HB4824 103RD GENERAL ASSEMBLY

LRB103 37229 KTG 67348 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB4824

Introduced 2/7/2024, by Rep. Kevin John Olickal

SYNOPSIS AS INTRODUCED:

210 ILCS 170/40
215 ILCS 5/356z.71 new
305 ILCS 5/5-16.8
305 ILCS 5/5-18.3 new
305 ILCS 5/5-18.5

Amends the Birth Center Licensing Act. Provides that all reimbursement rates set by the Department of Healthcare and Family Services for services provided at a birth center shall be equal to the reimbursement rates set by the Department for the same services provided at a hospital. Amends the Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for all services provided at a licensed birth center by a certified nurse midwife or a licensed certified professional midwife, including, but not limited to, prenatal care, labor and delivery care, care after birth, gynecological exams, and newborn care. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that notwithstanding any other provision of the Code, all services provided at a birth center by a certified nurse midwife or a licensed certified professional midwife, including, but not limited to, prenatal care, labor and delivery care, care after birth, gynecological exams, and newborn care shall be covered under the medical assistance program for persons who are otherwise eligible for medical assistance. Provides that all reimbursement rates set by the Department for services provided at a birth center shall be equal to the reimbursement rates set by the Department for the same services provided at a hospital. Requires the Department to seek a State Plan amendment or any federal waivers or approvals necessary to implement the provisions of the amendatory Act. Removes a provision providing that licensed certified professional midwife services shall be covered under the medical assistance program, subject to appropriation, and that the Department shall consult with midwives on reimbursement rates for midwifery services. Effective January 1, 2025.

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Birth Center Licensing Act is amended by changing Section 40 as follows:

(210 ILCS 170/40)

Sec. 40. Reimbursement requirements.

(a) A birth center shall seek certification under Titles XVIII and XIX of the federal Social Security Act.

(b) Reimbursement rates set by the Department of Healthcare and Family Services should be based on all types of medically necessary covered services provided to both the birthing person and the baby, including:

(1) a professional fee for both the birthing person and baby;

(2) a facility fee for the birthing person that is equal to no less than 75% of the statewide average facility payment rate made to a hospital for an uncomplicated vaginal birth;

(3) a facility fee for the baby that is equal to no less than 75% of the statewide average facility payment rate made to a hospital for a normal baby; and

(4) additional fees for other services, medications, laboratory tests, and supplies provided.

Notwithstanding any other law to the contrary, all reimbursement rates set by the Department of Healthcare and Family Services for services provided at a birth center shall be equal to the reimbursement rates set by the Department of Healthcare and Family Services for the same services provided at a hospital licensed under the Hospital Licensing Act.

(c) A birth center shall provide charitable care consistent with that provided by comparable health care providers in the geographic area.

(d) A birth center may not discriminate against any patient requiring treatment because of the source of payment for services, including Medicare and Medicaid recipients.

(Source: P.A. 102-518, eff. 8-20-21.)

Section 10. The Illinois Insurance Code is amended by adding Section 356z.71 as follows:

(215 ILCS 5/356z.71 new)

Sec. 356z.71. Coverage for birth center and midwife services. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for all services provided at a birth center by a certified nurse midwife or a licensed certified professional midwife, including, but not limited to, prenatal care, labor and delivery care, care after birth, gynecological exams, and newborn care. As use in this Section:

"Birth center" means a facility licensed under the Birth Center Licensing Act.

"Certified nurse midwife" means an individual who is licensed under the Nurse Practice Act as an advanced practice registered nurse and is certified as a nurse midwife.

"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.

Section 15. The Illinois Public Aid Code is amended by changing Sections 5-16.8, 5-18.3, and 5-18.5 as follows:

(305 ILCS 5/5-16.8)

Sec. 5-16.8. Required health benefits. The medical assistance program shall (i) provide the post-mastectomy care benefits required to be covered by a policy of accident and health insurance under Section 356t and the coverage required under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and 356z.61, 356z.64, 356z.67, and 356z.71 of the Illinois Insurance Code, (ii) be subject to the provisions of Sections 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois Insurance Code, and (iii) be subject to the provisions of subsection (d-5) of Section 10 of the Network Adequacy and Transparency Act.

The Department, by rule, shall adopt a model similar to the requirements of Section 356z.39 of the Illinois Insurance Code.

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.

To ensure full access to the benefits set forth in this Section, on and after January 1, 2016, the Department shall ensure that provider and hospital reimbursement for post-mastectomy care benefits required under this Section are no lower than the Medicare reimbursement rate.

(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)

(305 ILCS 5/5-18.3 new)

Sec. 5-18.3. Birth center and midwife services. Notwithstanding any other provision of this Code, all services provided at a birth center by a certified nurse midwife or a licensed certified professional midwife, including, but not limited to, prenatal care, labor and delivery care, care after birth, gynecological exams, and newborn care shall be covered under the medical assistance program for persons who are otherwise eligible for medical assistance under this Article. All reimbursement rates set by the Department for services provided at a birth center shall be equal to the reimbursement rates set by the Department for the same services provided at a hospital licensed under the Hospital Licensing Act. The Department shall seek a State Plan amendment or any federal waivers or approvals necessary to implement this Section. Implementation of the coverage and reimbursement rates under this Section shall be contingent on federal approval. As used in this Section:

"Birth center" means a facility licensed under the Birth Center Licensing Act.

"Certified nurse midwife" means an individual who is licensed under the Nurse Practice Act as an advanced practice registered nurse and is certified as a nurse midwife.

"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.

(305 ILCS 5/5-18.5)

Sec. 5-18.5. Perinatal doula and evidence-based home visiting services.

(a) As used in this Section:

"Home visiting" means a voluntary, evidence-based strategy used to support pregnant people, infants, and young children and their caregivers to promote infant, child, and maternal health, to foster educational development and school readiness, and to help prevent child abuse and neglect. Home visitors are trained professionals whose visits and activities focus on promoting strong parent-child attachment to foster healthy child development.

"Perinatal doula" means a trained provider who provides regular, voluntary physical, emotional, and educational support, but not medical or midwife care, to pregnant and birthing persons before, during, and after childbirth, otherwise known as the perinatal period.

"Perinatal doula training" means any doula training that focuses on providing support throughout the prenatal, labor and delivery, or postpartum period, and reflects the type of doula care that the doula seeks to provide.

(b) Notwithstanding any other provision of this Article, perinatal doula services and evidence-based home visiting services shall be covered under the medical assistance program, subject to appropriation, for persons who are otherwise eligible for medical assistance under this Article. Perinatal doula services include regular visits beginning in the prenatal period and continuing into the postnatal period, inclusive of continuous support during labor and delivery, that support healthy pregnancies and positive birth outcomes. Perinatal doula services may be embedded in an existing program, such as evidence-based home visiting. Perinatal doula services provided during the prenatal period may be provided weekly, services provided during the labor and delivery period may be provided for the entire duration of labor and the time immediately following birth, and services provided during the postpartum period may be provided up to 12 months postpartum.

(b-5) (Blank). Notwithstanding any other provision of this Article, beginning January 1, 2023, licensed certified professional midwife services shall be covered under the medical assistance program, subject to appropriation, for persons who are otherwise eligible for medical assistance under this Article. The Department shall consult with midwives on reimbursement rates for midwifery services.

(c) The Department of Healthcare and Family Services shall adopt rules to administer this Section. In this rulemaking, the Department shall consider the expertise of and consult with doula program experts, doula training providers, practicing doulas, and home visiting experts, along with State agencies implementing perinatal doula services and relevant bodies under the Illinois Early Learning Council. This body of experts shall inform the Department on the credentials necessary for perinatal doula and home visiting services to be eligible for Medicaid reimbursement and the rate of reimbursement for home visiting and perinatal doula services in the prenatal, labor and delivery, and postpartum periods. Every 2 years, the Department shall assess the rates of reimbursement for perinatal doula and home visiting services and adjust rates accordingly.

(d) The Department shall seek such State plan amendments or waivers as may be necessary to implement this Section and shall secure federal financial participation for expenditures made by the Department in accordance with this Section.

(Source: P.A. 102-4, eff. 4-27-21; 102-1037, eff. 6-2-22.)

Section 99. Effective date. This Act takes effect January 1, 2025.