Illinois General Assembly - Full Text of HB5013
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Full Text of HB5013  102nd General Assembly


Sen. Patricia Van Pelt

Filed: 3/31/2022





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2    AMENDMENT NO. ______. Amend House Bill 5013 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Birth Center Licensing Act is amended by
5changing Sections 5 and 25 as follows:
6    (210 ILCS 170/5)
7    Sec. 5. Definitions. In this Act:
8    "Birth center" means a designated site, other than a
10        (1) in which births are planned to occur following a
11    normal, uncomplicated, and low-risk pregnancy;
12        (2) that is not the pregnant person's usual place of
13    residence;
14        (3) that is exclusively dedicated to serving the
15    childbirth-related needs of pregnant persons and their
16    newborns, and has no more than 10 beds;



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1        (4) that offers prenatal care and community education
2    services and coordinates these services with other health
3    care services available in the community; and
4        (5) that does not provide general anesthesia or
5    surgery.
6    "Certified nurse midwife" means an advanced practice
7registered nurse licensed in Illinois under the Nurse Practice
8Act with full practice authority or who is delegated such
9authority as part of a written collaborative agreement with a
10physician who is associated with the birthing center or who
11has privileges at a nearby birthing hospital.
12    "Department" means the Illinois Department of Public
14    "Hospital" does not include places where pregnant females
15are received, cared for, or treated during delivery if it is in
16a licensed birth center, nor include any facility required to
17be licensed as a birth center.
18    "Licensed certified professional midwife" means a person
19who has successfully met the requirements under Section 45 of
20the Licensed Certified Professional Midwife Practice Act and
21holds an active license to practice as a licensed certified
22professional midwife in Illinois.
23    "Physician" means a physician licensed to practice
24medicine in all its branches in Illinois.
25(Source: P.A. 102-518, eff. 8-20-21.)



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1    (210 ILCS 170/25)
2    Sec. 25. Staffing.
3    (a) A birth center shall have a clinical director, who may
5        (1) a physician who is either certified or eligible
6    for certification by the American College of Obstetricians
7    and Gynecologists or the American Board of Osteopathic
8    Obstetricians and Gynecologists or has hospital
9    obstetrical privileges; or
10        (2) a certified nurse midwife.
11    (b) The clinical director shall be responsible for:
12        (1) the development of policies and procedures for
13    services as provided by Department rules;
14        (2) coordinating the clinical staff and overall
15    provision of patient care;
16        (3) developing and approving policies defining the
17    criteria to determine which pregnancies are accepted as
18    normal, uncomplicated, and low-risk; and
19        (4) developing and approving policing regarding the
20    anesthesia services available at the center.
21    (c) An obstetrician, family practitioner, or certified
22nurse midwife, or licensed certified professional midwife
23shall attend each person in labor from the time of admission
24through birth and throughout the immediate postpartum period.
25Attendance may be delegated only to another physician, or a
26certified nurse midwife, or a licensed certified professional



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2    (d) A second staff person shall be present at each birth
4        (1) is licensed or certified in Illinois in a
5    health-related field and under the supervision of a
6    physician, or a certified nurse midwife, or a licensed
7    certified professional midwife who is in attendance;
8        (2) has specialized training in labor and delivery
9    techniques and care of newborns; and
10        (3) receives planned and ongoing training as needed to
11    perform assigned duties effectively.
12(Source: P.A. 102-518, eff. 8-20-21.)
13    Section 10. The Illinois Public Aid Code is amended by
14changing Section 5-5.24 as follows:
15    (305 ILCS 5/5-5.24)
16    Sec. 5-5.24. Prenatal and perinatal care.
17    (a) The Department of Healthcare and Family Services may
18provide reimbursement under this Article for all prenatal and
19perinatal health care services that are provided for the
20purpose of preventing low-birthweight infants, reducing the
21need for neonatal intensive care hospital services, and
22promoting perinatal and maternal health. These services may
23include comprehensive risk assessments for pregnant
24individuals, individuals with infants, and infants, lactation



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1counseling, nutrition counseling, childbirth support,
2psychosocial counseling, treatment and prevention of
3periodontal disease, language translation, nurse home
4visitation, and other support services that have been proven
5to improve birth and maternal health outcomes. The Department
6shall maximize the use of preventive prenatal and perinatal
7health care services consistent with federal statutes, rules,
8and regulations. The Department of Public Aid (now Department
9of Healthcare and Family Services) shall develop a plan for
10prenatal and perinatal preventive health care and shall
11present the plan to the General Assembly by January 1, 2004. On
12or before January 1, 2006 and every 2 years thereafter, the
13Department shall report to the General Assembly concerning the
14effectiveness of prenatal and perinatal health care services
15reimbursed under this Section in preventing low-birthweight
16infants and reducing the need for neonatal intensive care
17hospital services. Each such report shall include an
18evaluation of how the ratio of expenditures for treating
19low-birthweight infants compared with the investment in
20promoting healthy births and infants in local community areas
21throughout Illinois relates to healthy infant development in
22those areas.
23    On and after July 1, 2012, the Department shall reduce any
24rate of reimbursement for services or other payments or alter
25any methodologies authorized by this Code to reduce any rate
26of reimbursement for services or other payments in accordance



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1with Section 5-5e.
2    (b)(1) As used in this subsection:
3    "Affiliated provider" means a provider who is enrolled in
4the medical assistance program and has an active contract with
5a managed care organization.
6    "Non-affiliated provider" means a provider who is enrolled
7in the medical assistance program but does not have a contract
8with an MCO.
9    "Preventive prenatal and perinatal health care services"
10means services described in subsection (a) including the
11following non-emergent diagnostic and ancillary services:
12        (i) Diagnostic labs and imaging, including level II
13    ultrasounds.
14        (ii) RhoGAM injections.
15        (iii) Injectable 17-alpha-hydroxyprogesterone
16    caproate (commonly called 17P).
17        (iv) Intrapartum (labor and delivery) services.
18        (v) Any other outpatient or inpatient service relating
19    to pregnancy or the 12 months following childbirth or
20    fetal loss.
21    (2) In order to maximize the accessibility of preventive
22prenatal and perinatal health care services, the Department of
23Healthcare and Family Services shall amend its managed care
24contracts such that an MCO must pay for preventive prenatal
25services, perinatal healthcare services, and postpartum
26services rendered by a non-affiliated provider, for which the



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1health plan would pay if rendered by an affiliated provider,
2at the rate paid under the Illinois Medicaid fee-for-service
3program methodology for such services, including all policy
4adjusters, including, but not limited to, Medicaid High Volume
5Adjustments, Medicaid Percentage Adjustments, Outpatient High
6Volume Adjustments, and all outlier add-on adjustments to the
7extent such adjustments are incorporated in the development of
8the applicable MCO capitated rates, unless a different rate
9was agreed upon by the health plan and the non-affiliated
11    (3) In cases where a managed care organization must pay
12for preventive prenatal services, perinatal healthcare
13services, and postpartum services rendered by a non-affiliated
14provider, the requirements under paragraph (2) shall not apply
15if the services were not emergency services, as defined in
16Section 5-30.1, and:
17        (A) the non-affiliated provider is a perinatal
18    hospital and has, within the 12 months preceding the date
19    of service, rejected a contract that was offered in good
20    faith by the health plan as determined by the Department;
21    or
22        (B) the health plan has terminated a contract with the
23    non-affiliated provider for cause, and the Department has
24    not deemed the termination to have been without merit. The
25    Department may deem that a determination for cause has
26    merit if:



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1            (i) an institutional provider has repeatedly
2        failed to conduct discharge planning; or
3            (ii) the provider's conduct adversely and
4        substantially impacts the health of Medicaid patients;
5        or
6            (iii) the provider's conduct constitutes fraud,
7        waste, or abuse; or
8            (iv) the provider's conduct violates the code of
9        ethics governing his or her profession.
10(Source: P.A. 102-665, eff. 10-8-21.)
11    Section 99. Effective date. This Act takes effect January
121, 2023.".