Chapter 205

2006 -- S 2106 SUBSTITUTE A AS AMENDED

Enacted 06/29/06

A N A C T

RELATING TO INSURANCE

Introduced By: Senators Ciccone, Lanzi, Badeau, Ruggerio, and Felag

Date Introduced: January 19, 2006

It is enacted by the General Assembly as follows:

SECTION 1. Title 27 of the General Laws entitled "Insurance" is hereby amended by

adding thereto the following chapter:

CHAPTER 29.2

FREEDOM OF CHOICE FOR ORTHOTIC OR PROSTHETIC SERVICES

27-29.2-1. Legislative Findings – Freedom of choice. -- The general assembly hereby

finds that all patients who are in need of an orthosis or prosthesis in the state of Rhode Island

shall have the freedom of choice to select any orthotist or prosthetist licensed by the state to

practice orthotics or prosthetics.

27-29.2-2. Definitions. -- As used in this chapter:

(a) "Orthosis" means a custom fabricated brace or support that is designed based on

medical necessity. "Orthosis" does not include prefabricated or direct-formed orthotic devices, or

any of the following assistive technology devices: Commercially available knee orthoses used

following injury or surgery; spastic muscle-tone inhibiting orthoses; upper extremity adaptive

equipment; finger splints; hand splints; wrists gauntlets; face masks used following burns;

wheelchair seating that is an integral part of the wheelchair and not worn by the patient

independent of the wheelchair; fabric or elastic supports; corsets; low-temperature formed plastic

splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances; and other similar

devises as determined by the director of the department of business regulation such as those

commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply

facility.

(b) "Orthotics" means the science and practice of evaluating, measuring, designing,

fabricating, assembling, fitting, adjusting or servicing, as well as providing the initial training

necessary to accomplish the fitting of an orthosis for the support, correction, or alleviation of

neuromuscular or musculoskeletal dysfunction, disease, injury or deformity. The practice of

orthotics encompasses evaluation, treatment and consultation with basic observational gait and

postural analysis. Orthotists assess and design orthoses to maximize function and provide not

only the support but the alignment necessary to either prevent or correct deformity or to improve

the safety and efficiency of mobility or locomotion, or both. Orthotic practice includes, providing

continuing patient care in order to assess its effect on the patient's tissues and to assure proper fit

and function of the orthotic device by periodic evaluation.

applications, capable of weight bearing. Prosthesis means an artificial medical device that is not

surgically implanted and that is used to replace a missing limb, appendage, or other external

human body part including an artificial limb, hand, or foot. The term does not include artificial

eyes, ears, noses, dental appliances, osotmy products, or devices such as eyelashes or wigs.

(d) "Prosthetics" means the science and practice of evaluating, measuring, designing,

fabricating, assembling, fitting, aligning, adjusting or servicing, as well as providing the initial

training necessary to accomplish the fitting of a prosthesis through the replacement of external

parts of a human body lost due to amputation or congenital deformities or absences. The practice

of prosthetics also includes the generation of an image, form, or mold that replicates the patient's

body or body segment and that requires rectification of dimensions, contours and volumes for use

in the design and fabrication of a socket to accept a residual anatomic limb to, in turn, create an

artificial appendage that is designed either to support body weight or to improve or restore

function or cosmesis, or both. Involved in the practice of prosthetics is observational gait analysis

and clinical assessment of the requirements necessary to refine and mechanically fix the relative

position of various parts of the prosthesis to maximize function, stability, and safety of the

patient. The practice of prosthetics includes providing and continuing patient care in order to

assess the prosthetic device's effect on the patient's tissues and to assure proper fit and function of

the prosthetic device by periodic evaluation.

27-29.2-3. Exclusion. -- This chapter shall not apply to the policies and procedures of the

Veterans' Affairs Medical Center of Rhode Island or Veterans' Affairs Medical Center Prosthetics

and Orthotics Clinics.

27-29.2-4. Application. -- This chapter shall apply to every individual or group health

insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after

July 1, 2007, which provides medical coverage that includes coverage for physician services in a

physician's office and every policy which provides major medical or similar comprehensive-type

coverage; provided, however, this chapter shall not apply to insurance coverage providing

benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4)

long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease

indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit

policies.

SECTION 2. This act shall take effect on July 1, 2006.

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LC00759/SUB A/2

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