The bill also stipulates substantial changes to reimbursement rates for these medical devices. Specifically, it requires a 21% increase in the current 2024 Medicaid rate for custom prosthetics and orthotics, with staggered increases of 7% scheduled for January 1 of 2025, 2026, and 2027. This change is significant as it aims to address the financial challenges that individuals requiring such devices face and is expected to improve access to care while adhering to network adequacy requirements within managed care plans.
Summary
House Bill 5769, introduced by Rep. Will Guzzardi, seeks to amend the Medical Assistance Article of the Illinois Public Aid Code. The bill mandates that coverage for custom prosthetic and orthotic devices under both fee-for-service medical assistance programs and Medicaid managed care plans must be at least as favorable as that provided for other medical and surgical benefits. This is aimed at ensuring that patients who require these custom devices receive equitable treatment under the state's Medicaid programs.
Contention
One area of potential contention within HB5769 relates to the funding and implementation of these changes. While the objectives to improve prosthetic and orthotic coverage and reimbursement rates are broadly supported, concerns about the financial implications for the state's Medicaid budget may arise. Additionally, ensuring compliance with the Orthotics, Prosthetics, and Pedorthics Practice Act by both the Department of Healthcare and Family Services and contracted managed care organizations could present regulatory and logistical challenges, thus introducing debates on the feasibility of the proposed enhancements.
A BILL to amend and reenact ยงยง 38.2-3418.15 and 38.2-3418.15:1 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 32.1-325.6, relating to health insurance; State Plan for Medical Assistance; coverage for prosthetic and custom orthotic devices and components; reports.