Bill Text: IL HB3261 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: 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.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2019-03-29 - Rule 19(a) / Re-referred to Rules Committee [HB3261 Detail]

Download: Illinois-2019-HB3261-Introduced.html

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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.
LRB101 10013 KTG 55115 b
FISCAL NOTE ACT MAY APPLY
A BILL FOR
HB3261 LRB101 10013 KTG 55115 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; managed
care coverage.
(a) Within 30 days after the effective date of this
amendatory Act of the 101st General Assembly, the 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.
(b) 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 contract terms and
conditions, nothing in this Section shall be construed to allow
the Department or its contracted managed care organizations to

HB3261 - 2 - LRB101 10013 KTG 55115 b
enter into sole source contracts for the provision of custom
prosthetic or orthotic devices to recipients of medical
assistance or Medicaid managed care enrollees.
Section 99. Effective date. This Act takes effect upon
becoming law.