MedicaidDocumentationMedium impact
Power Mobility Devices and Custom Manual Wheelchairs
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab)·Provider Notice
Effective date
Jul 1, 2006
We identified it
Jun 21, 2026
Summary
Illinois Medicaid is replacing the power wheelchair questionnaire form with new HFS 3701H and 3701K forms effective July 1, 2006. Prior approval requests for power mobility devices and custom manual wheelchairs must include these new forms and will not be processed without complete documentation from physicians, therapists, and DME providers.
Action Required
By July 1, 2006: DME providers must use new HFS 3701H (Seating/Mobility Evaluation) and HFS 3701K (Power Mobility Devices and Custom Manual Wheelchairs) forms for all prior approval requests. Update workflow to ensure complete documentation from ordering physicians and licensed physiatrists/therapists before submitting. Submit orders via mail only using Form DPA 2240 - faxed requests will be returned. Incomplete requests will be returned for proper completion.