Illinois General Assembly - Full Text of HB3084
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Full Text of HB3084  102nd General Assembly



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1    AN ACT concerning health.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the
5Consumer Choice in Maternal Care for African-American Mothers
6Pilot Program Act.
7    Section 5. Findings. The General Assembly finds the
9        (1) In its 2018 Illinois Maternal Morbidity and
10    Mortality Report, the Department of Public Health reported
11    that Black women were 6 times as likely to die from a
12    pregnancy-related condition as white women; and that in
13    Illinois, 72% of pregnancy-related deaths and 93% of
14    violent pregnancy-associated deaths were deemed
15    preventable.
16        (2) The Department of Public Health also found that
17    between 2016 and 2017, Black women had the highest rate of
18    severe maternal morbidity with a rate of 101.5 per 10,000
19    deliveries, which is almost 3 times as high as the rate for
20    white women.
21        (3) In 2019, the Chicago Department of Public Health
22    released a data report on Maternal Morbidity and Mortality
23    in Chicago and found that "(w)omen for whom Medicaid was



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1    the delivery payment source are significantly more likely
2    than those who used private insurance to experience severe
3    maternal morbidity." The Chicago Department of Public
4    Health identified zip codes within the city that had the
5    highest rates of severe maternal morbidity in 2016-2017
6    (100.4-172.8 per 10,000 deliveries). These zip codes
7    included: 60653, 60637, 60649, 60621, 60612, 60624, and
8    60644. All of the zip codes were identified as
9    experiencing high economic hardship. According to the
10    Chicago Department of Public Health "(c)hronic diseases,
11    including obesity, hypertension, and diabetes can increase
12    the risk of a woman experiencing adverse outcomes during
13    pregnancy." However, "there were no significant
14    differences in pre-pregnancy BMI, hypertension, and
15    diabetes between women who experienced a
16    pregnancy-associated death and all women who delivered
17    babies in Chicago."
18        (4) In a national representative survey sample of
19    mothers who gave birth in an American hospital in
20    2011-2012, 1 out of 4 mothers who identified as Black or
21    African-American expressed that they would "definitely
22    want" to have a future birth at home, compared to 8.4% of
23    white mothers. Black mothers express a demand for planned
24    home birth services at almost 3 times the rate of white
25    mothers. And yet, in the United States, non-Hispanic white
26    women who can afford to pay out-of-pocket for their labor



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1    and delivery costs access planned home birth care at the
2    greatest rate. Similarly, an analysis of birth certificate
3    data from the Centers for Disease Control and Prevention
4    for the years 2016-2019 shows that non-Hispanic white
5    mothers are 7 times more likely than non-Hispanic Black
6    mothers to experience a planned home birth.
7        (5) According to calculations based on birth
8    certificate data from July 2019 in Cook County, there
9    would have to be 7 Black or African-American certified
10    professional midwives working in Cook County in order for
11    just 1% of Black mothers in Cook County to have access to
12    racially concordant midwifery care in a given month.
13        (6) For birthing persons of sufficient health who
14    desire to give birth outside of an institutional setting
15    without the assistance of epidural analgesia, planned home
16    birth under the care of a certified professional midwife
17    can be a dignifying and safe, evidence-based choice. In
18    contrast, regulatory impingement on Black families'
19    ability to access that choice does not serve to enhance
20    maternal or neonatal safety, but instead reifies the
21    institutionalization of Black bodies by the State.
22        (7) In order to make safe, planned home births
23    accessible to Black families in Illinois, the State must
24    require Medicaid provider networks to include certified
25    professional midwives. According to natality data from the
26    Centers for Disease Control and Prevention, every year



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1    from 2016 through 2019, 2 out of every 3 live births to
2    Black or African-American mothers living in Cook County
3    utilized Medicaid as the source of payment for delivery.
4    According to that same data, Medicaid paid for over 14,000
5    deliveries to Black or African-American mothers residing
6    in Cook County during the year 2019 alone.
7        (8) A population-level, retrospective cohort study
8    published in 2018 that used province-wide maternity,
9    medical billing, and demographic data from British
10    Columbia, Canada concluded that antenatal midwifery care
11    in British Columbia was associated with lower odds of
12    small-for-gestational-age birth, preterm birth, and low
13    birth weight for women of low socioeconomic position
14    compared with physician models of care. Results support
15    the development of policy to ensure antenatal midwifery
16    care is available and accessible for women of low
17    socioeconomic position.
18        (9) In its January 2018 report to the General
19    Assembly, the Department of Healthcare and Family Services
20    reported that its infant and maternal care expenditures in
21    calendar year 2015 totaled $1,410,000,000. The Department
22    of Healthcare and Family Services said, "(t)he majority of
23    HFS birth costs are for births with poor outcomes. Costs
24    for Medicaid covered births are increasing annually while
25    the number of covered births is decreasing for the same
26    period." The Department of Healthcare and Family Services'



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1    expenditures average $12,000/birth during calendar year
2    2015 for births that did not involve poor outcomes such as
3    low birth weight, very low birth weight, and infant
4    mortality. That $12,000 expenditure covered prenatal,
5    intrapartum, and postpartum maternal healthcare, as well
6    as infant care through the first year of life. The next
7    least expensive category of births averaged an expenditure
8    of $40,200. The most expensive category of births refers
9    to births resulting in very low birth weight which cost
10    the Department of Healthcare and Family Services over
11    $328,000 per birth.
12        (10) Expanding Medicaid coverage to include perinatal
13    and intrapartum care by certified professional midwives
14    will not contribute to increased taxpayer burden and, in
15    fact, will likely decrease the Department of Healthcare
16    and Family Services' expenditures on maternal care while
17    improving maternal health outcomes within the Black
18    community in Illinois.
19    Section 10. Medicaid voucher pilot program. The Task Force
20on Infant and Maternal Mortality Among African Americans shall
21partner with community-based maternal care providers to
22develop rules and regulations for a Medicaid voucher pilot
23program to expand consumer choice for Black mothers that
24includes planned home birth services and in-home perinatal and
25postpartum care services provided by racially concordant



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1nationally accredited certified professional midwives who are
2licensed and registered in Illinois. The Department of
3Healthcare and Family Services shall implement the pilot
4program no later than January 1, 2023 and the pilot program
5shall operate for a 5-year period. On January 1, 2024, and each
6January 1 thereafter through January 1, 2028, the Task Force
7shall submit a report to the General Assembly that provides a
8status update on the pilot program and annual impact measure
10    Section 15. Maternity episode payment model. The pilot
11program shall implement a maternity episode payment model that
12provides a single payment for all services across the
13prenatal, intrapartum, and postnatal period which covers the 9
14months of pregnancy plus 12 weeks of postpartum. The core
15elements of the maternity care episode payment model shall
16include all of the following:
17        (1) Limited exclusion of selected high-cost health
18    conditions and further adjustments to limit service
19    provider risk such as risk adjustment and stop loss.
20        (2) Duration from the initial entry into prenatal care
21    through the postpartum and newborn periods.
22        (3) Single payment for all services across the
23    episode.
24    The Department of Healthcare and Family Services shall
25make available to the Task Force all relevant data related to



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1maternal care expenditures made under the State's Medical
2Assistance Program so that budget-neutral reimbursement rates
3can be established for bundled maternal care services spanning
4the prenatal, labor and delivery, and postpartum phases of a
5maternity episode.