Full Text of HB3084 102nd General Assembly
HB3084ham001 102ND GENERAL ASSEMBLY | Rep. Lakesia Collins Filed: 3/16/2021
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| 1 | | AMENDMENT TO HOUSE BILL 3084
| 2 | | AMENDMENT NO. ______. Amend House Bill 3084 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the | 5 | | Consumer Choice in Maternal Care for African-American Mothers | 6 | | Pilot Program Act. | 7 | | Section 5. Findings. The General Assembly finds the | 8 | | following: | 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 | 2 | | Force on Infant and Maternal Mortality Among African Americans | 3 | | shall partner with community-based maternal care providers to | 4 | | develop rules and regulations for a Medicaid voucher pilot | 5 | | program to expand consumer choice for Black mothers that | 6 | | includes planned home birth services and in-home perinatal and | 7 | | postpartum care services provided by racially concordant | 8 | | nationally accredited certified professional midwives. The | 9 | | Department of Healthcare and Family Services shall implement | 10 | | the pilot program no later than January 1, 2023 and the pilot | 11 | | program shall operate for a 5-year period. On January 1, 2024, | 12 | | and each January 1 thereafter through January 1, 2028, the | 13 | | Task Force shall submit a report to the General Assembly that | 14 | | provides a status update on the pilot program and annual | 15 | | impact measure reporting. | 16 | | Section 15. Maternity episode payment model. The pilot | 17 | | program shall implement a maternity episode payment model that | 18 | | provides a single payment for all services across the | 19 | | prenatal, intrapartum, and postnatal period which covers the 9 | 20 | | months of pregnancy plus 12 weeks of postpartum.
The core | 21 | | elements of the maternity care episode payment model shall | 22 | | include 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 | 6 | | make available to the Task Force all relevant data related to | 7 | | maternal care expenditures made under the State's Medical | 8 | | Assistance Program so that budget-neutral reimbursement rates | 9 | | can be established for bundled maternal care services spanning | 10 | | the prenatal, labor and delivery, and postpartum phases of a | 11 | | maternity episode.".
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