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


Rep. Lakesia Collins

Filed: 3/16/2021





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2    AMENDMENT NO. ______. Amend House Bill 3084 by replacing
3everything after the enacting clause with the following:
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



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1    between 2016 and 2017, Black women had the highest rate of
2    severe maternal morbidity with a rate of 101.5 per 10,000
3    deliveries, which is almost 3 times as high as the rate for
4    white women.
5        (3) In 2019, the Chicago Department of Public Health
6    released a data report on Maternal Morbidity and Mortality
7    in Chicago and found that "(w]omen for whom Medicaid was
8    the delivery payment source are significantly more likely
9    than those who used private insurance to experience severe
10    maternal morbidity." The Chicago Department of Public
11    Health identified zip codes within the city that had the
12    highest rates of severe maternal morbidity in 2016-2017
13    (100.4-172.8 per 10,000 deliveries). These zip codes
14    included: 60653, 60637, 60649, 60621, 60612, 60624, and
15    60644. All of the zip codes were identified as
16    experiencing high economic hardship. According to the
17    Chicago Department of Public Health "(c)hronic diseases,
18    including obesity, hypertension, and diabetes can increase
19    the risk of a woman experiencing adverse outcomes during
20    pregnancy." However, "there were no significant
21    differences in pre-pregnancy BMI, hypertension, and
22    diabetes between women who experienced a
23    pregnancy-associated death and all women who delivered
24    babies in Chicago."
25        (4) In a national representative survey sample of
26    mothers who gave birth in an American hospital in



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1    2011-2012, 1 out of 4 mothers who identified as Black or
2    African-American expressed that they would "definitely
3    want" to have a future birth at home, compared to 8.4% of
4    white mothers. Black mothers express a demand for planned
5    home birth services at almost 3 times the rate of white
6    mothers. And yet, in the United States, non-Hispanic white
7    women who can afford to pay out-of-pocket for their labor
8    and delivery costs access planned home birth care at the
9    greatest rate. Similarly, an analysis of birth certificate
10    data from the Centers for Disease Control and Prevention
11    for the years 2016-2019 shows that non-Hispanic white
12    mothers are 7 times more likely than non-Hispanic Black
13    mothers to experience a planned home birth.
14        (5) According to calculations based on birth
15    certificate data from July 2019 in Cook County, there
16    would have to be 7 Black or African-American certified
17    professional midwives working in Cook County in order for
18    just 1% of Black mothers in Cook County to have access to
19    racially concordant midwifery care in a given month.
20        (6) For birthing persons of sufficient health who
21    desire to give birth outside of an institutional setting
22    without the assistance of epidural analgesia, planned home
23    birth under the care of a certified professional midwife
24    can be a dignifying and safe, evidence-based choice. In
25    contrast, regulatory impingement on Black families'
26    ability to access that choice does not serve to enhance



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1    maternal or neonatal safety, but instead reifies the
2    institutionalization of Black bodies by the State.
3        (7) In order to make safe, planned home births
4    accessible to Black families in Illinois, the State must
5    require Medicaid provider networks to include certified
6    professional midwives. According to natality data from the
7    Centers for Disease Control and Prevention, every year
8    from 2016 through 2019, 2 out of every 3 live births to
9    Black or African-American mothers living in Cook County
10    utilized Medicaid as the source of payment for delivery.
11    According to that same data, Medicaid paid for over 14,000
12    deliveries to Black or African-American mothers residing
13    in Cook County during the year 2019 alone.
14        (8) A population-level, retrospective cohort study
15    published in 2018 that used province-wide maternity,
16    medical billing, and demographic data from British
17    Columbia, Canada concluded that antenatal midwifery care
18    in British Columbia was associated with lower odds of
19    small-for-gestational-age birth, preterm birth, and low
20    birth weight for women of low socioeconomic position
21    compared with physician models of care. Results support
22    the development of policy to ensure antenatal midwifery
23    care is available and accessible for women of low
24    socioeconomic position.
25        (9) In its January 2018 report to the General
26    Assembly, the Department of Healthcare and Family Services



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1    reported that its infant and maternal care expenditures in
2    calendar year 2015 totaled $1,410,000,000. The Department
3    of Healthcare and Family Services said, "(t)he majority of
4    HFS birth costs are for births with poor outcomes. Costs
5    for Medicaid covered births are increasing annually while
6    the number of covered births is decreasing for the same
7    period." The Department of Healthcare and Family Services'
8    expenditures average $12,000/birth during calendar year
9    2015 for births that did not involve poor outcomes such as
10    low birth weight, very low birth weight, and infant
11    mortality. That $12,000 expenditure covered prenatal,
12    intrapartum, and postpartum maternal healthcare, as well
13    as infant care through the first year of life. The next
14    least expensive category of births averaged an expenditure
15    of $40,200. The most expensive category of births refers
16    to births resulting in very low birth weight which cost
17    the Department of Healthcare and Family Services over
18    $328,000 per birth.
19        (10) Expanding Medicaid coverage to include perinatal
20    and intrapartum care by certified professional midwives
21    will not contribute to increased taxpayer burden and, in
22    fact, will likely decrease the Department of Healthcare
23    and Family Services' expenditures on maternal care while
24    improving maternal health outcomes within the Black
25    community in Illinois.



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1    Section 10. Medicaid voucher pilot program. The Task
2Force on Infant and Maternal Mortality Among African Americans
3shall partner with community-based maternal care providers to
4develop rules and regulations for a Medicaid voucher pilot
5program to expand consumer choice for Black mothers that
6includes planned home birth services and in-home perinatal and
7postpartum care services provided by racially concordant
8nationally accredited certified professional midwives. The
9Department of Healthcare and Family Services shall implement
10the pilot program no later than January 1, 2023 and the pilot
11program shall operate for a 5-year period. On January 1, 2024,
12and each January 1 thereafter through January 1, 2028, the
13Task Force shall submit a report to the General Assembly that
14provides a status update on the pilot program and annual
15impact measure reporting.
16    Section 15. Maternity episode payment model. The pilot
17program shall implement a maternity episode payment model that
18provides a single payment for all services across the
19prenatal, intrapartum, and postnatal period which covers the 9
20months of pregnancy plus 12 weeks of postpartum. The core
21elements of the maternity care episode payment model shall
22include all of the following:
23        (1) Limited exclusion of selected high-cost health
24    conditions and further adjustments to limit service
25    provider risk such as risk adjustment and stop loss.



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1        (2) Duration from the initial entry into prenatal care
2    through the postpartum and newborn periods.
3        (3) Single payment for all services across the
4    episode.
5    The Department of Healthcare and Family Services shall
6make available to the Task Force all relevant data related to
7maternal care expenditures made under the State's Medical
8Assistance Program so that budget-neutral reimbursement rates
9can be established for bundled maternal care services spanning
10the prenatal, labor and delivery, and postpartum phases of a
11maternity episode.".