Bill Text: IL SB3910 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: 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.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-04-15 - Chief Sponsor Changed to Sen. Don Harmon [SB3910 Detail]

Download: Illinois-2023-SB3910-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3910 Introduced 3/7/2024, by Sen. Ann Gillespie 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.
LRB103 39768 KTG 70287 b
A BILL FOR
SB3910 LRB103 39768 KTG 70287 b
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

SB3910 - 2 - LRB103 39768 KTG 70287 b