Illinois SB 1737: DHFS-MCO-DURABLE MED EQUIPMENT

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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

SB1737LRB104 10358 KTG 20433 b

1 AN ACT concerning public aid.

2 Be it enacted by the People of the State of Illinois, 

3represented in the General Assembly:

4 Section 5. The Illinois Public Aid Code is amended by 

5adding Section 5-30.19 as follows:

6 (305 ILCS 5/5-30.19 new)

7 Sec. 5-30.19. Durable medical equipment; MCO reimbursement 

8requirement. The Department shall require Medicaid managed 

9care organizations to reimburse at no less than 100% of the 

10Medical Assistance program's Durable Medical Equipment fee 

11schedule for the same service or item of durable medical 

12equipment, complex rehab technology, prosthetics, orthotics, 

13or supplies. This reimbursement requirement shall also apply 

14to a Medicaid managed care organization's s