Bill Text: IL SB1737 | 2025-2026 | 104th General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to require Medicaid managed care organizations to reimburse at no less than 100% of the Medical Assistance program's Durable Medical Equipment fee schedule for the same service or item of durable medical equipment, complex rehab technology, prosthetics, orthotics, or supplies. Provides that the reimbursement requirement shall also apply to a Medicaid managed care organization's subcontractors and third-party administrators. Provides that the Department has the authority to implement the reimbursement requirement on and after July 1, 2025 and prior to the completion of any regulatory process undertaken in order to effect such change. Effective July 1, 2025.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2025-02-05 - Referred to Assignments [SB1737 Detail]

Download: Illinois-2025-SB1737-Introduced.html

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104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1737 Introduced 2/5/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-30.19 new
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to require Medicaid managed care organizations to reimburse at no less than 100% of the Medical Assistance program's Durable Medical Equipment fee schedule for the same service or item of durable medical equipment, complex rehab technology, prosthetics, orthotics, or supplies. Provides that the reimbursement requirement shall also apply to a Medicaid managed care organization's subcontractors and third-party administrators. Provides that the Department has the authority to implement the reimbursement requirement on and after July 1, 2025 and prior to the completion of any regulatory process undertaken in order to effect such change. Effective July 1, 2025.
LRB104 10358 KTG 20433 b
A BILL FOR
SB1737 LRB104 10358 KTG 20433 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 5-30.19 as follows:
(305 ILCS 5/5-30.19 new)
Sec. 5-30.19. Durable medical equipment; MCO reimbursement
requirement. The Department shall require Medicaid managed
care organizations to reimburse at no less than 100% of the
Medical Assistance program's Durable Medical Equipment fee
schedule for the same service or item of durable medical
equipment, complex rehab technology, prosthetics, orthotics,
or supplies. This reimbursement requirement shall also apply
to a Medicaid managed care organization's subcontractors and
third-party administrators. The Department has the authority
to implement the reimbursement requirement on and after July
1, 2025 and prior to the completion of any regulatory process
undertaken in order to effect such change.
Section 99. Effective date. This Act takes effect July 1,
2025.