HB2713 amends the Illinois Public Aid Code to require the Department of Healthcare and Family Services to direct Medicaid managed care organizations (MCOs) to reimburse durable medical equipment, complex rehab technology, prosthetics, orthotics, and related supplies at no less than 100% of the state Medicaid fee schedule for the same items or services. The bill also extends this requirement to MCO subcontractors and third-party administrators, ensuring the payment floor applies throughout the managed care payment chain.
The bill authorizes the Department to begin implementing the reimbursement requirement on or after July 1, 2025, even before any related rulemaking is fully completed. In practical terms, it would set a minimum reimbursement standard for Medicaid managed care payments tied to these medical goods and supplies, likely affecting how MCO contracts are structured and how providers of durable medical equipment and related products are paid under Illinois Medicaid.
Impact
HB2713 would add a new Section 5-30.19 to the Illinois Public Aid Code and create a statutory reimbursement mandate for Medicaid managed care plans. It would require the Department of Healthcare and Family Services to enforce a payment floor equal to 100% of the Medical Assistance durable medical equipment fee schedule for covered items, and it would bind subcontractors and third-party administrators as well. The bill would directly affect Medicaid MCOs, DME suppliers, prosthetics and orthotics providers, complex rehab technology vendors, and the Department’s oversight of managed care reimbursement practices.
Sentiment
Based on the bill text and the absence of recorded committee testimony or votes in the provided materials, the overall sentiment appears supportive and policy-driven rather than contentious. The measure is framed as a reimbursement parity requirement intended to standardize payment levels and improve provider compensation within Medicaid managed care. Because no debate transcripts or vote history are included, there is no evidence here of organized opposition or bipartisan division.
Contention
The main likely point of contention is cost: requiring MCOs to pay at least the state fee schedule could increase Medicaid managed care spending and reduce plan flexibility in negotiating lower rates. Managed care organizations and their administrators may object to the mandate as an administrative and financial constraint, while providers of durable medical equipment and related services would likely support it as a safeguard against underpayment. Another possible issue is the bill’s authorization for implementation before completion of the regulatory process, which may raise concerns about expedited enforcement and reduced stakeholder input.
Expands pharmacy benefit management services to include the management or administration of benefits relating to durable medical equipment; defines "durable medical equipment"; relates to pharmacy or durable medical equipment provider audits by pharmacy benefit managers.
Provides parity to durable medical equipment providers by requiring Medicaid managed care organizations to reimburse such providers at no less than one hundred percent of the medical assistance durable medical equipment fee schedule for the same service or item.
Provides parity to durable medical equipment providers by requiring Medicaid managed care organizations to reimburse such providers at no less than one hundred percent of the medical assistance durable medical equipment fee schedule for the same service or item.
An Act Concerning A Five-year Medicaid Rate Review, Dental Representation On A Medical Assistance Oversight Council, Biomarker Testing And Opioid Prescription Coverage Requirements And A Study Concerning Payment Of Spouses For State-subsidized Home Care.