Illinois General Assembly - Bill Status for HB5769

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.

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