SB0637eng 101ST GENERAL ASSEMBLY

SB0637 Engrossed LRB101 04381 KTG 49389 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 5-36 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%.

(c) The Department must ensure that all Medicaid managed care plans comply with network adequacy requirements for custom prosthetic and 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.