A Multi-State Analysis of the Fiscal Impact of Commercial Insurance Coverage for General-Use & Activity-Specific Prosthetic & Orthotic Devices in the United States

• DOI: 10.18103/mra.v12i3.5104
• Publication Date: 2024-04-01T16:58:06Z
• Authors: Shaneis Malouff; Sara Cartwright

Prosthetic and orthotic devices are assistive utilized by individuals with limb loss, difference, mobility impairment. Research has shown these improve functionality, independence, overall quality of life for disabilities who depend on them. This report focuses two use types prosthetic devices: general-use activity-specific. General-use prostheses orthoses designed to achieve the basic needs ambulation upper-limb functionality. In contrast, activity-specific support higher-intensity physical activities recreation. Currently, 29 states do not require insurance coverage devices, 45 hindering impairment from essential functions, including regular exercise required prevent chronic illnesses. study analyzes proposed legislation in 11 states, aiming expand state-regulated purpose improving longevity health, illness prevention. The methodology includes estimating per member month (PMPM) net cost variations state based U.S. Census populations, Center Medicare Medicaid Services (CMS) Public Use Data Files state-specific fee schedules. authors hypothesize that expanded could yield long-term social fiscal benefits patient healthcare systems. Results show PMPM estimates pursuing various levels coverage, encompassing both devices. analysis conservatively small increases assumptions related device costs utilization. results further emphasize potential savings implementation legislative initiatives, improved health outcomes, minimal impact.