So EveryBODY Can Move!

Insurance Coverage of Activity Specific Devices

Bill is passed and signed into law by Governor Moore.

Sheryl Sachs, Dankmeyer CPO and a prime mover in the effort to get the So EveryBody Can Move legislation passed in Maryland writes:

As the State Lead Advocate for So Every BODY Can Move - Maryland, I am thrilled to share a monumental achievement for our community and state. So Every BODY Can Move is a grassroots policy and advocacy initiative to create equitable and life-changing access to orthotic and prosthetic care necessary for physical activity for individuals with disabilities.

After months of hard work, dedication, and passion from countless advocates, partners, and legislative sponsors Senator Beidle, Senator Elfreth, and Delegate Martinez, I am pleased to share that SB 614/HB 865 have passed the Maryland legislature, have been signed into law by Governor Moore, and will go into effect on January 1, 2025.

Thanks to the unwavering support, advocacy, and collective effort of individuals and organizations like yours, our state has successfully passed legislation that mandates health insurance coverage for prosthetic devices specifically designed for physical activity, sport, and exercise. This legislative victory marks a significant step forward in dismantling healthcare inequities and reaffirms our belief that access to movement is a right, not a privilege.

What This Legislation Means:

This new law addresses a critical gap in our healthcare system for the limb loss and limb difference community. Historically, insurance did not cover prosthetic devices for physical activity, sports, and exercise. Although exercise and physical activity are viewed as an integral part of everyday life by the general public, insurance companies often consider a second, activity-specific prosthesis not medically necessary. Our successful legislative reform ensures that qualifying patient candidates are not denied the right to move, engage in sports, or exercise due to the lack of access to necessary prosthetics.

Next Steps

The legislation will go into effect on January 1, 2025 with the following key provisions:

• Commercial health insurance plans and state Medicaid are required to cover an additional prosthetic device for physical activity deemed medically necessary by a treating physician in a non-discriminatory manner.

• Coverage includes the assessment, fitting, all materials and components necessary to use the devices, repairs/replacements, and maintenance of these devices, ensuring that individuals receive comprehensive support.

• Insurers subject to the legislation must submit a report of claims data to the state’s insurance agency.

The So Every BODY Can Move legislation in Maryland impacts the following:

• Patient Age: all ages

• Insurance Plans Affected: state commercial plans, state employee plans, and Medicaid

• Devices Covered: activity-specific prostheses (when deemed medically necessary)

• Additional implementation communication will be developed in collaboration with healthcare providers, insurance companies, and advocacy groups to ensure smooth adoption and compliance.

How to Start Getting Access:

Starting on January 1, 2025, individuals with health insurance plans impacted by the legislation can start the following:

1. Review Patient Plan: After the bill goes into effect, beneficiaries are encouraged to review their health insurance plans and understand the new coverage options available.

2. Consult Healthcare Provider: Individuals requiring prosthetic devices for physical activity should consult their healthcare providers about their needs and support with the medical necessity authorization.

3. Partner with O&P Provider: Patients should collaborate with the O&P provider to determine which device will meet their need for physical activity and to start the claims process. Healthcare and O&P Providers will be instrumental in navigating the new coverage provisions.

4. Begin Claims and Reimbursement Process: After our state’s So Every BODY Can Move legislation goes into effect, O&P providers can begin the claims and reimbursement process. The claims and reimbursement process will remain the same as receiving a device for daily living.

5. Stay Informed: So Every BODY Can Move will continue to offer resources and support to healthcare providers and the community to ensure everyone can make the most of this legislative change.

Your Role Moving Forward:

As valued stakeholders in this initiative, your ongoing support and advocacy remain crucial. We encourage you to:

● Spread the word within your networks about this legislative win and the new coverage provisions.

● Engage with us in upcoming initiatives to monitor the implementation of the law and address any challenges that may arise.

● Continue championing the rights to health and movement in our community and beyond.

Stay connected with all things So Every BODY Can Move - https://soeverybodycanmove.org/

This victory is a testament to what we can achieve together. Let us continue to work together to ensure that every individual has the opportunity to move freely and live a full, active life.

Thank you for your unwavering support and dedication to this cause.

Warmest regards,

Sheryl N Sachs, MSPO, CPO

Lead Advocate

So Every BODY Can Move- Maryland

sebcm.md@gmail.com

 Dankmeyer’s Sheryl N Sachs, MSPO, CPO is one of the national leaders in this initiative and is working hard in Maryland to promote legal action to accomplish these goals. A long time patient advocate, Sheryl has written more about advocacy efforts on our Advocacy page.