KentuckySB 972026 Regular SessionSenateWALLET

AN ACT relating to coverage for prostheses and orthoses.

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 3 benefits, 0 costs, 2 mixed.

All health plans must cover prosthetics

Beginning January 1, 2027, all Kentucky health plans must cover prostheses and orthoses. Plans must meet at least the Medicare coverage and payment standards listed in federal law. The law also counts these devices as habilitative or rehabilitative essential health benefits. This applies to plans issued or renewed on or after that date, including student plans sold by Kentucky‑licensed insurers.

More device coverage, with some limits

Starting January 1, 2027, your plan must cover prostheses and orthoses your provider prescribes and a licensed prosthetist or orthotist says are appropriate. It must also pay for needed parts, user training, repairs, and replacements when medically needed, including when repair would cost more than 60% of a new device. Insurers cannot charge higher copays or coinsurance for these devices than for inpatient doctor and surgical care. Plans may limit to three devices per affected limb in three years, and can ask your doctor to confirm replacements for devices under three years old.

Fair reviews and stronger provider networks

Beginning January 1, 2027, insurers must review prosthetic and orthotic claims fairly and cannot deny them because of a real or perceived disability. Networks must include enough accessible prosthetists and orthotists. If a claim is denied for medical necessity, the insurer must explain why in writing to you and your provider. Plan documents and denial letters must also tell you about your nondiscrimination and review rights.

Public and college employee plans included

Starting January 1, 2027, public employee health plans and self‑insured plans run by state colleges must follow the prostheses and orthoses coverage rules. Employees and their dependents in these plans get the same coverage, network, and appeal protections.

State seeks federal benefits clarification

Within 30 days of this law taking effect, the Department of Insurance tells federal health officials whether any prosthetic and orthotic rules go beyond federal essential health benefits. Federal officials have one year to reply. If they do not reply in a year, Kentucky treats its view as accepted.

Sponsors & Cosponsors

Sponsor

Rick Girdler
Republican • Senate

Cosponsors

Amanda Mays Bledsoe
Republican • Senate
Aaron Reed
Republican • Senate
Brandon J. Storm
Republican • Senate
Greg Elkins
Republican • Senate
Julie Raque Adams
Republican • Senate
Matthew Deneen
Republican • Senate
Michael Meredith
Republican • House
Matt Nunn
Republican • Senate
Phillip Wheeler
Republican • Senate
Scott Madon
Republican • Senate
Steve Rawlings
Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 171 • No: 0

Senate vote • 3/31/2026

passed

Yes: 38 • No: 0

House vote • 3/27/2026

3rd reading, passed

Yes: 95 • No: 0

Senate vote • 3/12/2026