SB1575sam001 101ST GENERAL ASSEMBLY

Sen. Antonio Muņoz

Filed: 3/12/2019

10100SB1575sam001 LRB101 09293 KTG 57236 a

AMENDMENT TO SENATE BILL 1575

AMENDMENT NO. ______. Amend Senate Bill 1575 by replacing everything after the enacting clause with the following:

"Section 5. The Illinois Public Aid Code is amended by adding Section 5-36 as follows:

(305 ILCS 5/5-36 new)

Sec. 5-36. Custom prosthetic and orthotic devices.

(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 set a rate of reimbursement under the fee-for-service medical assistance program for custom prosthetic and orthotic devices at a rate no less than the Medicare rate for the year minus 6%. The Department shall set a rate of reimbursement payable by contracted managed care organizations to contracted, in-network providers for custom prosthetic and orthotic devices at a rate no less than the Medicare rate for the year minus 6%.

(c) Notwithstanding any other law or any other contract terms and conditions, nothing in this Section shall be construed to allow the Department or its contracted managed care organizations to enter into sole source contracts for the provision of custom prosthetic or orthotic devices to recipients of medical assistance or Medicaid managed care enrollees.

(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.".