Rep. Robyn Gabel

Filed: 3/22/2021





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2    AMENDMENT NO. ______. Amend House Bill 3995 by replacing
3everything after the enacting clause with the following:
4    "Section 1. Short title. This Act may be cited as the Birth
5Center Licensing Act.
6    Section 5. Definitions. In this Act:
7    "Birth center" means a designated site, other than a
9        (1) in which births are planned to occur following a
10    normal, uncomplicated, and low-risk pregnancy;
11        (2) that is not the pregnant person's usual place of
12    residence;
13        (3) that is exclusively dedicated to serving the
14    childbirth-related needs of pregnant persons and their
15    newborns, and has no more than 10 beds; and
16        (4) that offers prenatal care and community education



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1    services and coordinates these services with other health
2    care services available in the community.
3    "Department" means the Department of Public Health.
4    "Hospital" does not include places where pregnant females
5are received, cared for, or treated during delivery if it is in
6a licensed birth center, nor include any facility required to
7be licensed as a birth center.
8    Section 10. License required. Except as provided by this
9Act, no person shall open, manage, conduct, offer, maintain,
10or advertise as a birth center without a valid license issued
11by the Department. All birth centers in existence as of the
12effective date of this Act shall obtain a valid license to
13operate within 2 years after the adoption of rules by the
14Department to implement this Act under Section 60.
15    Section 15. Issuance and renewal of license.
16    (a) An applicant for a license under this Act shall submit
17an application on forms prescribed by the Department. Each
18application shall be accompanied by a nonrefundable license
19fee, as established by rule by the Department under Section
21    (b) The Department may grant a temporary initial license
22to an applicant. A temporary initial license expires on the
23earlier of the date the Department denies the license or the
24date 6 months after the temporary initial license was issued.



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1    (c) The Department shall issue a license under this Act
2if, after application, inspection, and investigation, it finds
3the applicant meets the requirements of this Act and the rules
4and standards adopted pursuant to this Act.
5    (d) A license is renewable every year upon submission of:
6(i) the renewal application and fee and (ii) a report on a form
7prescribed by the Department that includes information related
8to quality of care at a birth center. The report must be in the
9form and documented by evidence as required by the Department
10by rule under Section 60.
11    Section 17. Certificate of need; licenses.
12    (a) A birth center shall obtain a certificate of need from
13the Health Facilities and Services Review Board under the
14Health Facilities Planning Act before receiving a license by
15the Department under this Act.
16    (b) If, after obtaining an initial certificate of need
17under subsection (a), a birth center seeks to increase the bed
18capacity of the birth center, the birth center must obtain a
19certificate of need from the Health Facilities and Services
20Review Board before increasing the bed capacity.
21    (c) A birth center in a medically underserved area, as
22determined by the U.S. Department of Health and Human
23Services, shall receive priority in obtaining a certificate of
24need under this Section.



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1    Section 20. Linkages.
2    (a) A birth center shall, to the extent possible, link and
3integrate its services with nearby health care facilities.
4    (b) A birth center shall have a written plan for transfer
5of patients that addresses emergency and nonemergency
6situations for both pregnant persons and newborns in
7antepartum, intrapartum, and postpartum phases. This should
8include plans for communication with the receiving hospital
9before and after transfer.
10    Section 25. Staffing.
11    (a) A birth center shall have a clinical director, who may
13        (1) a physician who is either certified or eligible
14    for certification by the American College of Obstetricians
15    and Gynecologists or the American Board of Osteopathic
16    Obstetricians and Gynecologists or has hospital
17    obstetrical privileges; or
18        (2) a midwife who is either certified or eligible for
19    certification by his or her governing body.
20    (b) The clinical director shall be responsible for:
21        (1) the development of policies and procedures for
22    services as provided by Department rules;
23        (2) coordinating the clinical staff and overall
24    provision of patient care;
25        (3) developing and approving policies defining the



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1    criteria to determine which pregnancies are accepted as
2    normal, uncomplicated, and low-risk; and
3        (4) developing and approving policing regarding the
4    anesthesia services available at the center.
5    (c) An obstetrician, family practitioner, or midwife
6licensed in Illinois shall attend each person in labor from
7the time of admission through birth and throughout the
8immediate postpartum period. Attendance may be delegated only
9to another physician or midwife licensed in Illinois.
10    (d) A second staff person shall be present at each birth
12        (1) is licensed or certified in Illinois in a
13    health-related field and under the supervision of a
14    physician or a licensed midwife in Illinois that is in
15    attendance;
16        (2) has specialized training in labor and delivery
17    techniques and care of newborns; and
18        (3) receives planned and ongoing training as needed to
19    perform assigned duties effectively.
20    Section 30. Minimum standards.
21    (a) The Department's rules adopted pursuant to Section 60
22of this Act shall contain minimum standards to protect the
23health and safety of a patient of a birth center. In adopting
24rules for birth centers, the Department shall consider:
25        (1) the Commission for the Accreditation of Birth



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1    Centers' Standards for Freestanding Birth Centers;
2        (2) the American Academy of Pediatrics and American
3    College of Obstetricians and Gynecologists Guidelines for
4    Perinatal Care; and
5        (3) the Regionalized Perinatal Health Care Code.
6    Section 35. Quality of care. The Department's rules shall
7provide for a time period within which each birth center must
8become accredited by either the Commission for the
9Accreditation of Freestanding Birth Centers or The Joint
11    A birth center shall implement a quality improvement
12program consistent with the requirements of the accrediting
14    Section 40. Reimbursement requirements.
15    (a) A birth center shall seek certification under Titles
16XVIII and XIX of the federal Social Security Act.
17    (b) Reimbursement rates set by the Department of
18Healthcare and Family Services should be based on all types of
19medically necessary covered services provided to both the
20birthing person and the baby, including:
21        (1) a professional fee for both the birthing person
22    and baby;
23        (2) a facility fee for the birthing person that is no
24    less than 75% of the statewide average facility payment



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1    rate made to a hospital for an uncomplicated vaginal
2    birth;
3        (3) a facility fee for the baby that is no less than
4    75% of the statewide average facility payment rate made to
5    a hospital for a normal baby; and
6        (4) additional fees for other services, medications,
7    laboratory tests, and supplies provided.
8    (c) A birth center shall provide charitable care
9consistent with that provided by comparable health care
10providers in the geographic area.
11    (d) A birth center may not discriminate against any
12patient requiring treatment because of the source of payment
13for services, including Medicare and Medicaid recipients.
14    Section 45. Reporting requirements. The Department shall
15by rule require each birth center to report information every
16year that is consistent with the birth center's license
17renewal schedule, which the Department shall make publicly
18available and which shall include the following:
19        (1) utilization data involving patient length of stay;
20        (2) admissions and discharges;
21        (3) complications;
22        (4) transfers;
23        (5) deaths;
24        (6) any other publicly reported data required under
25    the Consumer Guide to Health Care; and



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1        (7) post-discharge patient status data where patients
2    are followed for 14 days after discharge from the birth
3    center to determine whether the mother or baby developed a
4    complication or infection.
5    Section 50. Training. A birth center shall establish and
6implement a policy to ensure appropriate training and
7competency of individuals employed within the birth center.
8The policy shall, at a minimum, define the acts and practices
9that are allowed or prohibited for such employees, establish
10how training will be conducted, and illustrate how initial
11competency will be established.
12    Section 55. Inspections; special inspections; reports.
13    (a) The Department shall deem an accreditation body
14applicable to birth centers as a substitute for its own
15periodic inspection. The Department, whenever it determines
16necessary, may conduct a special inspection, survey, or
17evaluation of a birth center to assess compliance with
18licensure requirements and standards or a plan of correction
19submitted as a result of deficiencies cited by the Department
20or accrediting body.
21    (b) Upon the Department's completion of any special
22inspection, survey, or evaluation, the appropriate Department
23personnel who conducted the special inspection, survey, or
24evaluation shall submit a copy of his or her report to the



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1licensee upon exiting the birth center, and shall submit the
2actual report to the appropriate regional office.
3    (c) The Department's report and any recommendation for
4action under this Act shall be sent to the Department's
5central office together with a plan of correction from the
6birth center.
7    (d) The plan of correction may contain related comments or
8documentation provided by the birth center that may refute
9findings in the report, explain extenuating circumstances that
10the birth center could not reasonably have prevented, or
11indicate methods and timetables for correction of deficiencies
12described in the report.
13    (e) A birth center has 10 days after the date of the
14Department's special inspection, survey, or evaluation to
15submit a plan of correction. The Department shall determine
16whether a birth center is in violation of this Section no later
17than 60 days after completion of each special inspection,
18survey, evaluation, or plan of correction.
19    (f) The Department shall maintain all special inspection,
20survey, or evaluation reports for at least 5 years in a manner
21accessible to the public.
22    Section 60. Rules.
23    (a) The Department shall adopt rules for the
24administration and enforcement of this Act.
25    (b) Rules adopted by the Department under this Act shall



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2        (1) the eligibility criteria for birth center
3    admission that are consistent with accreditation standards
4    and the midwife's or physician's scope of practice;
5        (2) the necessary equipment for emergency care
6    according to the Commission for Accreditation of Birth
7    Centers' standards;
8        (3) the travel time distance from the birth center
9    that is not located within a rural area and a general acute
10    care hospital with which the birth center the maintains a
11    transfer agreement that allows for an emergency cesarean
12    delivery to be started within 30 minutes of the decision
13    that a cesarean delivery is necessary;
14        (4) the travel time distance from the birth center
15    that is located within a rural area and a general acute
16    care hospital with which the birth center maintains a
17    transfer agreement that allows for an emergency cesarean
18    delivery to be started within 45 minutes of the decision
19    that a cesarean delivery is necessary;
20        (5) that the use of general anesthesia at a birth
21    center is prohibited; and
22        (6) the equipment used by the birth center to ensure
23    that it is compatible with the health and safety of the
24    patients.
25    Section 99. Effective date. This Act takes effect upon



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1becoming law.".