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




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1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
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;
17        (4) that offers prenatal care and community education
18    services and coordinates these services with other health
19    care services available in the community; and
20        (5) that does not provide general anesthesia or
21    surgery.
22    "Certified nurse midwife" means an advanced practice
23registered nurse licensed in Illinois under the Nurse Practice



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1Act with full practice authority or who is delegated such
2authority as part of a written collaborative agreement with a
3physician who is associated with the birthing center or who
4has privileges at a nearby birthing hospital.
5    "Department" means the Illinois Department of Public
7    "Hospital" does not include places where pregnant females
8are received, cared for, or treated during delivery if it is in
9a licensed birth center, nor include any facility required to
10be licensed as a birth center.
11    "Licensed certified professional midwife" means a person
12who has successfully met the requirements under Section 45 of
13the Licensed Certified Professional Midwife Practice Act and
14holds an active license to practice as a licensed certified
15professional midwife in Illinois.
16    "Physician" means a physician licensed to practice
17medicine in all its branches in Illinois.
18(Source: P.A. 102-518, eff. 8-20-21.)
19    (210 ILCS 170/25)
20    Sec. 25. Staffing.
21    (a) A birth center shall have a clinical director, who may
23        (1) a physician who is either certified or eligible
24    for certification by the American College of Obstetricians
25    and Gynecologists or the American Board of Osteopathic



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



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1        (2) has specialized training in labor and delivery
2    techniques and care of newborns; and
3        (3) receives planned and ongoing training as needed to
4    perform assigned duties effectively.
5(Source: P.A. 102-518, eff. 8-20-21.)
6    Section 10. The Illinois Public Aid Code is amended by
7changing Section 5-5.24 as follows:
8    (305 ILCS 5/5-5.24)
9    Sec. 5-5.24. Prenatal and perinatal care.
10    (a) The Department of Healthcare and Family Services may
11provide reimbursement under this Article for all prenatal and
12perinatal health care services that are provided for the
13purpose of preventing low-birthweight infants, reducing the
14need for neonatal intensive care hospital services, and
15promoting perinatal and maternal health. These services may
16include comprehensive risk assessments for pregnant
17individuals, individuals with infants, and infants, lactation
18counseling, nutrition counseling, childbirth support,
19psychosocial counseling, treatment and prevention of
20periodontal disease, language translation, nurse home
21visitation, and other support services that have been proven
22to improve birth and maternal health outcomes. The Department
23shall maximize the use of preventive prenatal and perinatal
24health care services consistent with federal statutes, rules,



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1and regulations. The Department of Public Aid (now Department
2of Healthcare and Family Services) shall develop a plan for
3prenatal and perinatal preventive health care and shall
4present the plan to the General Assembly by January 1, 2004. On
5or before January 1, 2006 and every 2 years thereafter, the
6Department shall report to the General Assembly concerning the
7effectiveness of prenatal and perinatal health care services
8reimbursed under this Section in preventing low-birthweight
9infants and reducing the need for neonatal intensive care
10hospital services. Each such report shall include an
11evaluation of how the ratio of expenditures for treating
12low-birthweight infants compared with the investment in
13promoting healthy births and infants in local community areas
14throughout Illinois relates to healthy infant development in
15those areas.
16    On and after July 1, 2012, the Department shall reduce any
17rate of reimbursement for services or other payments or alter
18any methodologies authorized by this Code to reduce any rate
19of reimbursement for services or other payments in accordance
20with Section 5-5e.
21    (b)(1) As used in this subsection:
22    "Affiliated provider" means a provider who is enrolled in
23the medical assistance program and has an active contract with
24a managed care organization.
25    "Non-affiliated provider" means a provider who is enrolled
26in the medical assistance program but does not have a contract



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1with an MCO.
2    "Preventive prenatal and perinatal health care services"
3means services described in subsection (a) including the
4following non-emergent diagnostic and ancillary services:
5        (i) Diagnostic labs and imaging, including level II
6    ultrasounds.
7        (ii) RhoGAM injections.
8        (iii) Injectable 17-alpha-hydroxyprogesterone
9    caproate (commonly called 17P).
10        (iv) Intrapartum (labor and delivery) services.
11        (v) Any other outpatient or inpatient service relating
12    to pregnancy or the 12 months following childbirth or
13    fetal loss.
14    (2) In order to maximize the accessibility of preventive
15prenatal and perinatal health care services, the Department of
16Healthcare and Family Services shall amend its managed care
17contracts such that an MCO must pay for preventive prenatal
18services, perinatal healthcare services, and postpartum
19services rendered by a non-affiliated provider, for which the
20health plan would pay if rendered by an affiliated provider,
21at the rate paid under the Illinois Medicaid fee-for-service
22program methodology for such services, including all policy
23adjusters, including, but not limited to, Medicaid High Volume
24Adjustments, Medicaid Percentage Adjustments, Outpatient High
25Volume Adjustments, and all outlier add-on adjustments to the
26extent such adjustments are incorporated in the development of



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1the applicable MCO capitated rates, unless a different rate
2was agreed upon by the health plan and the non-affiliated
4    (3) In cases where a managed care organization must pay
5for preventive prenatal services, perinatal healthcare
6services, and postpartum services rendered by a non-affiliated
7provider, the requirements under paragraph (2) shall not apply
8if the services were not emergency services, as defined in
9Section 5-30.1, and:
10        (A) the non-affiliated provider is a perinatal
11    hospital and has, within the 12 months preceding the date
12    of service, rejected a contract that was offered in good
13    faith by the health plan as determined by the Department;
14    or
15        (B) the health plan has terminated a contract with the
16    non-affiliated provider for cause, and the Department has
17    not deemed the termination to have been without merit. The
18    Department may deem that a determination for cause has
19    merit if:
20            (i) an institutional provider has repeatedly
21        failed to conduct discharge planning; or
22            (ii) the provider's conduct adversely and
23        substantially impacts the health of Medicaid patients;
24        or
25            (iii) the provider's conduct constitutes fraud,
26        waste, or abuse; or



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1            (iv) the provider's conduct violates the code of
2        ethics governing his or her profession.
3(Source: P.A. 102-665, eff. 10-8-21.)
4    Section 99. Effective date. This Act takes effect January
51, 2023.