State of Illinois
2019 and 2020


Introduced 2/14/2020, by Sen. Iris Y. Martinez


New Act
5 ILCS 80/4.41 new
215 ILCS 5/356z.43 new
225 ILCS 60/4  from Ch. 111, par. 4400-4
225 ILCS 65/50-15  was 225 ILCS 65/5-15
305 ILCS 5/5-5  from Ch. 23, par. 5-5

    Creates the Certified Professional Midwives Practice Act. Provides for the licensure of midwives by the Department of Financial and Professional Regulation and for certain limitations on the activities of licensed midwives. Creates the Illinois Midwifery Board. Sets forth provisions concerning application, qualifications, grounds for disciplinary action, and administrative procedures. Amends the Regulatory Sunset Act to set a repeal date for the new Act of January 1, 2031. Amends the Illinois Insurance Code, the Medical Practice Act of 1987, the Nurse Practice Act, and the Illinois Public Aid Code to make related changes.

LRB101 20758 SPS 70445 b






SB3851LRB101 20758 SPS 70445 b

1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the
5Certified Professional Midwives Practice Act.
6    Section 5. Purpose. The practice of midwifery in
7out-of-hospital settings is hereby declared to affect the
8public health, safety, and welfare and to be subject to
9regulation in the public interest. The purpose of this Act is
10to protect and benefit the public by setting standards for the
11qualifications, education, training, and experience of those
12who seek to obtain licensure and hold the title of licensed
13certified professional midwife, to promote high standards of
14professional performance for those licensed to practice
15midwifery in out-of-hospital settings in this State, to promote
16a collaborative and integrated maternity care delivery system
17in Illinois, and to protect the public from unprofessional
18conduct by persons licensed to practice midwifery, as defined
19in this Act. This Act shall be liberally construed to best
20carry out these purposes.
21    Section 10. Exemptions.
22    (a) This Act does not prohibit a person licensed under any



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1other Act in this State from engaging in the practice for which
2they are licensed or from delegating services as provided for
3under that other Act.
4    (b) Nothing in this Act shall be construed to prohibit or
5require licensing under this Act, with regard to:
6        (1) the gratuitous rendering of services;
7        (2) the rendering of services by a birth attendant, if
8    such attendance is in accordance with the birth attendant's
9    religious faith or cultural group and is rendered only to
10    women and families in a distinct cultural or religious
11    group as an exercise and enjoyment of their religious or
12    cultural freedom; and
13        (3) a student midwife or midwife's assistant working
14    under the supervision of a licensed midwife.
15    (c) Nothing in this Act abridges, limits, or changes in any
16way the right of parents to deliver their baby where, when,
17how, and with whom they choose, regardless of licensure under
18this Act.
19    Section 15. Definitions. In this Act:
20    "Board" means the Illinois Midwifery Board.
21    "Certified professional midwife" means a person who has met
22the standards for certification set by the North American
23Registry of Midwives and has been awarded the Certified
24Professional Midwife credential.
25    "Department" means the Department of Financial and



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1Professional Regulation.
2    "International Confederation of Midwives" means the
3organization that sets global standards for the education and
4autonomous practice of midwifery.
5    "Licensed certified professional midwife" means a person
6who has been granted a license under this Act to engage in the
7practice of midwifery.
8    "Midwifery Bridge Certificate" means the certificate
9issued by NARM based upon completion of accredited continuing
10education specific to content in emergency skills for
11pregnancy, birth, and newborn care, along with other midwifery
12topics addressing the core competencies of the International
13Confederation of Midwives.
14    "Midwifery Education and Accreditation Council" or "MEAC"
15means the nationally recognized accrediting agency, or its
16successor, that establishes standards for the education of
17direct-entry midwives in the United States.
18    "National Association of Certified Professional Midwives"
19means the professional organization, or its successor, that
20promotes the growth and development of the profession of
21certified professional midwives.
22    "North American Registry of Midwives" or "NARM" means the
23accredited international agency, or its successor, that has
24established and has continued to administer certification for
25the credentialing of certified professional midwives.
26    "Practice of midwifery" means providing the necessary



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1supervision, care, education, and advice to pregnant people
2during the antepartum, intrapartum, and postpartum period,
3conducting deliveries independently, and caring for the
4newborn, with such care including, without limitation,
5preventative measures, breastfeeding assistance, and
6education, the detection of abnormal conditions in the
7childbearing individual and the child, the procurement of
8medical assistance, and the execution of emergency measures in
9the absence of medical help. "Practice of midwifery" includes
10nonprescriptive family planning and basic well-woman care
11limited to Pap tests, sexually transmitted infection
12screenings, and preconception screenings. "Practice of
13midwifery" does not constitute the practice of medicine.
14    "Secretary" means the Secretary of Financial and
15Professional Regulation.
16    Section 20. Unlicensed practice. Beginning January 1,
172021, no person may practice, attempt to practice, or hold
18themselves out to practice as a licensed certified professional
19midwife unless they are licensed under this Act.
20    Section 25. Title. A licensed certified professional
21midwife may identify themselves as a "licensed certified
22professional midwife" and may use the abbreviation "LCPM".
23    Section 30. Informed Consent.



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1    (a) A licensed certified professional midwife shall, at an
2initial consultation with a prospective client, provide a copy
3of the rules under this Act and an informational brochure
4developed in cooperation by the Illinois chapters of the
5National Association of Certified Professional Midwives and
6the American College of Obstetricians and Gynecologists, or
7their successors, detailing the benefits and risks of having an
8out-of-hospital birth with a licensed certified professional
9midwife, and disclose to the client orally and in writing
10(informed consent documentation), all of the following:
11        (1) The licensed certified professional midwife's
12    experience, training, and current licensure status.
13        (2) Whether the licensed certified professional
14    midwife has malpractice liability insurance coverage and
15    the policy limits of any such coverage.
16        (3) A written protocol for the handling of medical
17    emergencies, including transportation to a hospital,
18    particular to each client.
19    (b) The informed consent documentation must be signed and
20dated by the client and the licensed certified professional
21midwife. A copy must be provided to the client and the original
22must be kept in the client's chart.
23    Section 35. Vicarious liability. Nothing in this Act is
24intended to expand the malpractice liability of physicians,
25advanced practice registered nurses, certified professional



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1midwives, or other health care providers beyond the limits
2existing in current Illinois statutory and common law.
3    Section 40. Advertising.
4    (a) Any person licensed under this Act may advertise the
5availability of professional midwifery services in the public
6media or on premises where professional services are rendered
7if the advertising is truthful and not misleading and is in
8conformity with any rules regarding the practice of a licensed
9certified professional midwife.
10    (b) A licensee must include in every advertisement for
11midwifery services regulated under this Act their title as it
12appears on the license or the initials "LCPM" as authorized
13under this Act.
14    Section 45. Powers and duties of the Department; rules.
15    (a) The Department shall exercise the powers and duties
16prescribed by the Civil Administrative Code of Illinois for the
17administration of licensing Acts and shall exercise such other
18powers and duties necessary for effectuating the purposes of
19this Act.
20    (b) The Secretary shall adopt rules consistent with the
21provisions of this Act for the administration and enforcement
22of this Act and for the payment of fees connected to this Act
23and may prescribe forms that shall be issued in connection with
24this Act.



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1    (c) Rules adopted by the Department must address the scope
2of practice and services provided and the use of equipment,
3procedures, medications, and other agents that are determined
4by the Department to be necessarily available in order to
5ensure the health and safety of the childbearing individual and
6her newborn.
7    (d) The rules adopted by the Department under this Section
8may not:
9        (1) require a licensed certified professional midwife
10    to practice midwifery under the supervision of another
11    health care provider;
12        (2) require a licensed certified professional midwife
13    to enter into a written agreement with another health care
14    provider;
15        (3) limit the location where a licensed certified
16    professional midwife may practice midwifery;
17        (4) permit a licensed certified professional midwife
18    to do any of the following:
19            (A) administer prescription pharmacological agents
20        intended to induce or augment labor;
21            (B) administer prescription pharmacological agents
22        to provide pain management;
23            (C) use vacuum extractors or forceps;
24            (D) prescribe medications;
25            (E) perform surgical procedures, including, but
26        not limited to, abortions, cesarean sections, and



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1        circumcisions; or
2            (F) provide out-of-hospital care to a woman who has
3        had a vertical uterine incision cesarean section.
4        (5) Permit the licensed certified professional midwife
5    to knowingly accept responsibility for prenatal or
6    intrapartum care of a client with any of the following risk
7    factors:
8            (A) chronic significant maternal cardiac,
9        pulmonary, renal, or hepatic disease;
10            (B) malignant disease in an active phase;
11            (C) significant hematological disorders or
12        coagulopathies or pulmonary embolism;
13            (D) insulin-requiring diabetes mellitus;
14            (E) confirmed isoimmunization, Rh disease, with
15        positive titer;
16            (F) active tuberculosis;
17            (G) active syphilis or gonorrhea;
18            (H) active genital herpes infection 2 weeks prior
19        to labor or in labor;
20            (I) pelvic or uterine abnormalities affecting
21        normal vaginal births, including tumors and
22        malformations;
23            (J) alcoholism or abuse;
24            (K) drug addiction or abuse;
25            (L) confirmed AIDS status;
26            (M) uncontrolled current serious psychiatric



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1        illness;
2            (N) social or familial conditions unsatisfactory
3        for out-of-hospital maternity care services; or
4            (O) fetus with suspected or diagnosed congenital
5        abnormalities that may require immediate medical
6        intervention.
7    (e) With regards to Medicaid reimbursement, no rules
8prescribed by the Department shall require the licensed midwife
9to carry liability insurance in order to be reimbursed by the
10State as a Medicaid provider.
11    (f) The Department shall consult with the Board in adopting
12rules. Notice of proposed rulemaking shall be transmitted to
13the Board and the Department shall review the Board's response
14and any recommendations made. The Department shall notify the
15Board in writing with proper explanation of deviations from the
16Board's recommendations and responses.
17    (g) The Department may at any time seek the advice and the
18expert knowledge of the Board on any matter relating to the
19administration of this Act.
20    (h) The Department shall issue a quarterly report to the
21Board of the status of all complaints related to the profession
22filed with the Department.
23    (i) Rules adopted by the Department regarding the practice
24of midwifery must be consistent with the standards regarding
25the practice of midwifery established by the National
26Association of Certified Professional Midwives, or a successor



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1organization whose essential documents include, without
2limitation, subject matter concerning scope of practice,
3standards of practice, informed consent, appropriate
4consultation, collaboration or referral, and acknowledgment of
5a woman's right to self-determination concerning her maternity
7    Section 50. Drugs and screenings.
8    (a) A licensed certified professional midwife may not
9prescribe medications, but may, in the course of providing care
10within their scope of practice, as defined in the rules,
11administer those medications and vaccines approved by the
12Department and listed in the rules. The medication indications,
13dose, route of administration, and duration of treatment
14relating to the administration of drugs and procedures
15identified under this Section shall be determined by rule as
16the Department deems necessary to be in keeping with current
17evidence-based practice standards. The Department may approve
18additional medications, agents, or procedures based upon
19limited availability of standard medications or agents.
20    (b) A licensed certified professional midwife may obtain
21appropriate screenings and testing for clients, including, but
22not limited to, ultrasounds and non-stress tests.
23    (c) In addition to the drugs, devices, and procedures
24identified in rules, a licensed certified professional midwife
25may administer any other prescription drug, use any other



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1device, or perform any other procedure as an authorized agent
2of a licensed practitioner with prescriptive authority.
3    (d) Nothing in this Act is intended to restrict the
4licensed certified professional midwife's ability to
5administer herbal or homeopathic remedies in keeping with the
6client's usual home practices or in keeping with the licensed
7certified professional midwife's midwifery education or
8continuing education programs.
9    Section 55. Consultation and referral.
10    (a) A licensed certified professional midwife shall
11consult with a physician licensed to practice medicine in all
12of its branches or a licensed certified nurse midwife providing
13obstetrical care whenever there are significant deviations,
14including abnormal laboratory results, relative to a client's
15pregnancy or to a neonate. If a referral to health care
16provider trained in high risk pregnancy is needed, the licensed
17certified professional midwife shall refer the client to a
18physician or certified nurse midwife and, if possible, remain
19in consultation with the physician or certified nurse midwife
20until resolution of the concern. Consultation does not preclude
21the possibility of an out-of-hospital birth. It is appropriate
22for the licensed certified professional midwife to maintain
23care of the client to the greatest degree possible, in
24accordance with the client's wishes, during the pregnancy and,
25if possible, during labor, birth, and the postpartum period.



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1    (b) Specific parameters for required consultation shall be
2determined by the Department by rule.
3    Section 60. Transfer.
4    (a) The licensed certified professional midwife shall
5provide all clients with information, in writing, regarding the
6potential benefits of filing prenatal records prior to the
7birth with the emergency transport hospital identified in the
8informed consent documentation.
9    (b) The licensed certified professional midwife shall file
10the client's prenatal records with the emergency hospital at 36
11weeks of pregnancy or shall document the client's refusal using
12standard forms provided by the Department.
13    (c) The licensed certified professional midwife shall, in
14case of emergency, initiate immediate transport according to
15the licensed certified professional midwife's emergency plan,
16provide emergency stabilization until emergency medical
17services arrive or transfer is completed, accompany the client
18or follow the client to a hospital in a timely fashion, provide
19pertinent information to the receiving facility, and complete
20an emergency transport record. Transport via private vehicle is
21an acceptable method of transport if it is the most expedient
22and safest method for accessing medical services.
23    (d) Specific parameters for required transfer shall be
24determined by the Department by rule.
25    (e) A licensed certified professional midwife may deliver a



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1client's infant with any of the complications or conditions set
2forth in by the Department by rule if no physician or other
3equivalent medical services are available and the situation
4presents immediate harm to the health and safety of the client,
5if the complication or condition entails extraordinary and
6unnecessary human suffering, or if delivery occurs during
8    Section 65. Reporting requirements. All licensed certified
9professional midwives must file such reports as are required in
10rules, at such times as are designated by the Department using
11forms developed by the Department. These reports shall, at a
12minimum, detail any serious adverse outcomes for or death of
13the childbearing individual or the neonate.
14    Section 70. Illinois Midwifery Board.
15    (a) There is created under the authority of the Department
16the Illinois Midwifery Board, which shall consist of 7 members
17appointed by the Secretary, 4 of whom shall be licensed
18certified professional midwives, except that initial
19appointees must have at least 3 years of experience in the
20practice of midwifery in an out-of-hospital setting, be
21certified by the North American Registry of Midwives, and meet
22the qualifications for licensure set forth in this Act; one of
23whom shall be a licensed obstetrician or a family practice
24physician who has a minimum of 2 years experience providing



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1home birth services; one of whom shall be a licensed certified
2nurse midwife who has a minimum of 2 years experience providing
3home birth services; and one of whom shall be a knowledgeable
4public member who has given birth with the assistance of a
5certified professional midwife in an out-of-hospital birth
6setting. A physician or certified nurse midwife who has a
7minimum or 2 years experience consulting or collaborating with
8a home birth provider may stand in substitution if the criteria
9for physician or certified nurse midwife board members cannot
10be met. Board members shall serve 4-year terms, except that in
11the case of initial appointments, terms shall be staggered as
12follows: 3 members shall serve for 4 years, 2 members shall
13serve for 3 years, and 2 members shall serve for 2 years. The
14Board shall annually elect a chairperson and vice chairperson.
15    (b) Any appointment made to fill a vacancy shall be for the
16unexpired portion of the term. Appointments to fill vacancies
17shall be made in the same manner as original appointments. No
18Board member may be reappointed for a term that would cause his
19or her continuous service on the Board to exceed 9 years.
20    (c) Board membership must have a reasonable representation
21from different geographic areas of this State, if possible.
22    (d) The members of the Board may be reimbursed for all
23legitimate, necessary, and authorized expenses incurred in
24attending the meetings of the Board.
25    (e) The Secretary may remove any member of the Board for
26misconduct, incapacity, or neglect of duty at any time prior to



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1the expiration of their term.
2    (f) Four Board members shall constitute a quorum. A vacancy
3in the membership of the Board shall not impair the right of a
4quorum to perform all of the duties of the Board.
5    (g) The Board shall provide the Department with
6recommendations concerning the administration of this Act and
7may perform each of the following duties:
8        (1) Recommend to the Department the prescription and,
9    from time to time, the revision of any rules that may be
10    necessary to carry out the provisions of this Act,
11    including those that are designed to protect the health,
12    safety, and welfare of the public.
13        (2) Recommend changes to the medication formulary list
14    as standards and drug availability change.
15        (3) Conduct hearing and disciplinary conferences on
16    disciplinary charges of licensees.
17        (4) Report to the Department, upon completion of a
18    hearing, the disciplinary actions recommended to be taken
19    against a person found in violation of this Act.
20        (5) Recommend the approval, denial of approval, and
21    withdrawal of approval of required education and
22    continuing educational programs.
23        (6) Assist the Department in drafting forms and
24    informational handouts relative to this Act.
25    (h) The Secretary shall give due consideration to all
26recommendations of the Board. If the Secretary takes action



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1contrary to a recommendation of the Board, the Secretary must
2promptly provide a written explanation of that action.
3    (i) The Board may recommend to the Secretary that one or
4more licensed midwives be selected by the Secretary to assist
5in any investigation under this Act. Compensation shall be
6provided to any licensee who provides assistance under this
7subsection in an amount determined by the Secretary.
8    (j) Members of the Board shall be immune from suit in an
9action based upon a disciplinary proceeding or other activity
10performed in good faith as a member of the Board, except for
11willful or wanton misconduct.
12    (k) Members of the Board may participate in and act at any
13meeting of the Illinois Midwifery Board through the use of any
14real-time Internet or telephone communications media, by means
15of which all persons participating in the meeting can
16communicate with each other. Participation in such meeting
17shall constitute attendance and presence in person at the
18meetings of the person or persons so participating.
19    Section 75. Qualifications for licensed certified
20professional midwives.
21    (a) Each applicant who successfully meets the requirements
22of this Section shall be licensed as a licensed certified
23professional midwife.
24    (b) An applicant for licensure as a licensed certified
25professional midwife must:



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1        (1) submit a completed written application, on forms
2    provided by the Department, and fees as established by the
3    Department;
4        (2) be at least 21 years old;
5        (3) be a high school graduate or have completed
6    equivalent education;
7        (4) successfully complete one of the following formal
8    midwifery education and training programs:
9            (A) Accredited Educational Pathway:
10                (i) applicants who are certified professional
11            midwives and who have successfully completed an
12            educational program or pathway accredited by the
13            MEAC;
14                (ii) after January 1, 2022, all new applicants
15            for licensure as a licensed certified professional
16            midwife must have graduated from an educational
17            program or pathway that is accredited by MEAC;
18            (B) Non-Accredited Educational Pathway:
19                (i) applicants who are certified professional
20            midwives before January 1, 2022, and who have
21            completed non-accredited educational pathways will
22            be required to obtain a Midwifery Bridge
23            Certificate in order to become a licensed
24            certified professional midwife;
25                (ii) applicants who have maintained licensure
26            in a state that does not require MEAC-accredited



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1            education, regardless of the date of their
2            certification, shall obtain the Midwifery Bridge
3            Certificate to be eligible for licensure;
4        (5) hold a current valid Certified Professional
5    Midwife Credential granted by NARM or its successor
6    organization;
7        (6) hold current cardiopulmonary resuscitation or
8    basic life support certification for health care
9    professionals or providers issued by the American Red Cross
10    or the American Heart Association;
11        (7) within the last 2 years, have successfully
12    completed the American Academy of Pediatrics/American
13    Heart Association Neonatal Resuscitation Program;
14        (8) not have violated the provisions of this Act
15    concerning the grounds for disciplinary action; the
16    Department may take into consideration any felony
17    conviction of the applicant, but such a conviction may not
18    operate as an absolute bar to licensure as a licensed
19    certified professional midwife; and
20        (9) meet all other requirements established by the
21    Department by rule.
22    Section 80. Social Security Number on application. In
23addition to any other information required to be contained in
24the application, every application for an original, renewal,
25reinstated, or restored license under this Act shall include



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1the applicant's Social Security Number.
2    Section 85. Renewal of licensure.
3    (a) Licensed certified professional midwives shall renew
4their license every 2 years at the discretion of the
6    (b) Rules adopted under this Act shall require the licensed
7certified professional midwife to maintain certified
8professional midwife certification by meeting all continuing
9education requirements and other requirements set forth by the
10North American Registry of Midwives and current
11cardiopulmonary resuscitation or basic life support
12certification as required under Section 75.
13    Section 90. Inactive status.
14    (a) A licensed certified professional midwife who notifies
15the Department in writing on forms prescribed by the Department
16may elect to place his or her license on inactive status and
17shall be excused from payment of renewal fees until he or she
18notifies the Department in writing of his or her intent to
19restore the license.
20    (b) A licensed certified professional midwife whose
21license is on inactive status may not practice licensed
22certified professional midwifery in the State of Illinois.
23    (c) A licensed certified professional midwife requesting
24restoration from inactive status shall be required to pay the



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1current renewal fee, as provided by the Department, to restore
2his or her license.
3    (d) Any licensee who engages in the practice of midwifery
4while his or her license is lapsed or on inactive status shall
5be considered to be practicing without a license, which shall
6be grounds for discipline.
7    Section 95. Restoration of licensure; military service.
8    (a) Any licensed certified professional midwife who has
9permitted his or her license to expire or who has had his or
10her license on inactive status may have the license restored by
11making application to the Department and filing proof
12acceptable to the Department of fitness to have the license
13restored and by paying the required fees. Proof of fitness may
14include evidence attesting to active lawful practice in another
16    (b) The Department shall determine, by an evaluation
17program, fitness for restoration of a license under this
18Section and shall establish procedures and requirements for
20    (c) A licensed certified professional midwife whose
21license expired while they were:
22        (i) in federal service on active duty with the Armed
23    Forces of the United States or the State Militia and called
24    into service or training; or
25        (ii) received education under the supervision of the



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1    United States preliminary to induction into the military
2    service;
3    may have the license restored without paying any lapsed
4renewal fees if, within 2 years after honorable termination of
5service, training, or education, they furnish the Department
6with satisfactory evidence to the effect that they have been so
8    Section 100. Roster. The Department shall maintain a roster
9of the names and addresses of all licensees and of all persons
10whose licenses have been suspended or revoked. This roster
11shall be available upon written request and payment of the
12required fee.
13    Section 105. Fees.
14    (a) The Department shall provide for a schedule of fees for
15the administration and enforcement of this Act, including
16without limitation original licensure, renewal, and
17restoration, which fees shall be nonrefundable.
18    (b) All fees collected under this Act shall be deposited
19into the General Professions Dedicated Fund and appropriated to
20the Department for the ordinary and contingent expenses of the
21Department in the administration of this Act.
22    Section 110. Returned checks; fines. Any person who
23delivers a check or other payment to the Department that is



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1returned to the Department unpaid by the financial institution
2upon which it is drawn shall pay to the Department, in addition
3to the amount already owed to the Department, a fine of $50.
4The fines imposed by this Section are in addition to any other
5discipline provided under this Act for unlicensed practice or
6practice on a non-renewed license. The Department shall notify
7the person that fees and fines shall be paid to the Department
8by certified check or money order within 30 calendar days after
9the notification. If, after the expiration of 30 days from the
10date of the notification, the person has failed to submit the
11necessary remittance, the Department shall automatically
12terminate the license or deny the application, without hearing.
13If, after termination or denial, the person seeks a license, he
14or she shall apply to the Department for restoration or
15issuance of the license and pay all fees and fines due to the
16Department. The Department may establish a fee for the
17processing of an application for restoration of a license to
18defray all expenses of processing the application. The
19Secretary may waive the fines due under this Section in
20individual cases where the Secretary finds that the fines would
21be unreasonable or unnecessarily burdensome.
22    Section 115. Unlicensed practice; civil penalty. Any
23person who practices, offers to practice, attempts to practice,
24or holds himself or herself out to practice certified
25professional midwifery or as a midwife without being licensed



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1under this Act shall, in addition to any other penalty provided
2by law, pay a civil penalty to the Department in an amount not
3to exceed $5,000 for each offense, as determined by the
4Department. The civil penalty shall be assessed by the
5Department after a hearing is held in accordance with the
6provisions set forth in this Act regarding the provision of a
7hearing for the discipline of a licensee. The civil penalty
8shall be paid within 60 days after the effective date of the
9order imposing the civil penalty. The order shall constitute a
10judgment and may be filed and execution had thereon in the same
11manner as any judgment from any court of record. The Department
12may investigate any unlicensed activity.
13    Section 120. Grounds for disciplinary action.
14    (a) The Department may refuse to issue or to renew or may
15revoke, suspend, place on probation, reprimand, or take other
16disciplinary action as the Department may deem proper,
17including fines not to exceed $5,000 for each violation, with
18regard to any licensee or license for any one or combination of
19the following causes:
20        (1) Violations of this Act or its rules.
21        (2) Material misstatement in furnishing information to
22    the Department.
23        (3) Conviction of any crime under the laws of any U.S.
24    jurisdiction that is (i) a felony, (ii) a misdemeanor, an
25    essential element of which is dishonesty, (iii) directly



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1    related to the practice of the profession.
2        (4) Making any misrepresentation for the purpose of
3    obtaining a license.
4        (5) Professional incompetence or gross negligence.
5        (6) Gross malpractice.
6        (7) Aiding or assisting another person in violating any
7    provision of this Act or its rules.
8        (8) Failing to provide information within 60 days in
9    response to a written request made by the Department.
10        (9) Engaging in dishonorable, unethical, or
11    unprofessional conduct of a character likely to deceive,
12    defraud, or harm the public.
13        (10) Habitual or excessive use or addiction to alcohol,
14    narcotics, stimulants, or any other chemical agent or drug
15    that results in the inability to practice with reasonable
16    judgment, skill, or safety.
17        (11) Discipline by another U.S. jurisdiction or
18    foreign nation if at least one of the grounds for the
19    discipline is the same or substantially equivalent to those
20    set forth in this Act.
21        (12) Directly or indirectly giving to or receiving from
22    any person, firm, corporation, partnership, or association
23    any fee, commission, rebate, or other form of compensation
24    for any professional services not actually or personally
25    rendered. This shall not be deemed to include rent or other
26    remunerations paid to an individual, partnership, or



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1    corporation by a licensed certified professional midwife
2    for the lease, rental, or use of space, owned or controlled
3    by the individual, partnership, corporation, association.
4        (13) A finding by the Department that the licensee,
5    after having his or her license placed on probationary
6    status, has violated the terms of probation.
7        (14) Abandonment of a patient.
8        (15) Willfully making or filing false records or
9    reports relating to a licensee's practice, including, but
10    not limited to, false records filed with State agencies or
11    departments.
12        (16) Physical illness or mental illness, including,
13    but not limited to, deterioration through the aging process
14    or loss of motor skill that results in the inability to
15    practice the profession with reasonable judgment, skill,
16    or safety.
17        (17) Failure to provide a patient with a copy of his or
18    her record upon the written request of the patient.
19        (18) Conviction by any court of competent
20    jurisdiction, either within or without this State, of any
21    violation of any law governing the practice of licensed
22    certified professional midwifery or conviction in this or
23    another state of any crime that is a felony under the laws
24    of this State or conviction of a felony in a federal court,
25    if the Department determines, after investigation, that
26    the person has not been sufficiently rehabilitated to



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1    warrant the public trust.
2        (19) A finding that licensure has been applied for or
3    obtained by fraudulent means.
4        (20) Being named as a perpetrator in an indicated
5    report by the Department of Children and Family Services
6    under the Abused and Neglected Child Reporting Act and upon
7    proof by clear and convincing evidence that the licensee
8    has caused a child to be an abused child or a neglected
9    child, as defined in Section 3 of the Abused and Neglected
10    Child Reporting Act.
11        (21) Practicing or attempting to practice under a name
12    other than the full name shown on a license issued under
13    this Act.
14        (22) Immoral conduct in the commission of any act, such
15    as sexual abuse, sexual misconduct, or sexual
16    exploitation, related to the licensee's practice.
17        (23) Maintaining a professional relationship with any
18    person, firm, or corporation when the licensed certified
19    professional midwife knows or should know that a person,
20    firm, or corporation is violating this Act.
21        (24) Failure to provide satisfactory proof of having
22    participated in approved continuing education programs as
23    determined by the Board and approved by the Secretary.
24    Exceptions for extreme hardships are to be defined by the
25    Department.
26    (b) The Department may refuse to issue or may suspend the



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1license of any person who fails to:
2        (i) file a tax return or to pay the tax, penalty, or
3    interest shown in a filed return; or
4        (ii) pay any final assessment of the tax, penalty, or
5    interest, as required by any tax Act administered by the
6    Illinois Department of Revenue, until the time that the
7    requirements of that tax Act are satisfied.
8    (c) The determination by a circuit court that a licensee is
9subject to involuntary admission or judicial admission as
10provided in the Mental Health and Developmental Disabilities
11Code operates as an automatic suspension. The suspension shall
12end only upon a finding by a court that the patient is no
13longer subject to involuntary admission or judicial admission,
14the issuance of an order so finding and discharging the
15patient, and the recommendation of the Board to the Secretary
16that the licensee be allowed to resume their practice.
17    (d) In enforcing this Section, the Department, upon a
18showing of a possible violation, may compel any person licensed
19to practice under this Act or who has applied for licensure or
20certification pursuant to this Act to submit to a mental or
21physical examination, or both, as required by and at the
22expense of the Department. The examining physicians shall be
23those specifically designated by the Department. The
24Department may order an examining physician to present
25testimony concerning the mental or physical examination of the
26licensee or applicant. No information shall be excluded by



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1reason of any common law or statutory privilege relating to
2communications between the licensee or applicant and the
3examining physician. The person to be examined may have, at his
4or her own expense, another physician of his or her choice
5present during all aspects of the examination. Failure of any
6person to submit to a mental or physical examination when
7directed shall be grounds for suspension of a license until the
8person submits to the examination if the Department finds,
9after notice and hearing, that the refusal to submit to the
10examination was without reasonable cause. If the Department
11finds an individual unable to practice because of the reasons
12set forth in this subsection (d), the Department may require
13that individual to submit to care, counseling, or treatment by
14physicians approved or designated by the Department, as a
15condition, term, or restriction for continued, reinstated, or
16renewed licensure to practice or, in lieu of care, counseling,
17or treatment, the Department may file a complaint to
18immediately suspend, revoke, or otherwise discipline the
19license of the individual. Any person whose license was
20granted, reinstated, renewed, disciplined, or supervised
21subject to such terms, conditions, or restrictions and who
22fails to comply with such terms, conditions, or restrictions
23shall be referred to the Secretary for a determination as to
24whether or not the person shall have his or her license
25suspended immediately, pending a hearing by the Department. If
26the Secretary immediately suspends a person's license under



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1this Section, a hearing on that person's license must be
2convened by the Department within 15 days after the suspension
3and completed without appreciable delay. The Department may
4review the person's record of treatment and counseling
5regarding the impairment to the extent permitted by applicable
6federal statutes and regulations safeguarding the
7confidentiality of medical records. A person licensed under
8this Act and affected under this subsection (d) shall be
9afforded an opportunity to demonstrate to the Department that
10he or she can resume practice in compliance with acceptable and
11prevailing standards under the provisions of his or her
13    Section 125. Failure to pay restitution. The Department,
14without further process or hearing, shall suspend the license
15or other authorization to practice of any person issued under
16this Act who has been certified by court order as not having
17paid restitution to a person under Section 8A-3.5 of the
18Illinois Public Aid Code, under Section 46-1 of the Criminal
19Code of 1961, or under Sections 17-8.5 or 17-10.5 of the
20Criminal Code of 2012. A person whose license or other
21authorization to practice is suspended under this Section is
22prohibited from practicing until restitution is paid in full.
23    Section 130. Injunction; cease and desist order.
24    (a) If a person violates any provision of this Act, the



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1Secretary may, in the name of the People of the State of
2Illinois, through the Attorney General or the State's Attorney
3of any county in which the action is brought, petition for an
4order enjoining the violation or enforcing compliance with this
5Act. Upon the filing of a verified petition in court, the court
6may issue a temporary restraining order, without notice or
7bond, and may preliminarily and permanently enjoin the
8violation. If it is established that the person has violated or
9is violating the injunction, the court may punish the offender
10for contempt of court. Proceedings under this Section shall be
11in addition to, and not in lieu of, all other remedies and
12penalties provided by this Act.
13    (b) If any person practices as a licensed certified
14professional midwife or holds himself or herself out as a
15licensed certified professional midwife without being licensed
16under the provisions of this Act, then any licensed certified
17professional midwife, any interested party, or any person
18injured thereby may, in addition to the Secretary, petition for
19relief as provided in subsection (a) of this Section.
20    (c) Whenever, in the opinion of the Department, any person
21violates any provision of this Act, the Department may issue a
22rule to show cause why an order to cease and desist should not
23be entered against that person. The rule shall clearly set
24forth the grounds relied upon by the Department and shall
25provide a period of 7 days after the date of the rule to file an
26answer to the satisfaction of the Department. Failure to answer



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1to the satisfaction of the Department shall cause an order to
2cease and desist to be issued immediately.
3    Section 135. Violation; criminal penalty.
4    (a) Whoever knowingly practices or offers to practice
5midwifery in this State without being licensed for that purpose
6or exempt under this Act shall be guilty of a Class A
7misdemeanor; and shall be guilty of a Class 4 felony for a
8second or subsequent violation.
9    (b) Notwithstanding any other provision of this Act, all
10criminal fines, moneys, or other property collected or received
11by the Department under this Section or any other State or
12federal statute, including, but not limited to, property
13forfeited to the Department under Section 505 of the Illinois
14Controlled Substances Act or Section 85 of the Methamphetamine
15Control and Community Protection Act, shall be deposited into
16the Professional Regulation Evidence Fund.
17    Section 140. Investigation; notice; hearing. The
18Department may investigate the actions of any applicant or of
19any person or persons holding or claiming to hold a license
20under this Act. Before refusing to issue or to renew or taking
21any disciplinary action regarding a license, the Department
22shall, at least 30 days prior to the date set for the hearing,
23notify in writing the applicant or licensee of the nature of
24any charges and that a hearing shall be held on a date



SB3851- 32 -LRB101 20758 SPS 70445 b

1designated. The Department shall direct the applicant or
2licensee to file a written answer with the Board under oath
3within 20 days after the service of the notice and inform the
4applicant or licensee that failure to file an answer shall
5result in default being taken against the applicant or licensee
6and that the license may be suspended, revoked, or placed on
7probationary status or that other disciplinary action may be
8taken, including limiting the scope, nature, or extent of
9practice, as the Secretary may deem proper. Written notice may
10be served by personal delivery or certified or registered mail
11to the respondent at the address of his or her last
12notification to the Department. If the person fails to file an
13answer after receiving notice, his or her license may, in the
14discretion of the Department, be suspended, revoked, or placed
15on probationary status, or the Department may take any
16disciplinary action deemed proper, including limiting the
17scope, nature, or extent of the person's practice or the
18imposition of a fine, without a hearing, if the act or acts
19charged constitute sufficient grounds for such action under
20this Act. At the time and place fixed in the notice, the Board
21shall proceed to hear the charges and the parties or their
22counsel shall be accorded ample opportunity to present such
23statements, testimony, evidence, and argument as may be
24pertinent to the charges or to their defense. The Board may
25continue a hearing from time to time.



SB3851- 33 -LRB101 20758 SPS 70445 b

1    Section 145. Formal hearing; preservation of record. The
2Department, at its expense, shall preserve a record of all
3proceedings at the formal hearing of any case. The notice of
4hearing, complaint, and all other documents in the nature of
5pleadings and written motions filed in the proceedings, the
6transcript of testimony, the report of the Board or hearing
7officer, and order of the Department shall be the record of the
8proceeding. The Department shall furnish a transcript of the
9record to any person interested in the hearing upon payment of
10the fee required under Section 2105-115 of the Department of
11Professional Regulation Law.
12    Section 150. Witnesses; production of documents; contempt.
13Any circuit court may upon application of the Department or its
14designee or of the applicant or licensee against whom
15proceedings under Section 95 of this Act are pending, enter an
16order requiring the attendance of witnesses and their testimony
17and the production of documents, papers, files, books, and
18records in connection with any hearing or investigation. The
19court may compel obedience to its order by proceedings for
21    Section 155. Subpoena; oaths. The Department shall have the
22power to subpoena and bring before it any person in this State
23and to take testimony either orally or by deposition or both
24with the same fees and mileage and in the same manner as



SB3851- 34 -LRB101 20758 SPS 70445 b

1prescribed in civil cases in circuit courts of this State. The
2Secretary, the designated hearing officer, and every member of
3the Board has the power to administer oaths to witnesses at any
4hearing that the Department is authorized to conduct and any
5other oaths authorized in any Act administered by the
6Department. Any circuit court may, upon application of the
7Department or its designee or upon application of the person
8against whom proceedings under this Act are pending, enter an
9order requiring the attendance of witnesses and their
10testimony, and the production of documents, papers, files,
11books, and records in connection with any hearing or
12investigation. The court may compel obedience to its order by
13proceedings for contempt.
14    Section 160. Findings of fact, conclusions of law, and
15recommendations. At the conclusion of the hearing, the Board
16shall present to the Secretary a written report of its findings
17of fact, conclusions of law, and recommendations. The report
18shall contain a finding as to whether or not the accused person
19violated this Act or failed to comply with the conditions
20required under this Act. The Board shall specify the nature of
21the violation or failure to comply and shall make its
22recommendations to the Secretary. The findings of fact,
23conclusions of law, and recommendations of the Board shall be
24the basis for the Department's order. If the Secretary
25disagrees in any regard with the report of the Board, the



SB3851- 35 -LRB101 20758 SPS 70445 b

1Secretary may issue an order in contravention of the report.
2The finding is not admissible in evidence against the person in
3a criminal prosecution brought for the violation of this Act,
4but the hearing and findings are not a bar to a criminal
5prosecution brought for the violation of this Act.
6    Section 165. Hearing officer. The Secretary may appoint any
7attorney duly licensed to practice law in the State of Illinois
8to serve as the hearing officer in any action for departmental
9refusal to issue, renew, or license an applicant or for
10disciplinary action against a licensee. The hearing officer
11shall have full authority to conduct the hearing. The hearing
12officer shall report his or her findings of fact, conclusions
13of law, and recommendations to the Board and the Secretary. The
14Board shall have 60 calendar days after receipt of the report
15to review the report of the hearing officer and present its
16findings of fact, conclusions of law, and recommendations to
17the Secretary. If the Board fails to present its report within
18the 60-day period, the Secretary may issue an order based on
19the report of the hearing officer. If the Secretary disagrees
20with the recommendation of the Board or the hearing officer,
21the Secretary may issue an order in contravention of that
23    Section 170. Service of report; motion for rehearing. In
24any case involving the discipline of a license, a copy of the



SB3851- 36 -LRB101 20758 SPS 70445 b

1Board's report shall be served upon the respondent by the
2Department, either personally or as provided in this Act for
3the service of the notice of hearing. Within 20 days after the
4service, the respondent may present to the Department a motion
5in writing for a rehearing that shall specify the particular
6grounds for rehearing. If no motion for rehearing is filed,
7then upon the expiration of the time specified for filing a
8motion, or if a motion for rehearing is denied, then upon the
9denial, the Secretary may enter an order in accordance with
10this Act. If the respondent orders from the reporting service
11and pays for a transcript of the record within the time for
12filing a motion for rehearing, the 20-day period within which
13the motion may be filed shall commence upon the delivery of the
14transcript to the respondent.
15    Section 175. Rehearing. Whenever the Secretary is
16satisfied that substantial justice has not been done in the
17revocation, suspension, or refusal to issue or renew a license,
18the Secretary may order a rehearing by the same or another
19hearing officer or by the Board.
20    Section 180. Prima facie proof. An order or a certified
21copy thereof, over the seal of the Department and purporting to
22be signed by the Secretary, shall be prima facie proof of the
24        (1) that the signature is the genuine signature of the



SB3851- 37 -LRB101 20758 SPS 70445 b

1    Secretary;
2        (2) that such Secretary is duly appointed and
3    qualified;
4        (3) that the Board and its members are qualified to
5    act; and
6        (4) that the findings and conclusions set forth therein
7    are prima facie true and correct.
8    Section 185. Restoration of license. At any time after the
9suspension or revocation of any license, the Department may
10restore the license to the accused person, unless after an
11investigation and a hearing the Department determines that
12restoration is not in the public interest.
13    Section 190. Surrender of license. Upon the revocation or
14suspension of any license, the licensee shall immediately
15surrender the license to the Department. If the licensee fails
16to do so, the Department shall have the right to seize the
18    Section 195. Summary suspension. The Secretary may
19summarily suspend the license of a licensee under this Act
20without a hearing, simultaneously with the institution of
21proceedings for a hearing provided for in this Act if the
22Secretary finds that evidence in his or her possession
23indicates that continuation in practice would constitute an



SB3851- 38 -LRB101 20758 SPS 70445 b

1imminent danger to the public. If the Secretary summarily
2suspends a license without a hearing, a hearing by the
3Department must be held within 30 days after the suspension has
5    Section 200. Certificate of record. The Department shall
6not be required to certify any record to the court or file any
7answer in court or otherwise appear in any court in a judicial
8review proceeding, unless there is filed in the court, with the
9complaint, a receipt from the Department acknowledging payment
10of the costs of furnishing and certifying the record. Failure
11on the part of the plaintiff to file a receipt in court shall
12be grounds for dismissal of the action.
13    Section 205. Administrative Review Law. All final
14administrative decisions of the Department are subject to
15judicial review under the Administrative Review Law and its
16rules. The term "administrative decision" is defined as in
17Section 3-101 of the Code of Civil Procedure.
18    Section 210. Illinois Administrative Procedure Act. The
19Illinois Administrative Procedure Act is hereby expressly
20adopted and incorporated in this Act as if all of the
21provisions of such Act were included in this Act, except that
22the provision of subsection (d) of Section 10-65 of the
23Illinois Administrative Procedure Act that provides that at



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1hearings the licensee has the right to show compliance with all
2lawful requirements for retention, continuation, or renewal of
3the license is specifically excluded. For purposes of this Act,
4the notice required under Section 10-25 of the Illinois
5Administrative Procedure Act is deemed sufficient when mailed
6to the last known address of a party.
7    Section 215. Home rule. The regulation and licensing of
8midwives are exclusive powers and functions of the State. A
9home rule unit may not regulate or license midwives. This
10Section is a denial and limitation of home rule powers and
11functions under subsection (h) of Section 6 of Article VII of
12the Illinois Constitution.
13    Section 220. Severability. The provisions of this Act are
14severable under Section 1.31 of the Statute on Statutes.
15    Section 225. The Regulatory Sunset Act is amended by adding
16Section 4.41 as follows:
17    (5 ILCS 80/4.41 new)
18    Sec. 4.41. Act repealed on January 1, 2031. The following
19Act is repealed on January 1, 2031:
20    The Certified Professional Midwives Practice Act.
21    Section 230. The Illinois Insurance Code is amended by



SB3851- 40 -LRB101 20758 SPS 70445 b

1adding Section 356z.43 as follows:
2    (215 ILCS 5/356z.43 new)
3    Sec. 356z.43. Licensed certified professional midwife
4care. Notwithstanding anything in this Section, An individual
5or group policy of accident and health insurance that provides
6maternity coverage and is amended, delivered, issued, or
7renewed after the effective date of this amendatory Act of the
8101st General Assembly, and which provides maternity benefits,
9which are not limited to complications of pregnancy, or newborn
10care benefits, shall provide coverage for maternity services
11rendered by a licensed certified professional midwife licensed
12pursuant to this Amendatory Act of the 101st General Assembly,
13regardless of the site of services, in accordance with
14guidelines adopted by rule by the commissioner.
15    Section 235. The Medical Practice Act of 1987 is amended by
16changing Section 4 as follows:
17    (225 ILCS 60/4)  (from Ch. 111, par. 4400-4)
18    (Section scheduled to be repealed on January 1, 2022)
19    Sec. 4. Exemptions. This Act does not apply to the
21        (1) persons lawfully carrying on their particular
22    profession or business under any valid existing regulatory
23    Act of this State, including, without limitation, persons



SB3851- 41 -LRB101 20758 SPS 70445 b

1    engaged in the practice of midwifery who are licensed under
2    the Certified Professional Midwives Practice Act;
3        (2) persons rendering gratuitous services in cases of
4    emergency; or
5        (3) persons treating human ailments by prayer or
6    spiritual means as an exercise or enjoyment of religious
7    freedom.
8(Source: P.A. 96-7, eff. 4-3-09; 97-622, eff. 11-23-11.)
9    Section 240. The Nurse Practice Act is amended by changing
10Section 50-15 as follows:
11    (225 ILCS 65/50-15)   (was 225 ILCS 65/5-15)
12    (Section scheduled to be repealed on January 1, 2028)
13    Sec. 50-15. Policy; application of Act.
14    (a) For the protection of life and the promotion of health,
15and the prevention of illness and communicable diseases, any
16person practicing or offering to practice advanced,
17professional, or practical nursing in Illinois shall submit
18evidence that he or she is qualified to practice, and shall be
19licensed as provided under this Act. No person shall practice
20or offer to practice advanced, professional, or practical
21nursing in Illinois or use any title, sign, card or device to
22indicate that such a person is practicing professional or
23practical nursing unless such person has been licensed under
24the provisions of this Act.



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1    (b) This Act does not prohibit the following:
2        (1) The practice of nursing in Federal employment in
3    the discharge of the employee's duties by a person who is
4    employed by the United States government or any bureau,
5    division or agency thereof and is a legally qualified and
6    licensed nurse of another state or territory and not in
7    conflict with Sections 50-50, 55-10, 60-10, and 70-5 of
8    this Act.
9        (2) Nursing that is included in the program of study by
10    students enrolled in programs of nursing or in current
11    nurse practice update courses approved by the Department.
12        (3) The furnishing of nursing assistance in an
13    emergency.
14        (4) The practice of nursing by a nurse who holds an
15    active license in another state when providing services to
16    patients in Illinois during a bonafide emergency or in
17    immediate preparation for or during interstate transit.
18        (5) The incidental care of the sick by members of the
19    family, domestic servants or housekeepers, or care of the
20    sick where treatment is by prayer or spiritual means.
21        (6) Persons from being employed as unlicensed
22    assistive personnel in private homes, long term care
23    facilities, nurseries, hospitals or other institutions.
24        (7) The practice of practical nursing by one who is a
25    licensed practical nurse under the laws of another U.S.
26    jurisdiction and has applied in writing to the Department,



SB3851- 43 -LRB101 20758 SPS 70445 b

1    in form and substance satisfactory to the Department, for a
2    license as a licensed practical nurse and who is qualified
3    to receive such license under this Act, until (i) the
4    expiration of 6 months after the filing of such written
5    application, (ii) the withdrawal of such application, or
6    (iii) the denial of such application by the Department.
7        (8) The practice of advanced practice registered
8    nursing by one who is an advanced practice registered nurse
9    under the laws of another United States jurisdiction or a
10    foreign jurisdiction and has applied in writing to the
11    Department, in form and substance satisfactory to the
12    Department, for a license as an advanced practice
13    registered nurse and who is qualified to receive such
14    license under this Act, until (i) the expiration of 6
15    months after the filing of such written application, (ii)
16    the withdrawal of such application, or (iii) the denial of
17    such application by the Department.
18        (9) The practice of professional nursing by one who is
19    a registered professional nurse under the laws of another
20    United States jurisdiction or a foreign jurisdiction and
21    has applied in writing to the Department, in form and
22    substance satisfactory to the Department, for a license as
23    a registered professional nurse and who is qualified to
24    receive such license under Section 55-10, until (1) the
25    expiration of 6 months after the filing of such written
26    application, (2) the withdrawal of such application, or (3)



SB3851- 44 -LRB101 20758 SPS 70445 b

1    the denial of such application by the Department.
2        (10) The practice of professional nursing that is
3    included in a program of study by one who is a registered
4    professional nurse under the laws of another United States
5    jurisdiction or a foreign jurisdiction and who is enrolled
6    in a graduate nursing education program or a program for
7    the completion of a baccalaureate nursing degree in this
8    State, which includes clinical supervision by faculty as
9    determined by the educational institution offering the
10    program and the health care organization where the practice
11    of nursing occurs.
12        (11) Any person licensed in this State under any other
13    Act from engaging in the practice for which she or he is
14    licensed, including, without limitation, any person
15    engaged in the practice of midwifery who is licensed under
16    the Certified Professional Midwives Practice Act.
17        (12) Delegation to authorized direct care staff
18    trained under Section 15.4 of the Mental Health and
19    Developmental Disabilities Administrative Act consistent
20    with the policies of the Department.
21        (13) (Blank).
22        (14) County correctional personnel from delivering
23    prepackaged medication for self-administration to an
24    individual detainee in a correctional facility.
25    Nothing in this Act shall be construed to limit the
26delegation of tasks or duties by a physician, dentist, or



SB3851- 45 -LRB101 20758 SPS 70445 b

1podiatric physician to a licensed practical nurse, a registered
2professional nurse, or other persons.
3(Source: P.A. 100-513, eff. 1-1-18.)
4    Section 245. The Illinois Public Aid Code is amended by
5changing Section 5-5 as follows:
6    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
7    Sec. 5-5. Medical services. The Illinois Department, by
8rule, shall determine the quantity and quality of and the rate
9of reimbursement for the medical assistance for which payment
10will be authorized, and the medical services to be provided,
11which may include all or part of the following: (1) inpatient
12hospital services; (2) outpatient hospital services; (3) other
13laboratory and X-ray services; (4) skilled nursing home
14services; (5) physicians' services whether furnished in the
15office, the patient's home, a hospital, a skilled nursing home,
16or elsewhere; (6) medical care, or any other type of remedial
17care furnished by licensed practitioners, including the
18services of licensed certified professional midwives pursuant
19to the Certified Professional Midwives Practice Act; (7) home
20health care services; (8) private duty nursing service; (9)
21clinic services; (10) dental services, including prevention
22and treatment of periodontal disease and dental caries disease
23for pregnant women, provided by an individual licensed to
24practice dentistry or dental surgery; for purposes of this item



SB3851- 46 -LRB101 20758 SPS 70445 b

1(10), "dental services" means diagnostic, preventive, or
2corrective procedures provided by or under the supervision of a
3dentist in the practice of his or her profession; (11) physical
4therapy and related services; (12) prescribed drugs, dentures,
5and prosthetic devices; and eyeglasses prescribed by a
6physician skilled in the diseases of the eye, or by an
7optometrist, whichever the person may select; (13) other
8diagnostic, screening, preventive, and rehabilitative
9services, including to ensure that the individual's need for
10intervention or treatment of mental disorders or substance use
11disorders or co-occurring mental health and substance use
12disorders is determined using a uniform screening, assessment,
13and evaluation process inclusive of criteria, for children and
14adults; for purposes of this item (13), a uniform screening,
15assessment, and evaluation process refers to a process that
16includes an appropriate evaluation and, as warranted, a
17referral; "uniform" does not mean the use of a singular
18instrument, tool, or process that all must utilize; (14)
19transportation and such other expenses as may be necessary;
20(15) medical treatment of sexual assault survivors, as defined
21in Section 1a of the Sexual Assault Survivors Emergency
22Treatment Act, for injuries sustained as a result of the sexual
23assault, including examinations and laboratory tests to
24discover evidence which may be used in criminal proceedings
25arising from the sexual assault; (16) the diagnosis and
26treatment of sickle cell anemia; and (17) any other medical



SB3851- 47 -LRB101 20758 SPS 70445 b

1care, and any other type of remedial care recognized under the
2laws of this State. The term "any other type of remedial care"
3shall include nursing care and nursing home service for persons
4who rely on treatment by spiritual means alone through prayer
5for healing.
6    Notwithstanding any other provision of this Section, a
7comprehensive tobacco use cessation program that includes
8purchasing prescription drugs or prescription medical devices
9approved by the Food and Drug Administration shall be covered
10under the medical assistance program under this Article for
11persons who are otherwise eligible for assistance under this
13    Notwithstanding any other provision of this Code,
14reproductive health care that is otherwise legal in Illinois
15shall be covered under the medical assistance program for
16persons who are otherwise eligible for medical assistance under
17this Article.
18    Notwithstanding any other provision of this Code, the
19Illinois Department may not require, as a condition of payment
20for any laboratory test authorized under this Article, that a
21physician's handwritten signature appear on the laboratory
22test order form. The Illinois Department may, however, impose
23other appropriate requirements regarding laboratory test order
25    Upon receipt of federal approval of an amendment to the
26Illinois Title XIX State Plan for this purpose, the Department



SB3851- 48 -LRB101 20758 SPS 70445 b

1shall authorize the Chicago Public Schools (CPS) to procure a
2vendor or vendors to manufacture eyeglasses for individuals
3enrolled in a school within the CPS system. CPS shall ensure
4that its vendor or vendors are enrolled as providers in the
5medical assistance program and in any capitated Medicaid
6managed care entity (MCE) serving individuals enrolled in a
7school within the CPS system. Under any contract procured under
8this provision, the vendor or vendors must serve only
9individuals enrolled in a school within the CPS system. Claims
10for services provided by CPS's vendor or vendors to recipients
11of benefits in the medical assistance program under this Code,
12the Children's Health Insurance Program, or the Covering ALL
13KIDS Health Insurance Program shall be submitted to the
14Department or the MCE in which the individual is enrolled for
15payment and shall be reimbursed at the Department's or the
16MCE's established rates or rate methodologies for eyeglasses.
17    On and after July 1, 2012, the Department of Healthcare and
18Family Services may provide the following services to persons
19eligible for assistance under this Article who are
20participating in education, training or employment programs
21operated by the Department of Human Services as successor to
22the Department of Public Aid:
23        (1) dental services provided by or under the
24    supervision of a dentist; and
25        (2) eyeglasses prescribed by a physician skilled in the
26    diseases of the eye, or by an optometrist, whichever the



SB3851- 49 -LRB101 20758 SPS 70445 b

1    person may select.
2    On and after July 1, 2018, the Department of Healthcare and
3Family Services shall provide dental services to any adult who
4is otherwise eligible for assistance under the medical
5assistance program. As used in this paragraph, "dental
6services" means diagnostic, preventative, restorative, or
7corrective procedures, including procedures and services for
8the prevention and treatment of periodontal disease and dental
9caries disease, provided by an individual who is licensed to
10practice dentistry or dental surgery or who is under the
11supervision of a dentist in the practice of his or her
13    On and after July 1, 2018, targeted dental services, as set
14forth in Exhibit D of the Consent Decree entered by the United
15States District Court for the Northern District of Illinois,
16Eastern Division, in the matter of Memisovski v. Maram, Case
17No. 92 C 1982, that are provided to adults under the medical
18assistance program shall be established at no less than the
19rates set forth in the "New Rate" column in Exhibit D of the
20Consent Decree for targeted dental services that are provided
21to persons under the age of 18 under the medical assistance
23    Notwithstanding any other provision of this Code and
24subject to federal approval, the Department may adopt rules to
25allow a dentist who is volunteering his or her service at no
26cost to render dental services through an enrolled



SB3851- 50 -LRB101 20758 SPS 70445 b

1not-for-profit health clinic without the dentist personally
2enrolling as a participating provider in the medical assistance
3program. A not-for-profit health clinic shall include a public
4health clinic or Federally Qualified Health Center or other
5enrolled provider, as determined by the Department, through
6which dental services covered under this Section are performed.
7The Department shall establish a process for payment of claims
8for reimbursement for covered dental services rendered under
9this provision.
10    The Illinois Department, by rule, may distinguish and
11classify the medical services to be provided only in accordance
12with the classes of persons designated in Section 5-2.
13    The Department of Healthcare and Family Services must
14provide coverage and reimbursement for amino acid-based
15elemental formulas, regardless of delivery method, for the
16diagnosis and treatment of (i) eosinophilic disorders and (ii)
17short bowel syndrome when the prescribing physician has issued
18a written order stating that the amino acid-based elemental
19formula is medically necessary.
20    The Illinois Department shall authorize the provision of,
21and shall authorize payment for, screening by low-dose
22mammography for the presence of occult breast cancer for women
2335 years of age or older who are eligible for medical
24assistance under this Article, as follows:
25        (A) A baseline mammogram for women 35 to 39 years of
26    age.



SB3851- 51 -LRB101 20758 SPS 70445 b

1        (B) An annual mammogram for women 40 years of age or
2    older.
3        (C) A mammogram at the age and intervals considered
4    medically necessary by the woman's health care provider for
5    women under 40 years of age and having a family history of
6    breast cancer, prior personal history of breast cancer,
7    positive genetic testing, or other risk factors.
8        (D) A comprehensive ultrasound screening and MRI of an
9    entire breast or breasts if a mammogram demonstrates
10    heterogeneous or dense breast tissue or when medically
11    necessary as determined by a physician licensed to practice
12    medicine in all of its branches.
13        (E) A screening MRI when medically necessary, as
14    determined by a physician licensed to practice medicine in
15    all of its branches.
16        (F) A diagnostic mammogram when medically necessary,
17    as determined by a physician licensed to practice medicine
18    in all its branches, advanced practice registered nurse, or
19    physician assistant.
20    The Department shall not impose a deductible, coinsurance,
21copayment, or any other cost-sharing requirement on the
22coverage provided under this paragraph; except that this
23sentence does not apply to coverage of diagnostic mammograms to
24the extent such coverage would disqualify a high-deductible
25health plan from eligibility for a health savings account
26pursuant to Section 223 of the Internal Revenue Code (26 U.S.C.



SB3851- 52 -LRB101 20758 SPS 70445 b

2    All screenings shall include a physical breast exam,
3instruction on self-examination and information regarding the
4frequency of self-examination and its value as a preventative
6     For purposes of this Section:
7    "Diagnostic mammogram" means a mammogram obtained using
8diagnostic mammography.
9    "Diagnostic mammography" means a method of screening that
10is designed to evaluate an abnormality in a breast, including
11an abnormality seen or suspected on a screening mammogram or a
12subjective or objective abnormality otherwise detected in the
14    "Low-dose mammography" means the x-ray examination of the
15breast using equipment dedicated specifically for mammography,
16including the x-ray tube, filter, compression device, and image
17receptor, with an average radiation exposure delivery of less
18than one rad per breast for 2 views of an average size breast.
19The term also includes digital mammography and includes breast
21    "Breast tomosynthesis" means a radiologic procedure that
22involves the acquisition of projection images over the
23stationary breast to produce cross-sectional digital
24three-dimensional images of the breast.
25    If, at any time, the Secretary of the United States
26Department of Health and Human Services, or its successor



SB3851- 53 -LRB101 20758 SPS 70445 b

1agency, promulgates rules or regulations to be published in the
2Federal Register or publishes a comment in the Federal Register
3or issues an opinion, guidance, or other action that would
4require the State, pursuant to any provision of the Patient
5Protection and Affordable Care Act (Public Law 111-148),
6including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
7successor provision, to defray the cost of any coverage for
8breast tomosynthesis outlined in this paragraph, then the
9requirement that an insurer cover breast tomosynthesis is
10inoperative other than any such coverage authorized under
11Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
12the State shall not assume any obligation for the cost of
13coverage for breast tomosynthesis set forth in this paragraph.
14    On and after January 1, 2016, the Department shall ensure
15that all networks of care for adult clients of the Department
16include access to at least one breast imaging Center of Imaging
17Excellence as certified by the American College of Radiology.
18    On and after January 1, 2012, providers participating in a
19quality improvement program approved by the Department shall be
20reimbursed for screening and diagnostic mammography at the same
21rate as the Medicare program's rates, including the increased
22reimbursement for digital mammography.
23    The Department shall convene an expert panel including
24representatives of hospitals, free-standing mammography
25facilities, and doctors, including radiologists, to establish
26quality standards for mammography.



SB3851- 54 -LRB101 20758 SPS 70445 b

1    On and after January 1, 2017, providers participating in a
2breast cancer treatment quality improvement program approved
3by the Department shall be reimbursed for breast cancer
4treatment at a rate that is no lower than 95% of the Medicare
5program's rates for the data elements included in the breast
6cancer treatment quality program.
7    The Department shall convene an expert panel, including
8representatives of hospitals, free-standing breast cancer
9treatment centers, breast cancer quality organizations, and
10doctors, including breast surgeons, reconstructive breast
11surgeons, oncologists, and primary care providers to establish
12quality standards for breast cancer treatment.
13    Subject to federal approval, the Department shall
14establish a rate methodology for mammography at federally
15qualified health centers and other encounter-rate clinics.
16These clinics or centers may also collaborate with other
17hospital-based mammography facilities. By January 1, 2016, the
18Department shall report to the General Assembly on the status
19of the provision set forth in this paragraph.
20    The Department shall establish a methodology to remind
21women who are age-appropriate for screening mammography, but
22who have not received a mammogram within the previous 18
23months, of the importance and benefit of screening mammography.
24The Department shall work with experts in breast cancer
25outreach and patient navigation to optimize these reminders and
26shall establish a methodology for evaluating their



SB3851- 55 -LRB101 20758 SPS 70445 b

1effectiveness and modifying the methodology based on the
3    The Department shall establish a performance goal for
4primary care providers with respect to their female patients
5over age 40 receiving an annual mammogram. This performance
6goal shall be used to provide additional reimbursement in the
7form of a quality performance bonus to primary care providers
8who meet that goal.
9    The Department shall devise a means of case-managing or
10patient navigation for beneficiaries diagnosed with breast
11cancer. This program shall initially operate as a pilot program
12in areas of the State with the highest incidence of mortality
13related to breast cancer. At least one pilot program site shall
14be in the metropolitan Chicago area and at least one site shall
15be outside the metropolitan Chicago area. On or after July 1,
162016, the pilot program shall be expanded to include one site
17in western Illinois, one site in southern Illinois, one site in
18central Illinois, and 4 sites within metropolitan Chicago. An
19evaluation of the pilot program shall be carried out measuring
20health outcomes and cost of care for those served by the pilot
21program compared to similarly situated patients who are not
22served by the pilot program.
23    The Department shall require all networks of care to
24develop a means either internally or by contract with experts
25in navigation and community outreach to navigate cancer
26patients to comprehensive care in a timely fashion. The



SB3851- 56 -LRB101 20758 SPS 70445 b

1Department shall require all networks of care to include access
2for patients diagnosed with cancer to at least one academic
3commission on cancer-accredited cancer program as an
4in-network covered benefit.
5    Any medical or health care provider shall immediately
6recommend, to any pregnant woman who is being provided prenatal
7services and is suspected of having a substance use disorder as
8defined in the Substance Use Disorder Act, referral to a local
9substance use disorder treatment program licensed by the
10Department of Human Services or to a licensed hospital which
11provides substance abuse treatment services. The Department of
12Healthcare and Family Services shall assure coverage for the
13cost of treatment of the drug abuse or addiction for pregnant
14recipients in accordance with the Illinois Medicaid Program in
15conjunction with the Department of Human Services.
16    All medical providers providing medical assistance to
17pregnant women under this Code shall receive information from
18the Department on the availability of services under any
19program providing case management services for addicted women,
20including information on appropriate referrals for other
21social services that may be needed by addicted women in
22addition to treatment for addiction.
23    The Illinois Department, in cooperation with the
24Departments of Human Services (as successor to the Department
25of Alcoholism and Substance Abuse) and Public Health, through a
26public awareness campaign, may provide information concerning



SB3851- 57 -LRB101 20758 SPS 70445 b

1treatment for alcoholism and drug abuse and addiction, prenatal
2health care, and other pertinent programs directed at reducing
3the number of drug-affected infants born to recipients of
4medical assistance.
5    Neither the Department of Healthcare and Family Services
6nor the Department of Human Services shall sanction the
7recipient solely on the basis of her substance abuse.
8    The Illinois Department shall establish such regulations
9governing the dispensing of health services under this Article
10as it shall deem appropriate. The Department should seek the
11advice of formal professional advisory committees appointed by
12the Director of the Illinois Department for the purpose of
13providing regular advice on policy and administrative matters,
14information dissemination and educational activities for
15medical and health care providers, and consistency in
16procedures to the Illinois Department.
17    The Illinois Department may develop and contract with
18Partnerships of medical providers to arrange medical services
19for persons eligible under Section 5-2 of this Code.
20Implementation of this Section may be by demonstration projects
21in certain geographic areas. The Partnership shall be
22represented by a sponsor organization. The Department, by rule,
23shall develop qualifications for sponsors of Partnerships.
24Nothing in this Section shall be construed to require that the
25sponsor organization be a medical organization.
26    The sponsor must negotiate formal written contracts with



SB3851- 58 -LRB101 20758 SPS 70445 b

1medical providers for physician services, inpatient and
2outpatient hospital care, home health services, treatment for
3alcoholism and substance abuse, and other services determined
4necessary by the Illinois Department by rule for delivery by
5Partnerships. Physician services must include prenatal and
6obstetrical care. The Illinois Department shall reimburse
7medical services delivered by Partnership providers to clients
8in target areas according to provisions of this Article and the
9Illinois Health Finance Reform Act, except that:
10        (1) Physicians participating in a Partnership and
11    providing certain services, which shall be determined by
12    the Illinois Department, to persons in areas covered by the
13    Partnership may receive an additional surcharge for such
14    services.
15        (2) The Department may elect to consider and negotiate
16    financial incentives to encourage the development of
17    Partnerships and the efficient delivery of medical care.
18        (3) Persons receiving medical services through
19    Partnerships may receive medical and case management
20    services above the level usually offered through the
21    medical assistance program.
22    Medical providers shall be required to meet certain
23qualifications to participate in Partnerships to ensure the
24delivery of high quality medical services. These
25qualifications shall be determined by rule of the Illinois
26Department and may be higher than qualifications for



SB3851- 59 -LRB101 20758 SPS 70445 b

1participation in the medical assistance program. Partnership
2sponsors may prescribe reasonable additional qualifications
3for participation by medical providers, only with the prior
4written approval of the Illinois Department.
5    Nothing in this Section shall limit the free choice of
6practitioners, hospitals, and other providers of medical
7services by clients. In order to ensure patient freedom of
8choice, the Illinois Department shall immediately promulgate
9all rules and take all other necessary actions so that provided
10services may be accessed from therapeutically certified
11optometrists to the full extent of the Illinois Optometric
12Practice Act of 1987 without discriminating between service
14    The Department shall apply for a waiver from the United
15States Health Care Financing Administration to allow for the
16implementation of Partnerships under this Section.
17    The Illinois Department shall require health care
18providers to maintain records that document the medical care
19and services provided to recipients of Medical Assistance under
20this Article. Such records must be retained for a period of not
21less than 6 years from the date of service or as provided by
22applicable State law, whichever period is longer, except that
23if an audit is initiated within the required retention period
24then the records must be retained until the audit is completed
25and every exception is resolved. The Illinois Department shall
26require health care providers to make available, when



SB3851- 60 -LRB101 20758 SPS 70445 b

1authorized by the patient, in writing, the medical records in a
2timely fashion to other health care providers who are treating
3or serving persons eligible for Medical Assistance under this
4Article. All dispensers of medical services shall be required
5to maintain and retain business and professional records
6sufficient to fully and accurately document the nature, scope,
7details and receipt of the health care provided to persons
8eligible for medical assistance under this Code, in accordance
9with regulations promulgated by the Illinois Department. The
10rules and regulations shall require that proof of the receipt
11of prescription drugs, dentures, prosthetic devices and
12eyeglasses by eligible persons under this Section accompany
13each claim for reimbursement submitted by the dispenser of such
14medical services. No such claims for reimbursement shall be
15approved for payment by the Illinois Department without such
16proof of receipt, unless the Illinois Department shall have put
17into effect and shall be operating a system of post-payment
18audit and review which shall, on a sampling basis, be deemed
19adequate by the Illinois Department to assure that such drugs,
20dentures, prosthetic devices and eyeglasses for which payment
21is being made are actually being received by eligible
22recipients. Within 90 days after September 16, 1984 (the
23effective date of Public Act 83-1439), the Illinois Department
24shall establish a current list of acquisition costs for all
25prosthetic devices and any other items recognized as medical
26equipment and supplies reimbursable under this Article and



SB3851- 61 -LRB101 20758 SPS 70445 b

1shall update such list on a quarterly basis, except that the
2acquisition costs of all prescription drugs shall be updated no
3less frequently than every 30 days as required by Section
5    Notwithstanding any other law to the contrary, the Illinois
6Department shall, within 365 days after July 22, 2013 (the
7effective date of Public Act 98-104), establish procedures to
8permit skilled care facilities licensed under the Nursing Home
9Care Act to submit monthly billing claims for reimbursement
10purposes. Following development of these procedures, the
11Department shall, by July 1, 2016, test the viability of the
12new system and implement any necessary operational or
13structural changes to its information technology platforms in
14order to allow for the direct acceptance and payment of nursing
15home claims.
16    Notwithstanding any other law to the contrary, the Illinois
17Department shall, within 365 days after August 15, 2014 (the
18effective date of Public Act 98-963), establish procedures to
19permit ID/DD facilities licensed under the ID/DD Community Care
20Act and MC/DD facilities licensed under the MC/DD Act to submit
21monthly billing claims for reimbursement purposes. Following
22development of these procedures, the Department shall have an
23additional 365 days to test the viability of the new system and
24to ensure that any necessary operational or structural changes
25to its information technology platforms are implemented.
26    The Illinois Department shall require all dispensers of



SB3851- 62 -LRB101 20758 SPS 70445 b

1medical services, other than an individual practitioner or
2group of practitioners, desiring to participate in the Medical
3Assistance program established under this Article to disclose
4all financial, beneficial, ownership, equity, surety or other
5interests in any and all firms, corporations, partnerships,
6associations, business enterprises, joint ventures, agencies,
7institutions or other legal entities providing any form of
8health care services in this State under this Article.
9    The Illinois Department may require that all dispensers of
10medical services desiring to participate in the medical
11assistance program established under this Article disclose,
12under such terms and conditions as the Illinois Department may
13by rule establish, all inquiries from clients and attorneys
14regarding medical bills paid by the Illinois Department, which
15inquiries could indicate potential existence of claims or liens
16for the Illinois Department.
17    Enrollment of a vendor shall be subject to a provisional
18period and shall be conditional for one year. During the period
19of conditional enrollment, the Department may terminate the
20vendor's eligibility to participate in, or may disenroll the
21vendor from, the medical assistance program without cause.
22Unless otherwise specified, such termination of eligibility or
23disenrollment is not subject to the Department's hearing
24process. However, a disenrolled vendor may reapply without
26    The Department has the discretion to limit the conditional



SB3851- 63 -LRB101 20758 SPS 70445 b

1enrollment period for vendors based upon category of risk of
2the vendor.
3    Prior to enrollment and during the conditional enrollment
4period in the medical assistance program, all vendors shall be
5subject to enhanced oversight, screening, and review based on
6the risk of fraud, waste, and abuse that is posed by the
7category of risk of the vendor. The Illinois Department shall
8establish the procedures for oversight, screening, and review,
9which may include, but need not be limited to: criminal and
10financial background checks; fingerprinting; license,
11certification, and authorization verifications; unscheduled or
12unannounced site visits; database checks; prepayment audit
13reviews; audits; payment caps; payment suspensions; and other
14screening as required by federal or State law.
15    The Department shall define or specify the following: (i)
16by provider notice, the "category of risk of the vendor" for
17each type of vendor, which shall take into account the level of
18screening applicable to a particular category of vendor under
19federal law and regulations; (ii) by rule or provider notice,
20the maximum length of the conditional enrollment period for
21each category of risk of the vendor; and (iii) by rule, the
22hearing rights, if any, afforded to a vendor in each category
23of risk of the vendor that is terminated or disenrolled during
24the conditional enrollment period.
25    To be eligible for payment consideration, a vendor's
26payment claim or bill, either as an initial claim or as a



SB3851- 64 -LRB101 20758 SPS 70445 b

1resubmitted claim following prior rejection, must be received
2by the Illinois Department, or its fiscal intermediary, no
3later than 180 days after the latest date on the claim on which
4medical goods or services were provided, with the following
6        (1) In the case of a provider whose enrollment is in
7    process by the Illinois Department, the 180-day period
8    shall not begin until the date on the written notice from
9    the Illinois Department that the provider enrollment is
10    complete.
11        (2) In the case of errors attributable to the Illinois
12    Department or any of its claims processing intermediaries
13    which result in an inability to receive, process, or
14    adjudicate a claim, the 180-day period shall not begin
15    until the provider has been notified of the error.
16        (3) In the case of a provider for whom the Illinois
17    Department initiates the monthly billing process.
18        (4) In the case of a provider operated by a unit of
19    local government with a population exceeding 3,000,000
20    when local government funds finance federal participation
21    for claims payments.
22    For claims for services rendered during a period for which
23a recipient received retroactive eligibility, claims must be
24filed within 180 days after the Department determines the
25applicant is eligible. For claims for which the Illinois
26Department is not the primary payer, claims must be submitted



SB3851- 65 -LRB101 20758 SPS 70445 b

1to the Illinois Department within 180 days after the final
2adjudication by the primary payer.
3    In the case of long term care facilities, within 45
4calendar days of receipt by the facility of required
5prescreening information, new admissions with associated
6admission documents shall be submitted through the Medical
7Electronic Data Interchange (MEDI) or the Recipient
8Eligibility Verification (REV) System or shall be submitted
9directly to the Department of Human Services using required
10admission forms. Effective September 1, 2014, admission
11documents, including all prescreening information, must be
12submitted through MEDI or REV. Confirmation numbers assigned to
13an accepted transaction shall be retained by a facility to
14verify timely submittal. Once an admission transaction has been
15completed, all resubmitted claims following prior rejection
16are subject to receipt no later than 180 days after the
17admission transaction has been completed.
18    Claims that are not submitted and received in compliance
19with the foregoing requirements shall not be eligible for
20payment under the medical assistance program, and the State
21shall have no liability for payment of those claims.
22    To the extent consistent with applicable information and
23privacy, security, and disclosure laws, State and federal
24agencies and departments shall provide the Illinois Department
25access to confidential and other information and data necessary
26to perform eligibility and payment verifications and other



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1Illinois Department functions. This includes, but is not
2limited to: information pertaining to licensure;
3certification; earnings; immigration status; citizenship; wage
4reporting; unearned and earned income; pension income;
5employment; supplemental security income; social security
6numbers; National Provider Identifier (NPI) numbers; the
7National Practitioner Data Bank (NPDB); program and agency
8exclusions; taxpayer identification numbers; tax delinquency;
9corporate information; and death records.
10    The Illinois Department shall enter into agreements with
11State agencies and departments, and is authorized to enter into
12agreements with federal agencies and departments, under which
13such agencies and departments shall share data necessary for
14medical assistance program integrity functions and oversight.
15The Illinois Department shall develop, in cooperation with
16other State departments and agencies, and in compliance with
17applicable federal laws and regulations, appropriate and
18effective methods to share such data. At a minimum, and to the
19extent necessary to provide data sharing, the Illinois
20Department shall enter into agreements with State agencies and
21departments, and is authorized to enter into agreements with
22federal agencies and departments, including, but not limited
23to: the Secretary of State; the Department of Revenue; the
24Department of Public Health; the Department of Human Services;
25and the Department of Financial and Professional Regulation.
26    Beginning in fiscal year 2013, the Illinois Department



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1shall set forth a request for information to identify the
2benefits of a pre-payment, post-adjudication, and post-edit
3claims system with the goals of streamlining claims processing
4and provider reimbursement, reducing the number of pending or
5rejected claims, and helping to ensure a more transparent
6adjudication process through the utilization of: (i) provider
7data verification and provider screening technology; and (ii)
8clinical code editing; and (iii) pre-pay, pre- or
9post-adjudicated predictive modeling with an integrated case
10management system with link analysis. Such a request for
11information shall not be considered as a request for proposal
12or as an obligation on the part of the Illinois Department to
13take any action or acquire any products or services.
14    The Illinois Department shall establish policies,
15procedures, standards and criteria by rule for the acquisition,
16repair and replacement of orthotic and prosthetic devices and
17durable medical equipment. Such rules shall provide, but not be
18limited to, the following services: (1) immediate repair or
19replacement of such devices by recipients; and (2) rental,
20lease, purchase or lease-purchase of durable medical equipment
21in a cost-effective manner, taking into consideration the
22recipient's medical prognosis, the extent of the recipient's
23needs, and the requirements and costs for maintaining such
24equipment. Subject to prior approval, such rules shall enable a
25recipient to temporarily acquire and use alternative or
26substitute devices or equipment pending repairs or



SB3851- 68 -LRB101 20758 SPS 70445 b

1replacements of any device or equipment previously authorized
2for such recipient by the Department. Notwithstanding any
3provision of Section 5-5f to the contrary, the Department may,
4by rule, exempt certain replacement wheelchair parts from prior
5approval and, for wheelchairs, wheelchair parts, wheelchair
6accessories, and related seating and positioning items,
7determine the wholesale price by methods other than actual
8acquisition costs.
9    The Department shall require, by rule, all providers of
10durable medical equipment to be accredited by an accreditation
11organization approved by the federal Centers for Medicare and
12Medicaid Services and recognized by the Department in order to
13bill the Department for providing durable medical equipment to
14recipients. No later than 15 months after the effective date of
15the rule adopted pursuant to this paragraph, all providers must
16meet the accreditation requirement.
17    In order to promote environmental responsibility, meet the
18needs of recipients and enrollees, and achieve significant cost
19savings, the Department, or a managed care organization under
20contract with the Department, may provide recipients or managed
21care enrollees who have a prescription or Certificate of
22Medical Necessity access to refurbished durable medical
23equipment under this Section (excluding prosthetic and
24orthotic devices as defined in the Orthotics, Prosthetics, and
25Pedorthics Practice Act and complex rehabilitation technology
26products and associated services) through the State's



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1assistive technology program's reutilization program, using
2staff with the Assistive Technology Professional (ATP)
3Certification if the refurbished durable medical equipment:
4(i) is available; (ii) is less expensive, including shipping
5costs, than new durable medical equipment of the same type;
6(iii) is able to withstand at least 3 years of use; (iv) is
7cleaned, disinfected, sterilized, and safe in accordance with
8federal Food and Drug Administration regulations and guidance
9governing the reprocessing of medical devices in health care
10settings; and (v) equally meets the needs of the recipient or
11enrollee. The reutilization program shall confirm that the
12recipient or enrollee is not already in receipt of same or
13similar equipment from another service provider, and that the
14refurbished durable medical equipment equally meets the needs
15of the recipient or enrollee. Nothing in this paragraph shall
16be construed to limit recipient or enrollee choice to obtain
17new durable medical equipment or place any additional prior
18authorization conditions on enrollees of managed care
20    The Department shall execute, relative to the nursing home
21prescreening project, written inter-agency agreements with the
22Department of Human Services and the Department on Aging, to
23effect the following: (i) intake procedures and common
24eligibility criteria for those persons who are receiving
25non-institutional services; and (ii) the establishment and
26development of non-institutional services in areas of the State



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1where they are not currently available or are undeveloped; and
2(iii) notwithstanding any other provision of law, subject to
3federal approval, on and after July 1, 2012, an increase in the
4determination of need (DON) scores from 29 to 37 for applicants
5for institutional and home and community-based long term care;
6if and only if federal approval is not granted, the Department
7may, in conjunction with other affected agencies, implement
8utilization controls or changes in benefit packages to
9effectuate a similar savings amount for this population; and
10(iv) no later than July 1, 2013, minimum level of care
11eligibility criteria for institutional and home and
12community-based long term care; and (v) no later than October
131, 2013, establish procedures to permit long term care
14providers access to eligibility scores for individuals with an
15admission date who are seeking or receiving services from the
16long term care provider. In order to select the minimum level
17of care eligibility criteria, the Governor shall establish a
18workgroup that includes affected agency representatives and
19stakeholders representing the institutional and home and
20community-based long term care interests. This Section shall
21not restrict the Department from implementing lower level of
22care eligibility criteria for community-based services in
23circumstances where federal approval has been granted.
24    The Illinois Department shall develop and operate, in
25cooperation with other State Departments and agencies and in
26compliance with applicable federal laws and regulations,



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1appropriate and effective systems of health care evaluation and
2programs for monitoring of utilization of health care services
3and facilities, as it affects persons eligible for medical
4assistance under this Code.
5    The Illinois Department shall report annually to the
6General Assembly, no later than the second Friday in April of
71979 and each year thereafter, in regard to:
8        (a) actual statistics and trends in utilization of
9    medical services by public aid recipients;
10        (b) actual statistics and trends in the provision of
11    the various medical services by medical vendors;
12        (c) current rate structures and proposed changes in
13    those rate structures for the various medical vendors; and
14        (d) efforts at utilization review and control by the
15    Illinois Department.
16    The period covered by each report shall be the 3 years
17ending on the June 30 prior to the report. The report shall
18include suggested legislation for consideration by the General
19Assembly. The requirement for reporting to the General Assembly
20shall be satisfied by filing copies of the report as required
21by Section 3.1 of the General Assembly Organization Act, and
22filing such additional copies with the State Government Report
23Distribution Center for the General Assembly as is required
24under paragraph (t) of Section 7 of the State Library Act.
25    Rulemaking authority to implement Public Act 95-1045, if
26any, is conditioned on the rules being adopted in accordance



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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5    On and after July 1, 2012, the Department shall reduce any
6rate of reimbursement for services or other payments or alter
7any methodologies authorized by this Code to reduce any rate of
8reimbursement for services or other payments in accordance with
9Section 5-5e.
10    Because kidney transplantation can be an appropriate,
11cost-effective alternative to renal dialysis when medically
12necessary and notwithstanding the provisions of Section 1-11 of
13this Code, beginning October 1, 2014, the Department shall
14cover kidney transplantation for noncitizens with end-stage
15renal disease who are not eligible for comprehensive medical
16benefits, who meet the residency requirements of Section 5-3 of
17this Code, and who would otherwise meet the financial
18requirements of the appropriate class of eligible persons under
19Section 5-2 of this Code. To qualify for coverage of kidney
20transplantation, such person must be receiving emergency renal
21dialysis services covered by the Department. Providers under
22this Section shall be prior approved and certified by the
23Department to perform kidney transplantation and the services
24under this Section shall be limited to services associated with
25kidney transplantation.
26    Notwithstanding any other provision of this Code to the



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1contrary, on or after July 1, 2015, all FDA approved forms of
2medication assisted treatment prescribed for the treatment of
3alcohol dependence or treatment of opioid dependence shall be
4covered under both fee for service and managed care medical
5assistance programs for persons who are otherwise eligible for
6medical assistance under this Article and shall not be subject
7to any (1) utilization control, other than those established
8under the American Society of Addiction Medicine patient
9placement criteria, (2) prior authorization mandate, or (3)
10lifetime restriction limit mandate.
11    On or after July 1, 2015, opioid antagonists prescribed for
12the treatment of an opioid overdose, including the medication
13product, administration devices, and any pharmacy fees related
14to the dispensing and administration of the opioid antagonist,
15shall be covered under the medical assistance program for
16persons who are otherwise eligible for medical assistance under
17this Article. As used in this Section, "opioid antagonist"
18means a drug that binds to opioid receptors and blocks or
19inhibits the effect of opioids acting on those receptors,
20including, but not limited to, naloxone hydrochloride or any
21other similarly acting drug approved by the U.S. Food and Drug
23    Upon federal approval, the Department shall provide
24coverage and reimbursement for all drugs that are approved for
25marketing by the federal Food and Drug Administration and that
26are recommended by the federal Public Health Service or the



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1United States Centers for Disease Control and Prevention for
2pre-exposure prophylaxis and related pre-exposure prophylaxis
3services, including, but not limited to, HIV and sexually
4transmitted infection screening, treatment for sexually
5transmitted infections, medical monitoring, assorted labs, and
6counseling to reduce the likelihood of HIV infection among
7individuals who are not infected with HIV but who are at high
8risk of HIV infection.
9    A federally qualified health center, as defined in Section
101905(l)(2)(B) of the federal Social Security Act, shall be
11reimbursed by the Department in accordance with the federally
12qualified health center's encounter rate for services provided
13to medical assistance recipients that are performed by a dental
14hygienist, as defined under the Illinois Dental Practice Act,
15working under the general supervision of a dentist and employed
16by a federally qualified health center.
17(Source: P.A. 100-201, eff. 8-18-17; 100-395, eff. 1-1-18;
18100-449, eff. 1-1-18; 100-538, eff. 1-1-18; 100-587, eff.
196-4-18; 100-759, eff. 1-1-19; 100-863, eff. 8-14-18; 100-974,
20eff. 8-19-18; 100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19;
21100-1148, eff. 12-10-18; 101-209, eff. 8-5-19; 101-580, eff.
221-1-20; revised 9-18-19.)