DHFS-MCO-DURABLE MED EQUIPMENT

Illinois General Assembly - Full Text of HB2713

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB2713

Introduced 2/6/2025, by Rep. Dagmara Avelar

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 10357 KTG 20432 b

A BILL FOR

HB2713
LRB104 10357 KTG 20432 b
1

AN ACT concerning public aid.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Illinois Public Aid Code is amended by
5
adding Section 5-30.19 as follows:

6

(305 ILCS 5/5-30.19 new)
7

Sec. 5-30.19.
Durable medical equipment; MCO reimbursement
8
requirement.
The Department shall require Medicaid managed
9
care organizations to reimburse at no less than 100% of the
10
Medical Assistance program's Durable Medical Equipment fee
11
schedule for the same service or item of durable medical
12
equipment, complex rehab technology, prosthetics, orthotics,
13
or supplies. This reimbursement requirement shall also apply
14
to a Medicaid managed care organization's subcontractors and
15
third-party administrators. The Department has the authority
16
to implement the reimbursement requirement on and after July
17
1, 2025 and prior to the completion of any regulatory process
18
undertaken in order to effect such change.

19

Section 99.
Effective date.
This Act takes effect July 1,
20
2025.

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