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Public Act 102-0964
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| HB5013 Enrolled | LRB102 25451 KTG 34737 b |
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AN ACT concerning public aid.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Birth Center Licensing Act is amended by |
changing Sections 5 and 25 as follows:
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(210 ILCS 170/5)
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Sec. 5. Definitions. In this Act: |
"Birth center" means a designated site, other than a |
hospital: |
(1) in which births are planned to occur following a |
normal, uncomplicated, and low-risk pregnancy; |
(2) that is not the pregnant person's usual place of |
residence; |
(3) that is exclusively dedicated to serving the |
childbirth-related needs of pregnant persons and their |
newborns, and has no more than 10 beds; |
(4) that offers prenatal care and community education |
services and coordinates these services with other health |
care services available in the community; and |
(5) that does not provide general anesthesia or |
surgery. |
"Certified nurse midwife" means an advanced practice |
registered nurse licensed in Illinois under the Nurse Practice |
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Act with full practice authority or who is delegated such |
authority as part of a written collaborative agreement with a |
physician who is associated with the birthing center or who |
has privileges at a nearby birthing hospital. |
"Department" means the Illinois Department of Public |
Health. |
"Hospital" does not include places where pregnant females |
are received, cared for, or treated during delivery if it is in |
a licensed birth center, nor include any facility required to |
be licensed as a birth center. |
"Licensed certified professional midwife" means a person |
who has successfully met the requirements under Section 45 of |
the Licensed Certified Professional Midwife Practice Act and |
holds an active license to practice as a licensed certified |
professional midwife in Illinois. |
"Physician" means a physician licensed to practice |
medicine in all its branches in Illinois.
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(Source: P.A. 102-518, eff. 8-20-21.)
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(210 ILCS 170/25)
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Sec. 25. Staffing. |
(a) A birth center shall have a clinical director, who may |
be: |
(1) a physician who is either certified or eligible |
for certification by the American College of Obstetricians
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and Gynecologists or the American Board of Osteopathic
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Obstetricians and Gynecologists or has hospital
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obstetrical privileges; or |
(2)
a certified nurse midwife.
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(b) The clinical director shall be responsible for: |
(1) the development of policies and procedures for |
services as provided by Department rules; |
(2) coordinating the clinical staff and overall |
provision of patient care; |
(3) developing and approving policies defining the |
criteria to determine which pregnancies are accepted as |
normal, uncomplicated, and low-risk; and |
(4) developing and approving policing regarding the |
anesthesia services available at the center.
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(c) An obstetrician, family practitioner, or certified |
nurse midwife, or licensed certified professional midwife |
shall attend each person in labor from the time of admission |
through birth and throughout the immediate postpartum period. |
Attendance may be delegated only to another physician, or a |
certified nurse midwife, or a licensed certified professional |
midwife. |
(d) A second staff person shall be present at each birth |
who: |
(1) is licensed or certified in Illinois in a |
health-related field and under the supervision of a |
physician, or a certified nurse midwife, or a licensed |
certified professional midwife who is in attendance; |
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(2) has specialized training in labor and delivery |
techniques and care of newborns; and |
(3) receives planned and ongoing training as needed to |
perform assigned duties effectively.
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(Source: P.A. 102-518, eff. 8-20-21.)
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Section 10. The Illinois Public Aid Code is amended by |
changing Section 5-5.24 as follows:
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(305 ILCS 5/5-5.24)
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Sec. 5-5.24. Prenatal and perinatal care. |
(a) The Department of
Healthcare and Family Services may |
provide reimbursement under this Article for all prenatal and
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perinatal health care services that are provided for the |
purpose of preventing
low-birthweight infants, reducing the |
need for neonatal intensive care hospital
services, and |
promoting perinatal and maternal health. These services may |
include
comprehensive risk assessments for pregnant |
individuals, individuals with infants, and
infants, lactation |
counseling, nutrition counseling, childbirth support,
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psychosocial counseling, treatment and prevention of |
periodontal disease, language translation, nurse home |
visitation, and
other support
services
that have been proven |
to improve birth and maternal health outcomes.
The Department
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shall
maximize the use of preventive prenatal and perinatal |
health care services
consistent with
federal statutes, rules, |
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and regulations.
The Department of Public Aid (now Department |
of Healthcare and Family Services)
shall develop a plan for |
prenatal and perinatal preventive
health care and
shall |
present the plan to the General Assembly by January 1, 2004.
On |
or before January 1, 2006 and
every 2 years
thereafter, the |
Department shall report to the General Assembly concerning the
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effectiveness of prenatal and perinatal health care services |
reimbursed under
this Section
in preventing low-birthweight |
infants and reducing the need for neonatal
intensive care
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hospital services. Each such report shall include an |
evaluation of how the
ratio of
expenditures for treating
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low-birthweight infants compared with the investment in |
promoting healthy
births and
infants in local community areas |
throughout Illinois relates to healthy infant
development
in |
those areas.
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On and after July 1, 2012, the Department shall reduce any |
rate of reimbursement for services or other payments or alter |
any methodologies authorized by this Code to reduce any rate |
of reimbursement for services or other payments in accordance |
with Section 5-5e. |
(b)(1) As used in this subsection: |
"Affiliated provider" means a provider who is enrolled in |
the medical assistance program and has an active contract with |
a managed care organization. |
"Non-affiliated provider" means a provider who is enrolled |
in the medical assistance program but does not have a contract |
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with an MCO. |
"Preventive prenatal and perinatal health care services" |
means services described in subsection (a) including the |
following non-emergent diagnostic and ancillary services: |
(i) Diagnostic labs and imaging, including level II |
ultrasounds. |
(ii) RhoGAM injections. |
(iii) Injectable 17-alpha-hydroxyprogesterone |
caproate (commonly called 17P). |
(iv) Intrapartum (labor and delivery) services. |
(v) Any other outpatient or inpatient service relating |
to pregnancy or the 12 months following childbirth or |
fetal loss. |
(2) In order to maximize the accessibility of preventive |
prenatal and perinatal health care services, the Department of |
Healthcare and Family Services shall amend its managed care |
contracts such that an MCO must pay for preventive prenatal |
services, perinatal healthcare services, and postpartum |
services rendered by a non-affiliated provider, for which the |
health plan would pay if rendered by an affiliated provider, |
at the rate paid under the Illinois Medicaid fee-for-service |
program methodology for such services, including all policy |
adjusters, including, but not limited to, Medicaid High Volume |
Adjustments, Medicaid Percentage Adjustments, Outpatient High |
Volume Adjustments, and all outlier add-on adjustments to the |
extent such adjustments are incorporated in the development of |
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the applicable MCO capitated rates, unless a different rate |
was agreed upon by the health plan and the non-affiliated |
provider. |
(3) In cases where a managed care organization must pay |
for preventive prenatal services, perinatal healthcare |
services, and postpartum services rendered by a non-affiliated |
provider, the requirements under paragraph (2) shall not apply |
if the services were not emergency services, as defined in |
Section 5-30.1, and: |
(A) the non-affiliated provider is a perinatal |
hospital and has, within the 12 months preceding the date |
of service, rejected a contract that was offered in good |
faith by the health plan as determined by the Department; |
or |
(B) the health plan has terminated a contract with the |
non-affiliated provider for cause, and the Department has |
not deemed the termination to have been without merit. The |
Department may deem that a determination for cause has |
merit if: |
(i) an institutional provider has repeatedly |
failed to conduct discharge planning; or |
(ii) the provider's conduct adversely and |
substantially impacts the health of Medicaid patients; |
or |
(iii) the provider's conduct constitutes fraud, |
waste, or abuse; or |