HB5769 103RD GENERAL ASSEMBLY

LRB103 39769 KTG 70288 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB5769

Introduced 3/7/2024, by Rep. Will Guzzardi

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-52 new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that coverage for custom prosthetic and orthotic devices under the fee-for-service medical assistance program and under any Medicaid managed care plan shall be no less favorable than the terms and conditions that apply to substantially all medical and surgical benefits provided under the fee-for-service medical assistance program or the Medicaid managed care plan. Requires the Department of Healthcare and Family Services to increase the current 2024 Medicaid rate by 21% with staggered 7% increases on January 1, 2025, January 1, 2026, and January 1, 2027 under the fee-for-service medical assistance program for custom prosthetic and orthotic devices. Requires the Department to ensure that all Medicaid managed care plans comply with the network adequacy requirements for custom prosthetic, custom orthotic devices, and custom cranial remolding orthotic device services. Provides that the Department and contracted managed care organizations must comply with the Orthotics, Prosthetics, and Pedorthics Practice Act when making payments for custom orthotic and custom prosthetic devices.

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by adding Section 5-52 as follows:

(305 ILCS 5/5-52 new)

Sec. 5-52. Custom prosthetic and orthotic devices; reimbursement rates.

(a) Coverage for custom prosthetic and orthotic devices under the fee-for-service medical assistance program and under any Medicaid managed care plan shall be no less favorable than the terms and conditions that apply to substantially all medical and surgical benefits provided under the fee-for-service medical assistance program or the Medicaid managed care plan.

(b) The Department shall increase the current 2024 Medicaid rate by 21% with staggered 7% increases on January 1, 2025, January 1, 2026, and January 1, 2027 under the fee-for-service medical assistance program for custom prosthetic and orthotic devices.

(c) The Department must ensure that all Medicaid managed care plans comply with the network adequacy requirements for custom prosthetic, custom orthotic devices, and custom cranial remolding orthotic device services.

(d) The Department and contracted managed care organizations must comply with the Orthotics, Prosthetics, and Pedorthics Practice Act when making payments for custom orthotic and custom prosthetic devices.