SB 200

Abstract

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on and after July 1, 2023, medically necessary orthodontic services may be covered under the medical assistance program. Requires the Department of Healthcare and Family Services to use certain auto-qualifiers when determining whether an individual, who is otherwise eligible for medical assistance, is also eligible for coverage for a medically necessary orthodontic service. Provides that if the Department denies a claim for a medically necessary orthodontic service, the Department must, at a minimum, provide the following information to the provider of the orthodontic service: (i) the actual score of the orthodontic case; (ii) the name of the dentist or orthodontist who scored the orthodontic case; (iii) a detailed scoring sheet outlining the reasons for the score of the orthodontic case; and (iv) instructions on how to appeal the denied claim.