Public Act 102-0518
 
HB3995 EnrolledLRB102 14648 CPF 21906 b


  
    AN ACT concerning regulation.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  



 
 
    Section 1. Short title. This Act may be cited as the Birth 
Center Licensing Act.
 
    Section 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.
    "Physician" means a physician licensed to practice 
medicine in all its branches in Illinois.
 
    Section 10. License required. Except as provided by this 
Act, no person shall open, manage, conduct, offer, maintain, 
or advertise as a birth center without a valid license issued 
by the Department. All birth centers in existence as of the 
effective date of this Act shall obtain a valid license to 
operate within 2 years after the adoption of rules by the 
Department to implement this Act under Section 60.
 
    Section 15. Issuance and renewal of license.
    (a) An applicant for a license under this Act shall submit 
an application on forms prescribed by the Department.  Each 
application shall be accompanied by a nonrefundable license 
fee, as established by rule by the Department under Section 
60.
    (b) The Department may grant a temporary initial license 
to an applicant. A temporary initial license expires on the 
earlier of the date the Department denies the license or the 
date 6 months after the temporary initial license was issued.
    (c) The Department shall issue a license under this Act 
if, after application, inspection, and investigation, it finds 
the applicant meets the requirements of this Act and the rules 
and standards adopted pursuant to this Act.
    (d) A license is renewable every year upon submission of: 
(i) the renewal application and fee and (ii) a report on a form 
prescribed by the Department that includes information related 
to quality of care at a birth center. The report must be in the 
form and documented by evidence as required by the Department 
by rule under Section 60.

 
    Section 17. Certificate of need; licenses. 
    (a) A birth center shall obtain a certificate of need from 
the Health Facilities and Services Review Board under the 
Health Facilities Planning Act before receiving a license by 
the Department under this Act.
    (b) If, after obtaining an initial certificate of need 
under subsection (a), a birth center seeks to increase the bed 
capacity of the birth center, the birth center must obtain a 
certificate of need from the Health Facilities and Services 
Review Board before increasing the bed capacity.
    (c) A birth center in a medically underserved area, as 
determined by the U.S. Department of Health and Human 
Services, shall receive priority in obtaining a certificate of 
need under this Section.

 
    Section 20. Linkages.
    (a) A birth center shall link and integrate its services 
with at least one birthing hospital with a minimum of a Level 1 
perinatal designation.
    (b) A birth center shall have an established agreement 
with a nearby receiving birthing hospital with policies and 
procedures for timely transfer of maternal and neonatal 
patients. The agreement shall include a determination of 
maternal and neonatal conditions necessitating consultation 
and referral. This should include plans
for communication with 
the receiving hospital before and after
transfer.

 
    Section 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 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.
    (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 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.

 
    Section 30. Minimum standards.
    (a) The Department's rules adopted pursuant to Section 60 
of this Act shall contain minimum standards to protect the 
health and safety of a patient of a birth center. In adopting 
rules for birth centers, the Department shall consider:
        (1) the Commission for the Accreditation of Birth 
    Centers' Standards for Freestanding Birth Centers;
        (2) the American Academy of Pediatrics and American 
    College of Obstetricians and Gynecologists Guidelines for 
    Perinatal Care; and
        (3) the Regionalized Perinatal Health Care Code.

 
    Section 35. Quality of care. The Department's rules shall 
provide for a time period within which each birth center must 
become accredited by either the Commission for the 
Accreditation of Freestanding Birth Centers or The Joint 
Commission. 
    A birth center shall implement a quality improvement 
program consistent with the requirements of the accrediting 
body and is encouraged to participate in quality improvement 
projects implemented by the Department's Administrative 
Perinatal Centers and other Department-supported perinatal 
quality improvement projects. Clinicians, or their clinical 
representative, attending persons in labor at the birth center 
shall attend morbidity and mortality reviews that occur at the 
receiving birthing hospital on their patients, when invited, 
at a mutually agreeable time. This includes, but is not 
limited to, maternal and neonatal patients transferred to the 
receiving birthing hospital.
 
    Section 40. Reimbursement requirements.
    (a) A birth center shall seek certification under Titles 
XVIII and XIX of the federal Social Security Act.
    (b) Reimbursement rates set by the Department of 
Healthcare and Family Services should be based on all types of 
medically necessary covered services provided to both the 
birthing person and the baby, including:
        (1) a professional fee for both the birthing person 
    and baby;
        (2) a facility fee for the birthing person that is no 
    less than 75% of the statewide average facility payment 
    rate made to a hospital for an uncomplicated vaginal 
    birth;
        (3) a facility fee for the baby that is no less than 
    75% of the statewide average facility payment rate made to 
    a hospital for a normal baby; and
        (4) additional fees for other services, medications, 
    laboratory tests, and supplies provided.
    (c) A birth center shall provide charitable care 
consistent with that provided by comparable health care 
providers in the geographic area.
    (d) A birth center may not discriminate against any 
patient requiring treatment because of the source of payment 
for services, including Medicare and Medicaid recipients.
 
    Section 45. Reporting requirements. The Department shall 
by rule require each birth center to report information every 
year that is consistent with the birth center's license 
renewal schedule, which the Department shall make publicly 
available and which shall include the following:
        (1) utilization data involving patient length of stay;
        (2) admissions and discharges;
        (3) complications;
        (4) transfers;
        (5) deaths;
        (6) any other publicly reported data required under 
    the Consumer Guide to Health Care; and
        (7) post-discharge patient status data where patients 
    are
followed for 14 days after discharge from the birth 
    center
to determine whether the mother or baby developed a

    complication or infection.
 
    Section 50. Training. A birth center shall, in 
consultation with the clinical director, establish and 
implement a policy to ensure appropriate training and 
competency of individuals employed within the birth center. 
The policy shall, at a minimum, define the acts and practices 
that are allowed or prohibited for such employees, establish 
how training will be conducted, and illustrate how initial 
competency will be established.
 
    Section 55. Inspections; special inspections; reports.
    (a) The Department, whenever it determines necessary, may 
conduct a
special inspection, survey, or evaluation of a birth 
center to assess
compliance with licensure requirements and 
standards or a plan of
correction submitted as a result of 
deficiencies cited by the
Department or an accrediting body.

    (b) Upon the Department's completion of any special 
inspection, survey, or evaluation, the appropriate Department 
personnel who conducted the special inspection, survey, or 
evaluation shall submit a copy of his or her report to the 
licensee upon exiting the birth center, and shall submit the 
actual report to the appropriate regional office.
    (c) The Department's report and any recommendation for 
action under this Act shall be sent to the Department's 
central office together with a plan of correction from the 
birth center.
    (d) The plan of correction may contain related comments or 
documentation provided by the birth center that may refute 
findings in the report, explain extenuating circumstances that 
the birth center could not reasonably have prevented, or 
indicate methods and timetables for correction of deficiencies 
described in the report.
    (e) A birth center has 10 days after the date of the 
Department's special inspection, survey, or evaluation to 
submit a plan of correction. The Department shall determine 
whether a birth center is in violation of this Section no later 
than 60 days after completion of each special inspection, 
survey, evaluation, or plan of correction.
    (f) The Department shall maintain all special inspection, 
survey, or evaluation reports for at least 5 years in a manner 
accessible to the public.

 
    Section 60. Rules. 
    (a) The Department shall adopt rules for the 
administration and enforcement of this Act.
    (b) Rules adopted by the Department under this Act shall 
stipulate:

        (1) the eligibility criteria for birth center 
    admission that are consistent with accreditation standards 
    and the certified nurse midwife's or physician's scope of 
    practice;
        (2) the necessary equipment for emergency care 
    according to the Commission for Accreditation of Birth 
    Centers' standards;
        (3) the minimum elements required in the transfer 
    agreement between a birth center and a receiving birth 
    hospital with at least a Level 1 perinatal designation, 
    including the amount of travel time between facilities in 
    rural and nonrural areas, the staff required to transfer 
    patients, and the mode of emergency transportation between 
    facilities; and
        (4) the equipment used by the birth center to ensure 
    that it is compatible with the health and safety of the 
    patients.
 
 
    Section 99. Effective date. This Act takes effect upon 
becoming law.