Game-Changing Legislation in Washington Could Improve Prosthetic Access
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One of the most awaited pieces of legislation in 2025 is Substitute House Bill (SHB) 1669. On April 21, 2025, Governor Bob Ferguson signed the bill into law in Washington, marking a welcome development in the U.S. healthcare landscape, particularly regarding access to medical devices like prosthetic limbs.
The new law enhances coverage standards for these essential medical devices. Starting January 1, 2026, both small and large group health plans must provide coverage for one or more prosthetics per limb and custom orthotic braces as deemed medically necessary. This change allows insured individuals to fully engage in their professional and personal activities, including physical pursuits like biking, running, swimming, and strength training.
This update represents a significant shift from the current benchmark plan in Washington, which restricts coverage to just one device per limb, concentrating primarily on basic functionality without considering recreational activities.
Additionally, the coverage under this law encompasses:
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The materials and components required to effectively use the devices
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Guidance on operating the equipment
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Reasonable repair services
The bill indicates that replacement or repair must be provided if any of these conditions are met:
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If the patient’s physiological condition has changed
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If the device is irreparably damaged
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If repair costs exceed 60% of replacement costs
On coverage denials
Notably, the legislation ensures that health insurers cannot refuse coverage to individuals with disabilities if they would offer similar services to those without disabilities.
This stipulation is essential. In the past, members of the limb loss community have pointed out that those needing joint replacement surgery encounter fewer barriers to coverage than those who need prostheses. In most cases, joint replacement surgery can be more expensive than prosthetic limbs. This disparity is viewed as discriminatory.
Related reading: Health Insurers Cut Back on Prosthesis Coverage Over Medical Doubts
Although the law allows for standard utilization management procedures, any denial of coverage must be accompanied by clear written justifications. Health plans are also mandated to ensure that payments for these services comply with federal regulations concerning the elderly and disabled.
Exclusions
However, it should be noted that these provisions do not extend to individual market health plans or self-insured large group plans that cater to public and school employees.
In March 2025, an amendment was proposed to extend the bill’s coverage to self-insured and fully insured health plans for public and school employees (plans under 41.05 of the Washington Revised Code). However, the amendment was not adopted.
Another bill to track
SHB 1669 is accompanied by SB 5629, which addresses the coverage requirements for prosthetic limbs and custom orthotic braces.
As of March 8, 2025, this bill has had its initial reading in the House and has been forwarded to the Health Care & Wellness Committee, which is tasked with evaluating and developing healthcare-related legislation.
The bottom line
The passage of SHB 1669 marks a significant advancement in the quest for equitable access to prosthetic limbs and orthotic braces in Washington. It promises to enhance the quality of life for many.
While challenges remain, particularly concerning individual market plans and self-insured public employee plans, this legislation sets a crucial precedent for future reforms. Hopefully, similar legislation will soon be enacted in other states.
