MedicaidPrior AuthMedium impact
New DME Forms for Standard Manual Wheelchairs; Enteral Nutrition; and Food Thickeners
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Nov 22, 2013
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now requires three new DME-specific forms in addition to the existing HFS 1409 form for prior approval requests for standard manual wheelchairs, food thickeners, and enteral nutrition. These PDF-fillable forms must be submitted with all relevant DME prior authorization requests.
Action Required
Immediately: Billing team must download new DME forms HFS 3701L (Standard Manual Wheelchair Evaluation), HFS 3701M (Questionnaire for Food Thickeners), and HFS 3701N (Questionnaire for Enteral Nutrition) from Illinois HFS Medical Programs Forms page. Update prior authorization workflow to require appropriate form submission alongside existing HFS 1409 form for all manual wheelchair rentals, food thickener requests, and enteral nutrition requests. Prior approval requests will be incomplete without these forms.