IL HB5769

Requires coverage for custom prosthetic and orthotic devices under Illinois Medicaid fee-for-service and managed care plans to be no less favorable than terms applied to substantially all other medical and surgical benefits.

Mandates the Department of Healthcare and Family Services increase 2024 Medicaid reimbursement rates for custom prosthetic and orthotic devices by 21% total, implemented as three staggered 7% increases on January 1, 2025, January 1, 2026, and January 1, 2027.

Requires all Medicaid managed care plans to comply with network adequacy requirements for custom prosthetic devices, custom orthotic devices, and custom cranial remolding orthotic device services.

Requires the Department and contracted managed care organizations to comply with the Orthotics, Prosthetics, and Pedorthics Practice Act when making payments for custom orthotic and prosthetic devices.