102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB5013

 

Introduced 1/27/2022, by Rep. Mary E. Flowers

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.24

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that 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 managed care organization must pay for preventive prenatal and perinatal healthcare services rendered by a non-affiliated provider, for which the health plan would pay if rendered by an affiliated provider, at the same rate the Department would pay for such services exclusive of disproportionate share payments and Medicaid percentage adjustments, unless a different rate was agreed upon by the health plan and the non-affiliated provider. Effective January 1, 2023.


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A BILL FOR

 

HB5013LRB102 25451 KTG 34737 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5.24 as follows:
 
6    (305 ILCS 5/5-5.24)
7    Sec. 5-5.24. Prenatal and perinatal care.
8    (a) The Department of Healthcare and Family Services may
9provide reimbursement under this Article for all prenatal and
10perinatal health care services that are provided for the
11purpose of preventing low-birthweight infants, reducing the
12need for neonatal intensive care hospital services, and
13promoting perinatal and maternal health. These services may
14include comprehensive risk assessments for pregnant
15individuals, individuals with infants, and infants, lactation
16counseling, nutrition counseling, childbirth support,
17psychosocial counseling, treatment and prevention of
18periodontal disease, language translation, nurse home
19visitation, and other support services that have been proven
20to improve birth and maternal health outcomes. The Department
21shall maximize the use of preventive prenatal and perinatal
22health care services consistent with federal statutes, rules,
23and regulations. The Department of Public Aid (now Department

 

 

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1of Healthcare and Family Services) shall develop a plan for
2prenatal and perinatal preventive health care and shall
3present the plan to the General Assembly by January 1, 2004. On
4or before January 1, 2006 and every 2 years thereafter, the
5Department shall report to the General Assembly concerning the
6effectiveness of prenatal and perinatal health care services
7reimbursed under this Section in preventing low-birthweight
8infants and reducing the need for neonatal intensive care
9hospital services. Each such report shall include an
10evaluation of how the ratio of expenditures for treating
11low-birthweight infants compared with the investment in
12promoting healthy births and infants in local community areas
13throughout Illinois relates to healthy infant development in
14those areas.
15    On and after July 1, 2012, the Department shall reduce any
16rate of reimbursement for services or other payments or alter
17any methodologies authorized by this Code to reduce any rate
18of reimbursement for services or other payments in accordance
19with Section 5-5e.
20    (b)(1) As used in this subsection:
21    
22    "Affiliated provider" means a provider who is enrolled in
23the medical assistance program and has an active contract with
24a managed care organization.
25    "Managed care organization" or "MCO" means any entity that
26contracts with the Department to provide services where

 

 

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1payment for medical services is made on a capitated basis.
2    "Non-affiliated provider" means a provider who is enrolled
3in the medical assistance program but does not have a contract
4with a MCO.
5    "Preventive prenatal and perinatal health care services"
6means services described in subsection (a) including the
7following non-emergent diagnostic and ancillary services:
8        (i) Diagnostic labs and imaging, including level II
9    ultrasounds.
10        (ii) RhoGAM injections.
11        (iii) Injectable 17-alpha-hydroxyprogesterone
12    caproate (commonly called 17P).
13        (iv) Intrapartum (labor and delivery) services.
14        (v) Any other outpatient or inpatient service relating
15    to pregnancy or the 12 months following childbirth or
16    fetal loss.
17    (2) In order to maximize the accessibility of preventive
18prenatal and perinatal health care services, the Department of
19Healthcare and Family Services shall amend its managed care
20contracts such that an MCO must pay for preventive prenatal
21and perinatal healthcare services rendered by a non-affiliated
22provider, for which the health plan would pay if rendered by an
23affiliated provider, at the same rate the Department would pay
24for such services exclusive of disproportionate share payments
25and Medicaid percentage adjustments, unless a different rate
26was agreed upon by the health plan and the non-affiliated

 

 

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1provider.
2(Source: P.A. 102-665, eff. 10-8-21.)
 
3    Section 99. Effective date. This Act takes effect January
41, 2023.