Illinois General Assembly - Full Text of SB0637
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Full Text of SB0637  101st General Assembly


Sen. Antonio Muñoz

Filed: 4/2/2019





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2    AMENDMENT NO. ______. Amend Senate Bill 637 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-36 as follows:
6    (305 ILCS 5/5-36 new)
7    Sec. 5-36. Custom prosthetic and orthotic devices.
8    (a) Coverage for custom prosthetic and orthotic devices
9under the fee-for-service medical assistance program and under
10any Medicaid managed care plan shall be no less favorable than
11the terms and conditions that apply to substantially all
12medical and surgical benefits provided under the
13fee-for-service medical assistance program or the Medicaid
14managed care plan.
15    (b) The Department shall set a rate of reimbursement under
16the fee-for-service medical assistance program for custom



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1prosthetic and orthotic devices at a rate no less than the
2Medicare rate for the year minus 6%.
3    (c) The Department must ensure that all Medicaid managed
4care plans comply with network adequacy requirements for custom
5prosthetic and orthotic device services.
6    (d) The Department and contracted managed care
7organizations must comply with the Orthotics, Prosthetics, and
8Pedorthics Practice Act when making payments for custom
9orthotic and custom prosthetic devices.".