Full Text of HB4824 103rd General Assembly
HB4824ham001 103RD GENERAL ASSEMBLY | Rep. Kevin John Olickal Filed: 3/15/2024 | | 10300HB4824ham001 | | LRB103 37229 KTG 70981 a |
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| 1 | | AMENDMENT TO HOUSE BILL 4824
| 2 | | AMENDMENT NO. ______. Amend House Bill 4824 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The Birth Center Licensing Act is amended by | 5 | | changing Section 40 as follows: | 6 | | (210 ILCS 170/40) | 7 | | Sec. 40. Reimbursement requirements. | 8 | | (a) A birth center shall seek certification under Titles | 9 | | XVIII and XIX of the federal Social Security Act. | 10 | | (b) Reimbursement rates set by the Department of | 11 | | Healthcare and Family Services should be based on all types of | 12 | | medically necessary covered services provided to both the | 13 | | birthing person and the baby, including: | 14 | | (1) a professional fee for both the birthing person | 15 | | and baby; | 16 | | (2) a facility fee for the birthing person that is |
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| 1 | | equal to no less than 75% of the statewide average | 2 | | facility payment rate made to a hospital for an | 3 | | uncomplicated vaginal birth; | 4 | | (3) a facility fee for the baby that is equal to no | 5 | | less than 75% of the statewide average facility payment | 6 | | rate made to a hospital for a normal baby; and | 7 | | (4) additional fees for other services, medications, | 8 | | laboratory tests, and supplies provided. | 9 | | Notwithstanding any other law to the contrary, all | 10 | | reimbursement rates set by the Department of Healthcare and | 11 | | Family Services for services provided at a birth center shall | 12 | | be equal to the reimbursement rates set by the Department of | 13 | | Healthcare and Family Services for the same services provided | 14 | | at a hospital licensed under the Hospital Licensing Act. | 15 | | (c) A birth center shall provide charitable care | 16 | | consistent with that provided by comparable health care | 17 | | providers in the geographic area. | 18 | | (d) A birth center may not discriminate against any | 19 | | patient requiring treatment because of the source of payment | 20 | | for services, including Medicare and Medicaid recipients. | 21 | | (Source: P.A. 102-518, eff. 8-20-21.) | 22 | | Section 10. The Illinois Insurance Code is amended by | 23 | | adding Section 356z.71 as follows: | 24 | | (215 ILCS 5/356z.71 new) |
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| 1 | | Sec. 356z.71. Coverage for birth center and midwife | 2 | | services. A group or individual policy of accident and health | 3 | | insurance or a managed care plan that is amended, delivered, | 4 | | issued, or renewed on or after January 1, 2025 shall provide | 5 | | coverage for all services provided at a birth center by a | 6 | | certified nurse midwife or a licensed certified professional | 7 | | midwife, including, but not limited to, prenatal care, labor | 8 | | and delivery care, care after birth, gynecological exams, and | 9 | | newborn care. As use in this Section: | 10 | | "Birth center" means a facility licensed under the | 11 | | Birth Center Licensing Act. | 12 | | "Certified nurse midwife" means an individual who is | 13 | | licensed under the Nurse Practice Act as an advanced | 14 | | practice registered nurse and is certified as a nurse | 15 | | midwife. | 16 | | "Licensed certified professional midwife" means a | 17 | | person who has successfully met the requirements under | 18 | | Section 45 of the Licensed Certified Professional Midwife | 19 | | Practice Act and holds an active license to practice as a | 20 | | licensed certified professional midwife in Illinois. | 21 | | Section 15. The Illinois Public Aid Code is amended by | 22 | | changing Sections 5-16.8, 5-18.3, and 5-18.5 as follows: | 23 | | (305 ILCS 5/5-16.8) | 24 | | Sec. 5-16.8. Required health benefits. The medical |
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| 1 | | assistance program shall (i) provide the post-mastectomy care | 2 | | benefits required to be covered by a policy of accident and | 3 | | health insurance under Section 356t and the coverage required | 4 | | under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, | 5 | | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, | 6 | | 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and | 7 | | 356z.61 , 356z.64, 356z.67, and 356z.71 of the Illinois | 8 | | Insurance Code, (ii) be subject to the provisions of Sections | 9 | | 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the | 10 | | Illinois Insurance Code, and (iii) be subject to the | 11 | | provisions of subsection (d-5) of Section 10 of the Network | 12 | | Adequacy and Transparency Act. | 13 | | The Department, by rule, shall adopt a model similar to | 14 | | the requirements of Section 356z.39 of the Illinois Insurance | 15 | | Code. | 16 | | On and after July 1, 2012, the Department shall reduce any | 17 | | rate of reimbursement for services or other payments or alter | 18 | | any methodologies authorized by this Code to reduce any rate | 19 | | of reimbursement for services or other payments in accordance | 20 | | with Section 5-5e. | 21 | | To ensure full access to the benefits set forth in this | 22 | | Section, on and after January 1, 2016, the Department shall | 23 | | ensure that provider and hospital reimbursement for | 24 | | post-mastectomy care benefits required under this Section are | 25 | | no lower than the Medicare reimbursement rate. | 26 | | (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; |
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| 1 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. | 2 | | 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, | 3 | | eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; | 4 | | 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | 5 | | 1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.) | 6 | | (305 ILCS 5/5-18.3 new) | 7 | | Sec. 5-18.3. Birth center and midwife services. | 8 | | Notwithstanding any other provision of this Code, all services | 9 | | provided at a birth center by a certified nurse midwife or a | 10 | | licensed certified professional midwife, including, but not | 11 | | limited to, prenatal care, labor and delivery care, care after | 12 | | birth, gynecological exams, and newborn care shall be covered | 13 | | under the medical assistance program for persons who are | 14 | | otherwise eligible for medical assistance under this Article. | 15 | | All reimbursement rates set by the Department for services | 16 | | provided at a birth center shall be equal to the reimbursement | 17 | | rates set by the Department for the same services provided at a | 18 | | hospital licensed under the Hospital Licensing Act. The | 19 | | Department shall seek a State Plan amendment or any federal | 20 | | waivers or approvals necessary to implement this Section. | 21 | | Implementation of the coverage and reimbursement rates under | 22 | | this Section shall be contingent on federal approval. As used | 23 | | in this Section: | 24 | | "Birth center" means a facility licensed under the | 25 | | Birth Center Licensing Act. |
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| 1 | | "Certified nurse midwife" means an individual who is | 2 | | licensed under the Nurse Practice Act as an advanced | 3 | | practice registered nurse and is certified as a nurse | 4 | | midwife. | 5 | | "Licensed certified professional midwife" means a | 6 | | person who has successfully met the requirements under | 7 | | Section 45 of the Licensed Certified Professional Midwife | 8 | | Practice Act and holds an active license to practice as a | 9 | | licensed certified professional midwife in Illinois. | 10 | | (305 ILCS 5/5-18.5) | 11 | | Sec. 5-18.5. Perinatal doula and evidence-based home | 12 | | visiting services. | 13 | | (a) As used in this Section: | 14 | | "Home visiting" means a voluntary, evidence-based strategy | 15 | | used to support pregnant people, infants, and young children | 16 | | and their caregivers to promote infant, child, and maternal | 17 | | health, to foster educational development and school | 18 | | readiness, and to help prevent child abuse and neglect. Home | 19 | | visitors are trained professionals whose visits and activities | 20 | | focus on promoting strong parent-child attachment to foster | 21 | | healthy child development. | 22 | | "Perinatal doula" means a trained provider who provides | 23 | | regular, voluntary physical, emotional, and educational | 24 | | support, but not medical or midwife care, to pregnant and | 25 | | birthing persons before, during, and after childbirth, |
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| 1 | | otherwise known as the perinatal period. | 2 | | "Perinatal doula training" means any doula training that | 3 | | focuses on providing support throughout the prenatal, labor | 4 | | and delivery, or postpartum period, and reflects the type of | 5 | | doula care that the doula seeks to provide. | 6 | | (b) Notwithstanding any other provision of this Article, | 7 | | perinatal doula services and evidence-based home visiting | 8 | | services shall be covered under the medical assistance | 9 | | program, subject to appropriation, for persons who are | 10 | | otherwise eligible for medical assistance under this Article. | 11 | | Perinatal doula services include regular visits beginning in | 12 | | the prenatal period and continuing into the postnatal period, | 13 | | inclusive of continuous support during labor and delivery, | 14 | | that support healthy pregnancies and positive birth outcomes. | 15 | | Perinatal doula services may be embedded in an existing | 16 | | program, such as evidence-based home visiting. Perinatal doula | 17 | | services provided during the prenatal period may be provided | 18 | | weekly, services provided during the labor and delivery period | 19 | | may be provided for the entire duration of labor and the time | 20 | | immediately following birth, or and services provided during | 21 | | the postpartum period may be provided up to 12 months | 22 | | postpartum. | 23 | | (b-5) (Blank). Notwithstanding any other provision of this | 24 | | Article, beginning January 1, 2023, licensed certified | 25 | | professional midwife services shall be covered under the | 26 | | medical assistance program, subject to appropriation, for |
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| 1 | | persons who are otherwise eligible for medical assistance | 2 | | under this Article. The Department shall consult with midwives | 3 | | on reimbursement rates for midwifery services. | 4 | | (c) The Department of Healthcare and Family Services shall | 5 | | adopt rules to administer this Section. In this rulemaking, | 6 | | the Department shall consider the expertise of and consult | 7 | | with doula program experts, doula training providers, | 8 | | practicing doulas, and home visiting experts, along with State | 9 | | agencies implementing perinatal doula services and relevant | 10 | | bodies under the Illinois Early Learning Council. This body of | 11 | | experts shall inform the Department on the credentials | 12 | | necessary for perinatal doula and home visiting services to be | 13 | | eligible for Medicaid reimbursement and the rate of | 14 | | reimbursement for home visiting and perinatal doula services | 15 | | in the prenatal, labor and delivery, and postpartum periods. | 16 | | Every 2 years, the Department shall assess the rates of | 17 | | reimbursement for perinatal doula and home visiting services | 18 | | and adjust rates accordingly. | 19 | | (d) The Department shall seek such State plan amendments | 20 | | or waivers as may be necessary to implement this Section and | 21 | | shall secure federal financial participation for expenditures | 22 | | made by the Department in accordance with this Section. | 23 | | (Source: P.A. 102-4, eff. 4-27-21; 102-1037, eff. 6-2-22.) | 24 | | Section 99. Effective date. This Act takes effect January | 25 | | 1, 2025.". |
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