SB3659 102ND GENERAL ASSEMBLY

LRB102 25729 KTG 35038 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB3659

Introduced 1/21/2022, by Sen. Cristina Castro

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-18.5

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that midwifery services shall be covered under the medical assistance program, subject to appropriation, for persons who are otherwise eligible for medical assistance under the Code. Requires the Department of Healthcare and Family Services to consult with midwives on formulating rules concerning reimbursement rates for midwifery services. Provides that reimbursement rates for certain related services shall be increased by 6% for dates of service on and after January 1, 2023. Effective immediately.

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by changing Section 5-18.5 as follows:

(305 ILCS 5/5-18.5)

Sec. 5-18.5. Perinatal doula and evidence-based home visiting services.

(a) As used in this Section:

"Home visiting" means a voluntary, evidence-based strategy used to support pregnant people, infants, and young children and their caregivers to promote infant, child, and maternal health, to foster educational development and school readiness, and to help prevent child abuse and neglect. Home visitors are trained professionals whose visits and activities focus on promoting strong parent-child attachment to foster healthy child development.

"Perinatal doula" means a trained provider who provides regular, voluntary physical, emotional, and educational support, but not medical or midwife care, to pregnant and birthing persons before, during, and after childbirth, otherwise known as the perinatal period.

"Perinatal doula training" means any doula training that focuses on providing support throughout the prenatal, labor and delivery, or postpartum period, and reflects the type of doula care that the doula seeks to provide.

(b) Notwithstanding any other provision of this Article, perinatal doula services and evidence-based home visiting services shall be covered under the medical assistance program, subject to appropriation, for persons who are otherwise eligible for medical assistance under this Article. Perinatal doula services include regular visits beginning in the prenatal period and continuing into the postnatal period, inclusive of continuous support during labor and delivery, that support healthy pregnancies and positive birth outcomes. Perinatal doula services may be embedded in an existing program, such as evidence-based home visiting. Perinatal doula services provided during the prenatal period may be provided weekly, services provided during the labor and delivery period may be provided for the entire duration of labor and the time immediately following birth, and services provided during the postpartum period may be provided up to 12 months postpartum.

(b-5) Notwithstanding any other provision of this Article, midwifery services shall be covered under the medical assistance program, subject to appropriation, for persons who are otherwise eligible for medical assistance under this Article. The Department shall consult with midwives on formulating rules concerning reimbursement rates for midwifery services. The reimbursement rates for the following related services shall be increased by 6% for dates of service on and after January 1, 2023:

59409 Vaginal Delivery Only.

59410 Obstetrical Care; Vaginal Delivery Only Including Postpartum Care.

59514 Cesarean Delivery Only.

59515 Cesarean Delivery Postpartum.

59612 Vaginal Delivery Only, After Previous Cesarean Delivery.

59614 Vaginal Delivery After Previous Cesarean Section, Including Postpartum Care.

59620 Cesarean Section Delivery After Attempted Vaginal Delivery After Previous Cesarean Section.

59622 Cesarean Section After Attempted Vaginal Delivery Intravenous/Cesarean Section/Including Postpartum Care.

99201 Evaluation and Management Office/Other Health Visit New Patient.

99202 Evaluation and Management Office/Other Health Visit New Patient.

99203 Office or Other Outpatient Visit for the Evaluation and Management of a New Patient.

99204 Office or Other Outpatient Visit for the Evaluation and Management of a New Patient.

99205 Office or Other Outpatient Visit for the Evaluation and Management of a New Patient.

99211 Face-to-Face Encounter With a Patient Consisting of Elements of Both Evaluation.

99212 Office or Other Outpatient Visit for the Evaluation and Management of an Established Patient.

99213 Office or Other Outpatient Visit for the Evaluation and Management of an Established Patient.

99214 Office or Other Outpatient Visit for the Evaluation and Management of an Established Patient.

99215 Office or Other Outpatient Visit for the Evaluation and Management of an Established Patient.

99381 Initial Comprehensive Preventive Medicine Evaluation and Management of an Individual Including an Age and Gender Appropriate History.

99382 Initial Comprehensive Preventive Medicine Evaluation and Management of an Individual Including an Age and Gender Appropriate History, Examination, Counseling/Anticipatory Guidance/Risk Factor Reduction Interventions.

99383 Initial Comprehensive Preventive Medicine Evaluation and Management of an Individual Including an Age and Gender Appropriate History.

99384 New Patient Preventive Medicine Services.

99385 Initial Comprehensive Preventive Medicine Evaluation and Management of an Individual Including an Age and Gender Appropriate History, Examination, Counseling/Anticipatory Guidance/Risk Factor Reduction Interventions.

99386 Initial Comprehensive Preventive Medicine Evaluation and Management of an Individual Including an Age and Gender Appropriate History, Examination.

99387 New Patient Preventive Medicine Services.

99391 Periodic Comprehensive Preventive Medicine Reevaluation and Management of an Individual Including an Age and Gender Appropriate History.

99392 Periodic Reevaluation Healthy Child.

99393 Periodic Reevaluation Healthy Child.

99394 Periodic Reevaluation Healthy Adolescent.

99395 Periodic Reevaluation/Management 18-39 Years.

99396 Periodic Reevaluation/Management 40-64 Years.

99397 Periodic Reevaluation/Management 65 Years and Greater.

(c) The Department of Healthcare and Family Services shall adopt rules to administer this Section. In this rulemaking, the Department shall consider the expertise of and consult with doula program experts, doula training providers, practicing doulas, and home visiting experts, along with State agencies implementing perinatal doula services and relevant bodies under the Illinois Early Learning Council. This body of experts shall inform the Department on the credentials necessary for perinatal doula and home visiting services to be eligible for Medicaid reimbursement and the rate of reimbursement for home visiting and perinatal doula services in the prenatal, labor and delivery, and postpartum periods. Every 2 years, the Department shall assess the rates of reimbursement for perinatal doula and home visiting services and adjust rates accordingly.

(d) The Department shall seek such State plan amendments or waivers as may be necessary to implement this Section and shall secure federal financial participation for expenditures made by the Department in accordance with this Section.

(Source: P.A. 102-4, eff. 4-27-21.)

Section 99. Effective date. This Act takes effect upon becoming law.