101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3261

 

Introduced , by Rep. Dan Brady

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-36 new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, within 30 days after the effective date of the amendatory Act, coverage required under a Medicaid managed care plan for custom prosthetic and orthotic devices shall be no less favorable than the terms and conditions that apply to substantially all medical and surgical benefits provided under the plan or coverage. Requires the Department of Healthcare and Family Services to 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%. Provides that the provisions of the amendatory Act shall not 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. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB3261LRB101 10013 KTG 55115 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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; managed
8care coverage.
9    (a) Within 30 days after the effective date of this
10amendatory Act of the 101st General Assembly, the coverage
11required under a Medicaid managed care plan for custom
12prosthetic and orthotic devices shall be no less favorable than
13the terms and conditions that apply to substantially all
14medical and surgical benefits provided under the plan or
15coverage.
16    (b) The Department shall set a rate of reimbursement
17payable by contracted managed care organizations to
18contracted, in-network providers for custom prosthetic and
19orthotic devices at a rate no less than the Medicare rate for
20the year minus 6%.
21    (c) Notwithstanding any other law or any contract terms and
22conditions, nothing in this Section shall be construed to allow
23the Department or its contracted managed care organizations to

 

 

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1enter into sole source contracts for the provision of custom
2prosthetic or orthotic devices to recipients of medical
3assistance or Medicaid managed care enrollees.
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.