Full Text of HB5013 102nd General Assembly
HB5013enr 102ND GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Birth Center Licensing Act is amended by | 5 | | changing Sections 5 and 25 as follows: | 6 | | (210 ILCS 170/5)
| 7 | | Sec. 5. Definitions. In this Act: | 8 | | "Birth center" means a designated site, other than a | 9 | | hospital: | 10 | | (1) in which births are planned to occur following a | 11 | | normal, uncomplicated, and low-risk pregnancy; | 12 | | (2) that is not the pregnant person's usual place of | 13 | | residence; | 14 | | (3) that is exclusively dedicated to serving the | 15 | | childbirth-related needs of pregnant persons and their | 16 | | newborns, and has no more than 10 beds; | 17 | | (4) that offers prenatal care and community education | 18 | | services and coordinates these services with other health | 19 | | care services available in the community; and | 20 | | (5) that does not provide general anesthesia or | 21 | | surgery. | 22 | | "Certified nurse midwife" means an advanced practice | 23 | | registered nurse licensed in Illinois under the Nurse Practice |
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| 1 | | Act with full practice authority or who is delegated such | 2 | | authority as part of a written collaborative agreement with a | 3 | | physician who is associated with the birthing center or who | 4 | | has privileges at a nearby birthing hospital. | 5 | | "Department" means the Illinois Department of Public | 6 | | Health. | 7 | | "Hospital" does not include places where pregnant females | 8 | | are received, cared for, or treated during delivery if it is in | 9 | | a licensed birth center, nor include any facility required to | 10 | | be licensed as a birth center. | 11 | | "Licensed certified professional midwife" means a person | 12 | | who has successfully met the requirements under Section 45 of | 13 | | the Licensed Certified Professional Midwife Practice Act and | 14 | | holds an active license to practice as a licensed certified | 15 | | professional midwife in Illinois. | 16 | | "Physician" means a physician licensed to practice | 17 | | medicine in all its branches in Illinois.
| 18 | | (Source: P.A. 102-518, eff. 8-20-21.) | 19 | | (210 ILCS 170/25)
| 20 | | Sec. 25. Staffing. | 21 | | (a) A birth center shall have a clinical director, who may | 22 | | be: | 23 | | (1) a physician who is either certified or eligible | 24 | | for certification by the American College of Obstetricians
| 25 | | and Gynecologists or the American Board of Osteopathic
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| 1 | | Obstetricians and Gynecologists or has hospital
| 2 | | obstetrical privileges; or | 3 | | (2)
a certified nurse midwife.
| 4 | | (b) The clinical director shall be responsible for: | 5 | | (1) the development of policies and procedures for | 6 | | services as provided by Department rules; | 7 | | (2) coordinating the clinical staff and overall | 8 | | provision of patient care; | 9 | | (3) developing and approving policies defining the | 10 | | criteria to determine which pregnancies are accepted as | 11 | | normal, uncomplicated, and low-risk; and | 12 | | (4) developing and approving policing regarding the | 13 | | anesthesia services available at the center.
| 14 | | (c) An obstetrician, family practitioner, or certified | 15 | | nurse midwife , or licensed certified professional midwife | 16 | | shall attend each person in labor from the time of admission | 17 | | through birth and throughout the immediate postpartum period. | 18 | | Attendance may be delegated only to another physician , or a | 19 | | certified nurse midwife , or a licensed certified professional | 20 | | midwife . | 21 | | (d) A second staff person shall be present at each birth | 22 | | who: | 23 | | (1) is licensed or certified in Illinois in a | 24 | | health-related field and under the supervision of a | 25 | | physician , or a certified nurse midwife , or a licensed | 26 | | certified professional midwife who is in attendance; |
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| 1 | | (2) has specialized training in labor and delivery | 2 | | techniques and care of newborns; and | 3 | | (3) receives planned and ongoing training as needed to | 4 | | perform assigned duties effectively.
| 5 | | (Source: P.A. 102-518, eff. 8-20-21.) | 6 | | Section 10. The Illinois Public Aid Code is amended by | 7 | | changing Section 5-5.24 as follows:
| 8 | | (305 ILCS 5/5-5.24)
| 9 | | Sec. 5-5.24. Prenatal and perinatal care. | 10 | | (a) The Department of
Healthcare and Family Services may | 11 | | provide reimbursement under this Article for all prenatal and
| 12 | | perinatal health care services that are provided for the | 13 | | purpose of preventing
low-birthweight infants, reducing the | 14 | | need for neonatal intensive care hospital
services, and | 15 | | promoting perinatal and maternal health. These services may | 16 | | include
comprehensive risk assessments for pregnant | 17 | | individuals, individuals with infants, and
infants, lactation | 18 | | counseling, nutrition counseling, childbirth support,
| 19 | | psychosocial counseling, treatment and prevention of | 20 | | periodontal disease, language translation, nurse home | 21 | | visitation, and
other support
services
that have been proven | 22 | | to improve birth and maternal health outcomes.
The Department
| 23 | | shall
maximize the use of preventive prenatal and perinatal | 24 | | health care services
consistent with
federal statutes, rules, |
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| 1 | | and regulations.
The Department of Public Aid (now Department | 2 | | of Healthcare and Family Services)
shall develop a plan for | 3 | | prenatal and perinatal preventive
health care and
shall | 4 | | present the plan to the General Assembly by January 1, 2004.
On | 5 | | or before January 1, 2006 and
every 2 years
thereafter, the | 6 | | Department shall report to the General Assembly concerning the
| 7 | | effectiveness of prenatal and perinatal health care services | 8 | | reimbursed under
this Section
in preventing low-birthweight | 9 | | infants and reducing the need for neonatal
intensive care
| 10 | | hospital services. Each such report shall include an | 11 | | evaluation of how the
ratio of
expenditures for treating
| 12 | | low-birthweight infants compared with the investment in | 13 | | promoting healthy
births and
infants in local community areas | 14 | | throughout Illinois relates to healthy infant
development
in | 15 | | those areas.
| 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 | | (b)(1) As used in this subsection: | 22 | | "Affiliated provider" means a provider who is enrolled in | 23 | | the medical assistance program and has an active contract with | 24 | | a managed care organization. | 25 | | "Non-affiliated provider" means a provider who is enrolled | 26 | | in the medical assistance program but does not have a contract |
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| 1 | | with an MCO. | 2 | | "Preventive prenatal and perinatal health care services" | 3 | | means services described in subsection (a) including the | 4 | | following non-emergent diagnostic and ancillary services: | 5 | | (i) Diagnostic labs and imaging, including level II | 6 | | ultrasounds. | 7 | | (ii) RhoGAM injections. | 8 | | (iii) Injectable 17-alpha-hydroxyprogesterone | 9 | | caproate (commonly called 17P). | 10 | | (iv) Intrapartum (labor and delivery) services. | 11 | | (v) Any other outpatient or inpatient service relating | 12 | | to pregnancy or the 12 months following childbirth or | 13 | | fetal loss. | 14 | | (2) In order to maximize the accessibility of preventive | 15 | | prenatal and perinatal health care services, the Department of | 16 | | Healthcare and Family Services shall amend its managed care | 17 | | contracts such that an MCO must pay for preventive prenatal | 18 | | services, perinatal healthcare services, and postpartum | 19 | | services rendered by a non-affiliated provider, for which the | 20 | | health plan would pay if rendered by an affiliated provider, | 21 | | at the rate paid under the Illinois Medicaid fee-for-service | 22 | | program methodology for such services, including all policy | 23 | | adjusters, including, but not limited to, Medicaid High Volume | 24 | | Adjustments, Medicaid Percentage Adjustments, Outpatient High | 25 | | Volume Adjustments, and all outlier add-on adjustments to the | 26 | | extent such adjustments are incorporated in the development of |
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| 1 | | the applicable MCO capitated rates, unless a different rate | 2 | | was agreed upon by the health plan and the non-affiliated | 3 | | provider. | 4 | | (3) In cases where a managed care organization must pay | 5 | | for preventive prenatal services, perinatal healthcare | 6 | | services, and postpartum services rendered by a non-affiliated | 7 | | provider, the requirements under paragraph (2) shall not apply | 8 | | if the services were not emergency services, as defined in | 9 | | Section 5-30.1, and: | 10 | | (A) the non-affiliated provider is a perinatal | 11 | | hospital and has, within the 12 months preceding the date | 12 | | of service, rejected a contract that was offered in good | 13 | | faith by the health plan as determined by the Department; | 14 | | or | 15 | | (B) the health plan has terminated a contract with the | 16 | | non-affiliated provider for cause, and the Department has | 17 | | not deemed the termination to have been without merit. The | 18 | | Department may deem that a determination for cause has | 19 | | merit if: | 20 | | (i) an institutional provider has repeatedly | 21 | | failed to conduct discharge planning; or | 22 | | (ii) the provider's conduct adversely and | 23 | | substantially impacts the health of Medicaid patients; | 24 | | or | 25 | | (iii) the provider's conduct constitutes fraud, | 26 | | waste, or abuse; or |
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| 1 | | (iv) the provider's conduct violates the code of | 2 | | ethics governing his or her profession. | 3 | | (Source: P.A. 102-665, eff. 10-8-21.)
| 4 | | Section 99. Effective date. This Act takes effect January | 5 | | 1, 2023. |
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