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HB 2713

DHFS-MCO-DURABLE MED EQUIPMENT

104th Regular Session Introduced by Dee Avelar

Requires Illinois Medicaid MCOs and subcontractors to reimburse at least 100% of the state DME fee schedule for DME, CRT, prosthetics, orthotics, and supplies.

Rule 19(a) / Re-referred to Rules Committee
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Bill Summary · HB 2713

Bill summary — HB 2713 (DHFS — MCO reimbursement for durable medical equipment)

Status note: the legislative packet provided contains text from multiple states’ HB 2713s (Arizona and Illinois). This summary addresses the Illinois measure titled in the packet as relating to DHFS/MCOs and durable medical equipment (DME).

Purpose

Require Illinois Medicaid managed care organizations (MCOs) to reimburse suppliers for durable medical equipment and related items at least at the same rates set by the State’s Medical Assistance (fee) schedule, and ensure the same requirement applies to MCO subcontractors and third‑party administrators (TPAs).

Key provisions

  • Adds Section 5-30.19 to the Illinois Public Aid Code.
  • Requires the Department of Healthcare and Family Services (DHFS) to require Medicaid MCOs to reimburse at no less than 100% of the Medical Assistance program’s Durable Medical Equipment fee schedule for the same service or item. Covered categories explicitly include:
    • Durable medical equipment (DME)
    • Complex rehabilitation technology (CRT)
    • Prosthetics
    • Orthotics
    • Supplies
  • The reimbursement floor also applies to an MCO’s subcontractors and third‑party administrators.
  • Grants DHFS authority to implement the reimbursement requirement on or after July 1, 2025, even if regulatory rulemaking to effect the change has not been completed.

Who is affected

  • Medicaid MCOs operating in Illinois and their subcontractors/TPAs (responsible for paying claims).
  • DME/CRT/prosthetics/orthotics/supplies vendors and providers — expected to receive at least state fee‑schedule rates from MCOs.
  • Medicaid beneficiaries indirectly (access to providers/supplies may be affected).
  • State and MCO finances — potential budgetary and rate-setting implications.

Timeline / procedural aspects

  • The statute text specifies implementation authority beginning July 1, 2025.
  • The provided legislative actions indicate the measure was passed by the General Assembly, sent to and signed by the Governor on June 20, 2025 (the packet lists the bill as effective immediately by gubernatorial signature). Note: the bill text itself cites an effective date of July 1, 2025 — this represents a discrepancy between the bill’s printed effective date and the listed post-enactment actions.

Potential impacts and considerations

  • For suppliers: higher or more predictable payment levels from MCOs may improve cash flow and willingness to serve Medicaid managed care enrollees.
  • For MCOs: increased claim costs for DME/CRT/prosthetics/orthotics/supplies; potential downstream effects on capitation negotiations or program expenditures.
  • For state budget/oversight: DHFS may need to adjust oversight, capitation rates, or payments to MCOs; implementation prior to full rulemaking may require administrative guidance.
  • The bill sets a reimbursement floor but does not prescribe specific payment methodologies beyond tying payment to the state fee schedule.

If you want, I can draft a short fiscal impact checklist (state, MCO, provider) or compare this requirement to reimbursement practices in other states.

Compiled from official sources — confirm details with the bill’s official record.

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