410 ILCS 225/ Prenatal and Newborn Care Act.

(410 ILCS 225/1) (from Ch. 111 1/2, par. 7021)

Sec. 1. Short title. This Act shall be known and may be cited as the Prenatal and Newborn Care Act.

(Source: P.A. 86-860.)

(410 ILCS 225/2) (from Ch. 111 1/2, par. 7022)

Sec. 2. Definitions. As used in this Act, unless the context otherwise requires:

"Advanced practice registered nurse" or "APRN" means an advanced practice registered nurse licensed under the Nurse Practice Act.

"Department" means the Illinois Department of Human Services.

"Early and Periodic Screening, Diagnosis and Treatment (EPSDT)" means the provision of preventative health care under 42 C.F.R. 441.50 et seq., including medical and dental services, needed to assess growth and development and detect and treat health problems.

"Hospital" means a hospital as defined under the Hospital Licensing Act.

"Local health authority" means the full-time official health department or board of health, as recognized by the Illinois Department of Public Health, having jurisdiction over a particular area.

"Nurse" means a nurse licensed under the Nurse Practice Act.

"Physician" means a physician licensed to practice medicine in all of its branches.

"Physician assistant" means a physician assistant licensed under the Physician Assistant Practice Act of 1987.

"Postnatal visit" means a visit occurring after birth, with reference to the newborn.

"Prenatal visit" means a visit occurring before birth.

"Program" means the Prenatal and Newborn Care Program established pursuant to this Act.

(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.)

(410 ILCS 225/3) (from Ch. 111 1/2, par. 7023)

Sec. 3. Prenatal and Newborn Care Program. The Department shall, subject to appropriations made available for this purpose, establish and operate the Prenatal and Newborn Care Program pursuant to this Act and promulgate any rules which it deems necessary for the implementation of this Act.

(Source: P.A. 89-507, eff. 7-1-97.)

(410 ILCS 225/4) (from Ch. 111 1/2, par. 7024)

Sec. 4. Program administration. The Department may administer this program through grants or contracts to local health authorities or private nonprofit agencies.

(Source: P.A. 86-860.)

(410 ILCS 225/5) (from Ch. 111 1/2, par. 7025)

Sec. 5. Application and eligibility requirements.

(a) Any person requesting program benefits shall be afforded the opportunity to apply for such benefits. The application shall be filed at a place designated by the Department.

(b) Program benefits may be provided to or on behalf of any person: (1) who has been medically diagnosed as pregnant, and who is living in this State voluntarily with the intention of making it her home and not for a temporary purpose; and, (2) who meets the financial eligibility requirements of the Department as set forth in rules promulgated pursuant to this Act. Such rules shall provide that any person will be eligible with a gross income that equals or is less than the nonfarm income official poverty line, as determined by the federal Office of Management and Budget and revised annually in accordance with Section 673(2) of the Omnibus Reconciliation Act of 1981. The Department may establish financial eligibility requirements for income levels above the official federal poverty line. Temporary absence from this State, with an intent to return, shall not render a person ineligible for benefits.

(c) No person receiving aid under Article V of The Illinois Public Aid Code shall be eligible for program benefits.

(d) No person detained in a Federal, State or local correctional facility as a result of being charged with or convicted of a criminal offense shall be eligible for program benefits.

(Source: P.A. 86-860.)

(410 ILCS 225/6) (from Ch. 111 1/2, par. 7026)

Sec. 6. Covered services.

(a) Covered services under the program may include, but are not necessarily limited to, the following:

(1) Laboratory services related to a recipient's pregnancy, performed or ordered by a physician, advanced practice registered nurse, or physician assistant.

(2) Screening and treatment for sexually transmitted disease.

(3) Prenatal visits to a physician in the physician's office, an advanced practice registered nurse in the advanced practice registered nurse's office, a physician assistant in the physician assistant's office, or to a hospital outpatient prenatal clinic, local health department maternity clinic, or community health center.

(4) Radiology services which are directly related to the pregnancy, are determined to be medically necessary and are ordered by a physician, an advanced practice registered nurse, or a physician assistant.

(5) Pharmacy services related to the pregnancy.

(6) Other medical consultations related to the pregnancy.

(7) Physician, advanced practice registered nurse, physician assistant, or nurse services associated with delivery.

(8) One postnatal office visit within 60 days after delivery.

(9) Two EPSDT-equivalent screenings for the infant within 90 days after birth.

(10) Social and support services.

(11) Nutrition services.

(12) Case management services.

(b) The following services shall not be covered under the program:

(1) Services determined by the Department not to be medically necessary.

(2) Services not directly related to the pregnancy, except for the 2 covered EPSDT-equivalent screenings.

(3) Hospital inpatient services.

(4) Anesthesiologist and radiologist services during a period of hospital inpatient care.

(5) Physician, advanced practice registered nurse, and physician assistant hospital visits.

(6) Services considered investigational or experimental.

(Source: P.A. 100-513, eff. 1-1-18.)

(410 ILCS 225/7) (from Ch. 111 1/2, par. 7027)

Sec. 7. Advisory board consultation. The Department shall consult with the Maternal and Child Health Advisory Board under the Advisory Board for the Maternal and Child Health Block Grant Programs Act regarding the implementation of this program. In addition, the Board shall advise the Department on the coordination of services provided under this program with services provided under the Illinois Family Case Management Act and the Problem Pregnancy Health Services and Care Act.

(Source: P.A. 99-901, eff. 8-26-16.)

(410 ILCS 225/8)

Sec. 8. Educational information on risks and healthcare needs of premature infants.

(a) It is the purpose of this Section to:

(1) improve healthcare quality and outcomes for infants born preterm through enhanced hospital discharge, follow-up care, and management processes and reduced rehospitalization from infectious disease and other complications; and

(2) reduce infant morbidity and mortality associated with prematurity.

(b) The General Assembly finds the following:

(1) Infants born premature at less than 37 weeks gestational age have greater morbidity and mortality than full-term infants.

(2) In 2006, 12.8% of all births in the United States were premature, accounting for more than 542,000 infants.

(3) In Illinois, 1 in 8 babies were born premature in 2006, or 13.3% of live births, accounting for 23,955 premature births.

(4) Between 1996 and 2006, the rate of infants born premature in Illinois increased nearly 15%.

(5) The rate of premature birth in Illinois is highest in African American infants, 19.3%, followed by Native Americans, 15.6%, Hispanics, 12.1%, and Caucasians, 11.9%.

(6) Approximately 70% of premature births occur in the late preterm period between 34 and 36 weeks of gestation, and late-preterm babies have significant differences in clinical outcomes than full-term infants, including greater risk for temperature instability, hypoglycemia, respiratory distress, and jaundice.

(7) In 2005, preterm birth cost the United States at least $26.2 billion, or $51,600 for every infant born prematurely.

(8) Medical costs for premature babies are greater than they are for healthy newborns. In 2007, the average medical costs for a preterm baby were more than 10 times as high as they were for a healthy full-term baby. The costs for a healthy baby from birth to his first birthday were $4,551. For a pre-term baby, the costs were $49,033.

(9) The costs of premature birth in Illinois may be significant because the State Medicaid Program paid for 40% of all births in 2003.

(10) Premature infant standard of care practices of clinicians and hospitals may vary across the State, particularly for late preterm births.

(c) The Department of Public Health shall publish on its website information about the possible health complications associated with newborn infants who are born premature at less than 37 weeks gestational age and the proper care and support for these newborn infants. The written information shall, at a minimum, include the following:

(1) The unique health issues affecting infants born premature, such as increased risk of developmental problems; nutritional challenges; infection; chronic lung disease (bronchopulmonary dysplasia); vision and hearing impairment; breathing problems; feeding; maintaining body temperature; jaundice; hyperactivity; infant mortality as well as long-term complications associated with growth and nutrition; respiratory problems; fine motor skills; reading; and speaking.

(2) The proper care needs of premature infants, developmental screenings, and monitoring and healthcare services available to premature infants through the Medicaid program or other public or private health programs.

(3) Methods, vaccines, and other preventative measures to protect premature infants from infectious diseases, including viral respiratory infections.

(4) The emotional and financial burdens and other challenges that parents and family members of premature infants experience and information about community resources available to support them.

(d) The information shall be easily accessible and written in clear language to educate parents of premature infants across a variety of socioeconomic statuses.

(e) In determining what information is most beneficial to the public, the Department may consult with pediatric healthcare providers, community organizations, or other experts as the Department deems necessary.

(f) The Department shall ensure that the information is accessible to children's health providers, maternal care providers, hospitals, public health departments, and medical organizations. The Department shall encourage those organizations to provide the publications to parents or guardians of premature infants.

(Source: P.A. 96-1117, eff. 7-20-10.)

(410 ILCS 225/9)

Sec. 9. The Illinois Department of Healthcare and Family Services; consultation; data reporting.

(a) The Illinois Department of Healthcare and Family Services, which administers the Illinois Medicaid Program and the Covering ALL KIDS Health Insurance Program, shall consult with statewide organizations focused on premature infant healthcare in order to:

(1) examine and improve hospital discharge and follow-up care procedures for premature infants born earlier than 37 weeks gestational age to ensure standardized and coordinated processes are followed as premature infants leave the hospital from either a Level 1 (well baby nursery), Level 2 (step down or transitional nursery), or Level 3 (neonatal intensive care unit) unit and transition to follow-up care by a health care provider in the community; and

(2) use guidance from the Centers for Medicare and Medicaid Services' Neonatal Outcome Improvement Project to implement programs to improve newborn outcome, reduce newborn health costs, and establish ongoing quality improvement for newborns.

(b) In consultation with statewide organizations representing hospitals, the Department of Public Health shall consider mechanisms to collect discharge data for purposes of analyzing readmission rates of certain premature infants.

(Source: P.A. 96-1117, eff. 7-20-10.)