replacement must be deemed medically necessary if there is adequate documentation of a physiological need, including, but not limited to, a change in the residual limb, a functional need change, irreparable damage, or wear and tear due to excessive weight of a covered person or physical demands of an active covered person.
(c) A health insurer is not required to replace or repair an orthotic device or prosthetic device due to misuse, malicious damage, gross neglect, loss or theft.
(6) The coverage required under this section:
(a) Must be considered as habilitative or rehabilitative benefits for purposes of any state or federal requirements for coverage of essential health benefits;
(b) Must be comparable to coverage for other medical and surgical benefits under the health benefit policy, including restorative internal devices;
(c) May be subject to the same cost-sharing requirements that apply to other medical devices and services covered by the health benefit policy; however, the requirements may not be solely applicable to this coverage; and
(d) May be limited, or the cost-sharing requirements for the coverage may be altered for out-of-network providers; however, any limitations may not be more restrictive than the restrictions and requirements applicable to the out-of-network coverage for the policy's medical or surgical coverage.
(7) This section may not be construed to prohibit a health insurer from issuing or renewing a health benefit policy that provides benefits greater than the minimum benefits required under this section or from issuing or renewing a policy that provides benefits that generally are more favorable to the covered person than those required under this section.
(8) Before July 1, 2032, the Commissioner of Insurance shall submit a report to the Insurance Committees of the House of Representatives and the Senate regarding the implementation of the coverage required under this section. Each health insurer issuing or renewing health benefit policies subject to this section shall provide the Department of Insurance with all data requested by the department for inclusion in the report, including, but limited to, the total number of claims submitted, the total number of claims paid, and the total amount of claims paid for the coverage provided for by this section for policy years from 2026 to 2030. (9) The Commissioner of Insurance shall promulgate rules and regulations necessary to implement this section.
SECTION 2. Section 25-15-9, Mississippi Code of 1972, is amended as follows:
25-15-9. (1) (a) The board shall design a plan of health insurance for state employees that provides benefits for semiprivate rooms in addition to other incidental coverages that the board deems necessary. The amount of the coverages shall be in such reasonable amount as may be determined by the board to be adequate, after due consideration of current health costs in Mississippi. The plan shall also include major medical benefits in such amounts as the board determines. The plan shall provide for coverage for telemedicine services as provided in Section 83-9-351. The plan also must include coverage for medically necessary orthotic devices and prosthetic devices and their materials and components, as required under Section 1 of this act. The board is also authorized to accept bids for such alternate coverage and optional benefits as the board deems proper. The board is authorized to accept bids for surgical services that include assistance in locating a surgeon, setting up initial consultation, travel, a negotiated single case rate bundle and payment for orthopedic, spine, bariatric, cardiovascular and general surgeries. The surgical services may only utilize surgeons and facilities located in the State of Mississippi unless otherwise provided by the board. Any contract for alternative coverage and optional benefits shall be awarded by the board after it has carefully studied and evaluated the bids and selected the best and most cost-effective bid. The board may reject all of the bids; however, the board shall notify all bidders of the rejection and shall actively solicit new bids if all bids are rejected. The board may employ or contract for such consulting or actuarial services as may be necessary to formulate the plan, and to assist the board in the preparation of specifications and in the process of advertising for the bids for the plan. Those contracts shall be solicited and entered into in accordance with Section 25-15-5. The board shall keep a record of all persons, agents and corporations who contract with or assist the board in preparing and developing the plan. The board in a timely manner shall provide copies of this record to the members of the advisory council created in this section and those legislators, or their designees, who may attend meetings of the advisory council. The board shall provide copies of this record in the solicitation of bids for the administration or servicing of the self-insured program. Each person, agent or corporation that, during the previous fiscal year, has assisted in the development of the plan or employed or compensated any person who assisted in the development of the plan, and that bids on the administration or servicing of the plan, shall submit to the board a statement accompanying the bid explaining in detail its participation with the development of the plan. This statement shall include the amount of compensation paid by the bidder to any such employee during the previous fiscal year. The board shall make all such information available to the members of the advisory council and those legislators, or their designees, who may attend meetings of the advisory council before any action is taken by the board on the bids submitted. The failure of any bidder to fully and accurately comply with this paragraph shall result in the rejection of any bid submitted by that bidder or the cancellation of any contract executed when the failure is discovered after the acceptance of that bid. The board is authorized to promulgate rules and regulations to implement the provisions of this subsection.
The board shall develop plans for the insurance plan authorized by this section in accordance with the provisions of Section 25-15-5.
Any corporation, association, company or individual that contracts with the board for the third-party claims administration of the self-insured plan shall prepare and keep on file an explanation of benefits for each claim processed. The explanation of benefits shall contain such information relative to each processed claim that the board deems necessary, and, at a minimum, each explanation shall provide the claimant's name, claim number, provider number, provider name, service dates, type of services, amount of charges, amount allowed to the claimant and reason codes. The information contained in the explanation of benefits shall be available for inspection upon request by the board. The board shall have access to all claims information utilized in the issuance of payments to employees and providers.
(b) There is created
an advisory council to advise the board in the formulation of the State and
School Employees Health Insurance Plan. The council shall be composed of the * * * Commissioner of Insurance,
or his designee, an employee-representative of the state institutions of
higher learning appointed by the board of trustees thereof, an employee-representative
of the Mississippi Department of Transportation appointed by the
director thereof, an employee-representative of the Department of Revenue
appointed by the Commissioner of Revenue, an employee-representative of the * * * State Department of Health
appointed by the State Health Officer, an employee-representative of the
Mississippi Department of Corrections appointed by the Commissioner of
Corrections, and an employee-representative of the Department of Human Services
appointed by the Executive Director of Human Services, two (2) * * * licensed public school
administrators appointed by the State Board of Education, two (2) * * * licensed classroom teachers
appointed by the State Board of Education, a * * * nonlicensed school
employee appointed by the State Board of Education and a community * * * or junior college employee appointed
by the Mississippi Community College Board.
The Lieutenant Governor may designate the Secretary of the Senate, the Chairman of the Senate Appropriations Committee, the Chairman of the Senate Education Committee and the Chairman of the Senate Insurance Committee, and the Speaker of the House of Representatives may designate the Clerk of the House, the Chairman of the House Appropriations Committee, the Chairman of the House Education Committee and the Chairman of the House Insurance Committee, to attend any meeting of the State and School Employees Insurance Advisory Council. The appointing authorities may designate an alternate member from their respective houses to serve when the regular designee is unable to attend the meetings of the council. Those designees shall have no jurisdiction or vote on any matter within the jurisdiction of the council. For attending meetings of the council, the legislators shall receive per diem and expenses, which shall be paid from the contingent expense funds of their respective houses in the same amounts as provided for committee meetings when the Legislature is not in session; however, no per diem and expenses for attending meetings of the council will be paid while the Legislature is in session. No per diem and expenses will be paid except for attending meetings of the council without prior approval of the proper committee in their respective houses.
(c) No change in the terms of the State and School Employees Health Insurance Plan may be made effective unless the board, or its designee, has provided notice to the State and School Employees Health Insurance Advisory Council and has called a meeting of the council at least fifteen (15) days before the effective date of the change. If the State and School Employees Health Insurance Advisory Council does not meet to advise the board on the proposed changes, the changes to the plan shall become effective at such time as the board has informed the council that the changes shall become effective.
(d) Medical benefits for retired employees and dependents under age sixty-five (65) years and not eligible for Medicare benefits. For employees who retire before July 1, 2005, and for employees retiring due to work-related disability under the Public Employees' Retirement System, the same health insurance coverage as for all other active employees and their dependents shall be available to retired employees and all dependents under age sixty-five (65) years who are not eligible for Medicare benefits, the level of benefits to be the same level as for all other active participants. For employees who retire on or after July 1, 2005, and not retiring due to work-related disability under the Public Employees' Retirement System, the same health insurance coverage as for all other active employees and their dependents shall be available to those retiring employees and all dependents under age sixty-five (65) years who are not eligible for Medicare benefits only if the retiring employees were participants in the State and School Employees Health Insurance Plan for four (4) years or more before their retirement, the level of benefits to be the same level as for all other active participants. This section will apply to those employees who retire due to one hundred percent (100%) medical disability as well as those employees electing early retirement.
(e) Medical benefits for retired employees and dependents over age sixty-five (65) years or otherwise eligible for Medicare benefits. For employees who retire before July 1, 2005, and for employees retiring due to work-related disability under the Public Employees' Retirement System, the health insurance coverage available to retired employees over age sixty-five (65) years or otherwise eligible for Medicare benefits, and all dependents over age sixty-five (65) years or otherwise eligible for Medicare benefits, shall be the major medical coverage. For employees retiring on or after July 1, 2005, and not retiring due to work-related disability under the Public Employees' Retirement System, the health insurance coverage described in this paragraph (e) shall be available to those retiring employees only if they were participants in the State and School Employees Health Insurance Plan for four (4) years or more and are over age sixty-five (65) years or otherwise eligible for Medicare benefits, and to all dependents over age sixty-five (65) years or otherwise eligible for Medicare benefits. Benefits shall be reduced by Medicare benefits as though the Medicare benefits were the base plan.
All covered individuals shall be assumed to have full Medicare coverage, Parts A and B; and any Medicare payments under both Parts A and B shall be computed to reduce benefits payable under this plan.
(f) Lifetime maximum: The lifetime maximum amount of benefits payable under the health insurance plan for each participant is Two Million Dollars ($2,000,000.00).
(2) Nonduplication of benefits � reduction of benefits by Title XIX benefits: When benefits would be payable under more than one (1) group plan, benefits under those plans will be coordinated to the extent that the total benefits under all plans will not exceed the total expenses incurred.
Benefits for hospital or surgical or medical benefits shall be reduced by any similar benefits payable in accordance with Title XIX of the Social Security Act or under any amendments thereto, or any implementing legislation.
Benefits for hospital or surgical or medical benefits shall be reduced by any similar benefits payable by workers' compensation.
No health care benefits under the state plan shall restrict coverage for medically appropriate treatment prescribed by a physician and agreed to by a fully informed insured, or if the insured lacks legal capacity to consent by a person who has legal authority to consent on his or her behalf, based on an insured's diagnosis with a terminal condition. As used in this paragraph, "terminal condition" means any aggressive malignancy, chronic end-stage cardiovascular or cerebral vascular disease, or any other disease, illness or condition which physician diagnoses as terminal.
Not later than January 1, 2016, the state health plan shall not require a higher co-payment, deductible or coinsurance amount for patient-administered anti-cancer medications, including, but not limited to, those orally administered or self-injected, than it requires for anti-cancer medications that are injected or intravenously administered by a health care provider, regardless of the formulation or benefit category determination by the plan. For the purposes of this paragraph, the term "anti-cancer medications" has the meaning as defined in Section 83-9-24.
(3) (a) Schedule of life insurance benefits � group term: The amount of term life insurance for each active employee of a department, agency or institution of the state government shall not be in excess of One Hundred Thousand Dollars ($100,000.00), or twice the amount of the employee's annual wage to the next highest One Thousand Dollars ($1,000.00), whichever may be less, but in no case less than Thirty Thousand Dollars ($30,000.00), with a like amount for accidental death and dismemberment on a twenty-four-hour basis. The plan will further contain a premium waiver provision if a covered employee becomes totally and permanently disabled before age sixty-five (65) years. Employees retiring after June 30, 1999, shall be eligible to continue life insurance coverage in an amount of Five Thousand Dollars ($5,000.00), Ten Thousand Dollars ($10,000.00) or Twenty Thousand Dollars ($20,000.00) into retirement.
(b) Effective October
1, 1999, schedule of life insurance benefits � group term: The amount of term
life insurance for each active employee of any school district, community * * * or junior college, public library or
university-based program authorized under Section 37-23-31 for deaf, aphasic
and emotionally disturbed children or any regular nonstudent bus driver shall
not be in excess of One Hundred Thousand Dollars ($100,000.00), or twice the
amount of the employee's annual wage to the next highest One Thousand Dollars
($1,000.00), whichever may be less, but in no case less than Thirty Thousand
Dollars ($30,000.00), with a like amount for accidental death and dismemberment
on a twenty-four-hour basis. The plan will further contain a premium waiver
provision if a covered employee of any school district, community * * * or junior college, public library or
university-based program authorized under Section 37-23-31 for deaf, aphasic
and emotionally disturbed children or any regular nonstudent bus driver becomes
totally and permanently disabled before age sixty-five (65) years. Employees
of any school district, community * * * or junior college, public library or
university-based program authorized under Section 37-23-31 for deaf, aphasic and
emotionally disturbed children or any regular nonstudent bus driver retiring
after September 30, 1999, shall be eligible to continue life insurance coverage
in an amount of Five Thousand Dollars ($5,000.00), Ten Thousand Dollars
($10,000.00) or Twenty Thousand Dollars ($20,000.00) into retirement.
(4) Any eligible employee who on March 1, 1971, was participating in a group life insurance program that has provisions different from those included in this article and for which the State of Mississippi was paying a part of the premium may, at his discretion, continue to participate in that plan. The employee shall pay in full all additional costs, if any, above the minimum program established by this article. Under no circumstances shall any individual who begins employment with the state after March 1, 1971, be eligible for the provisions of this subsection.
(5) The board may offer medical savings accounts as defined in Section 71-9-3 as a plan option.
(6) Any premium differentials, differences in coverages, discounts determined by risk or by any other factors shall be uniformly applied to all active employees participating in the insurance plan. It is the intent of the Legislature that the state contribution to the plan be the same for each employee throughout the state.
(7) On October 1, 1999, any
school district, community * * * or junior college district or public
library may elect to remain with an existing policy or policies of group life
insurance with an insurance company approved by the State and School Employees
Health Insurance Management Board, in lieu of participation in the State and
School Life Insurance Plan. On or after July 1, 2004, until October 1, 2004,
any school district, community * * * or junior college district or public
library may elect to choose a policy or policies of group life insurance
existing on October 1, 1999, with an insurance company approved by the State
and School Employees Health Insurance Management Board in lieu of participation
in the State and School Life Insurance Plan. The state's contribution of up to
fifty percent (50%) of the active employee's premium under the State and School
Life Insurance Plan may be applied toward the cost of coverage for full-time
employees participating in the approved life insurance company group plan. For
purposes of this subsection (7), "life insurance company group plan"
means a plan administered or sold by a private insurance company. After
October 1, 1999, the board may assess charges in addition to the existing State
and School Life Insurance Plan rates to such employees as a condition of
enrollment in the State and School Life Insurance Plan. In order for any life
insurance company group plan to be approved by the State and School
Employees Health Insurance Management Board under this subsection (7), it shall
meet the following criteria:
(a) The insurance company offering the group life insurance plan shall be rated "A-" or better by A.M. Best state insurance rating service and be licensed as an admitted carrier in the State of Mississippi by the Mississippi Department of Insurance.
(b) The insurance company group life insurance plan shall provide the same life insurance, accidental death and dismemberment insurance and waiver of premium benefits as provided in the State and School Life Insurance Plan.
(c) The insurance company group life insurance plan shall be fully insured, and no form of self-funding life insurance by the company shall be approved.
(d) The insurance company group life insurance plan shall have one (1) composite rate per One Thousand Dollars ($1,000.00) of coverage for active employees regardless of age and one (1) composite rate per One Thousand Dollars ($1,000.00) of coverage for all retirees regardless of age or type of retiree.
(e) The insurance company and its group life insurance plan shall comply with any administrative requirements of the State and School Employees Health Insurance Management Board. If any insurance company providing group life insurance benefits to employees under this subsection (7) fails to comply with any requirements specified in this subsection or any administrative requirements of the board, the state shall discontinue providing funding for the cost of that insurance.
SECTION 3. This act shall take effect and be in force from and after July 1, 2026.
