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.