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Public Act 102-0964


 

Public Act 0964 102ND GENERAL ASSEMBLY

  
  
  

 


 
Public Act 102-0964
 
HB5013 EnrolledLRB102 25451 KTG 34737 b

    AN ACT concerning public aid.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Birth Center Licensing Act is amended by
changing Sections 5 and 25 as follows:
 
    (210 ILCS 170/5)
    Sec. 5. Definitions. In this Act:
    "Birth center" means a designated site, other than a
hospital:
        (1) in which births are planned to occur following a
    normal, uncomplicated, and low-risk pregnancy;
        (2) that is not the pregnant person's usual place of
    residence;
        (3) that is exclusively dedicated to serving the
    childbirth-related needs of pregnant persons and their
    newborns, and has no more than 10 beds;
        (4) that offers prenatal care and community education
    services and coordinates these services with other health
    care services available in the community; and
        (5) that does not provide general anesthesia or
    surgery.
    "Certified nurse midwife" means an advanced practice
registered nurse licensed in Illinois under the Nurse Practice
Act with full practice authority or who is delegated such
authority as part of a written collaborative agreement with a
physician who is associated with the birthing center or who
has privileges at a nearby birthing hospital.
    "Department" means the Illinois Department of Public
Health.
    "Hospital" does not include places where pregnant females
are received, cared for, or treated during delivery if it is in
a licensed birth center, nor include any facility required to
be licensed as a birth center.
    "Licensed certified professional midwife" means a person
who has successfully met the requirements under Section 45 of
the Licensed Certified Professional Midwife Practice Act and
holds an active license to practice as a licensed certified
professional midwife in Illinois.
    "Physician" means a physician licensed to practice
medicine in all its branches in Illinois.
(Source: P.A. 102-518, eff. 8-20-21.)
 
    (210 ILCS 170/25)
    Sec. 25. Staffing.
    (a) A birth center shall have a clinical director, who may
be:
        (1) a physician who is either certified or eligible
    for certification by the American College of Obstetricians
    and Gynecologists or the American Board of Osteopathic
    Obstetricians and Gynecologists or has hospital
    obstetrical privileges; or
        (2) a certified nurse midwife.
    (b) The clinical director shall be responsible for:
        (1) the development of policies and procedures for
    services as provided by Department rules;
        (2) coordinating the clinical staff and overall
    provision of patient care;
        (3) developing and approving policies defining the
    criteria to determine which pregnancies are accepted as
    normal, uncomplicated, and low-risk; and
        (4) developing and approving policing regarding the
    anesthesia services available at the center.
    (c) An obstetrician, family practitioner, or certified
nurse midwife, or licensed certified professional midwife
shall attend each person in labor from the time of admission
through birth and throughout the immediate postpartum period.
Attendance may be delegated only to another physician, or a
certified nurse midwife, or a licensed certified professional
midwife.
    (d) A second staff person shall be present at each birth
who:
        (1) is licensed or certified in Illinois in a
    health-related field and under the supervision of a
    physician, or a certified nurse midwife, or a licensed
    certified professional midwife who is in attendance;
        (2) has specialized training in labor and delivery
    techniques and care of newborns; and
        (3) receives planned and ongoing training as needed to
    perform assigned duties effectively.
(Source: P.A. 102-518, eff. 8-20-21.)
 
    Section 10. The Illinois Public Aid Code is amended by
changing Section 5-5.24 as follows:
 
    (305 ILCS 5/5-5.24)
    Sec. 5-5.24. Prenatal and perinatal care.
    (a) The Department of Healthcare and Family Services may
provide reimbursement under this Article for all prenatal and
perinatal health care services that are provided for the
purpose of preventing low-birthweight infants, reducing the
need for neonatal intensive care hospital services, and
promoting perinatal and maternal health. These services may
include comprehensive risk assessments for pregnant
individuals, individuals with infants, and infants, lactation
counseling, nutrition counseling, childbirth support,
psychosocial counseling, treatment and prevention of
periodontal disease, language translation, nurse home
visitation, and other support services that have been proven
to improve birth and maternal health outcomes. The Department
shall maximize the use of preventive prenatal and perinatal
health care services consistent with federal statutes, rules,
and regulations. The Department of Public Aid (now Department
of Healthcare and Family Services) shall develop a plan for
prenatal and perinatal preventive health care and shall
present the plan to the General Assembly by January 1, 2004. On
or before January 1, 2006 and every 2 years thereafter, the
Department shall report to the General Assembly concerning the
effectiveness of prenatal and perinatal health care services
reimbursed under this Section in preventing low-birthweight
infants and reducing the need for neonatal intensive care
hospital services. Each such report shall include an
evaluation of how the ratio of expenditures for treating
low-birthweight infants compared with the investment in
promoting healthy births and infants in local community areas
throughout Illinois relates to healthy infant development in
those areas.
    On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate
of reimbursement for services or other payments in accordance
with Section 5-5e.
    (b)(1) As used in this subsection:
    "Affiliated provider" means a provider who is enrolled in
the medical assistance program and has an active contract with
a managed care organization.
    "Non-affiliated provider" means a provider who is enrolled
in the medical assistance program but does not have a contract
with an MCO.
    "Preventive prenatal and perinatal health care services"
means services described in subsection (a) including the
following non-emergent diagnostic and ancillary services:
        (i) Diagnostic labs and imaging, including level II
    ultrasounds.
        (ii) RhoGAM injections.
        (iii) Injectable 17-alpha-hydroxyprogesterone
    caproate (commonly called 17P).
        (iv) Intrapartum (labor and delivery) services.
        (v) Any other outpatient or inpatient service relating
    to pregnancy or the 12 months following childbirth or
    fetal loss.
    (2) In order to maximize the accessibility of preventive
prenatal and perinatal health care services, the Department of
Healthcare and Family Services shall amend its managed care
contracts such that an MCO must pay for preventive prenatal
services, perinatal healthcare services, and postpartum
services rendered by a non-affiliated provider, for which the
health plan would pay if rendered by an affiliated provider,
at the rate paid under the Illinois Medicaid fee-for-service
program methodology for such services, including all policy
adjusters, including, but not limited to, Medicaid High Volume
Adjustments, Medicaid Percentage Adjustments, Outpatient High
Volume Adjustments, and all outlier add-on adjustments to the
extent such adjustments are incorporated in the development of
the applicable MCO capitated rates, unless a different rate
was agreed upon by the health plan and the non-affiliated
provider.
    (3) In cases where a managed care organization must pay
for preventive prenatal services, perinatal healthcare
services, and postpartum services rendered by a non-affiliated
provider, the requirements under paragraph (2) shall not apply
if the services were not emergency services, as defined in
Section 5-30.1, and:
        (A) the non-affiliated provider is a perinatal
    hospital and has, within the 12 months preceding the date
    of service, rejected a contract that was offered in good
    faith by the health plan as determined by the Department;
    or
        (B) the health plan has terminated a contract with the
    non-affiliated provider for cause, and the Department has
    not deemed the termination to have been without merit. The
    Department may deem that a determination for cause has
    merit if:
            (i) an institutional provider has repeatedly
        failed to conduct discharge planning; or
            (ii) the provider's conduct adversely and
        substantially impacts the health of Medicaid patients;
        or
            (iii) the provider's conduct constitutes fraud,
        waste, or abuse; or
            (iv) the provider's conduct violates the code of
        ethics governing his or her profession.
(Source: P.A. 102-665, eff. 10-8-21.)
 
    Section 99. Effective date. This Act takes effect January
1, 2023.

Effective Date: 5/27/2022