103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB4824

 

Introduced 2/7/2024, by Rep. Kevin John Olickal

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 170/40
215 ILCS 5/356z.71 new
305 ILCS 5/5-16.8
305 ILCS 5/5-18.3 new
305 ILCS 5/5-18.5

    Amends the Birth Center Licensing Act. Provides that all reimbursement rates set by the Department of Healthcare and Family Services for services provided at a birth center shall be equal to the reimbursement rates set by the Department for the same services provided at a hospital. Amends the Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for all services provided at a licensed birth center by a certified nurse midwife or a licensed certified professional midwife, including, but not limited to, prenatal care, labor and delivery care, care after birth, gynecological exams, and newborn care. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that notwithstanding any other provision of the Code, all services provided at a birth center by a certified nurse midwife or a licensed certified professional midwife, including, but not limited to, prenatal care, labor and delivery care, care after birth, gynecological exams, and newborn care shall be covered under the medical assistance program for persons who are otherwise eligible for medical assistance. Provides that all reimbursement rates set by the Department for services provided at a birth center shall be equal to the reimbursement rates set by the Department for the same services provided at a hospital. Requires the Department to seek a State Plan amendment or any federal waivers or approvals necessary to implement the provisions of the amendatory Act. Removes a provision providing that licensed certified professional midwife services shall be covered under the medical assistance program, subject to appropriation, and that the Department shall consult with midwives on reimbursement rates for midwifery services. Effective January 1, 2025.


LRB103 37229 KTG 67348 b

 

 

A BILL FOR

 

HB4824LRB103 37229 KTG 67348 b

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 Section 40 as follows:
 
6    (210 ILCS 170/40)
7    Sec. 40. Reimbursement requirements.
8    (a) A birth center shall seek certification under Titles
9XVIII and XIX of the federal Social Security Act.
10    (b) Reimbursement rates set by the Department of
11Healthcare and Family Services should be based on all types of
12medically necessary covered services provided to both the
13birthing person and the baby, including:
14        (1) a professional fee for both the birthing person
15    and baby;
16        (2) a facility fee for the birthing person that is
17    equal to no less than 75% of the statewide average
18    facility payment rate made to a hospital for an
19    uncomplicated vaginal birth;
20        (3) a facility fee for the baby that is equal to no
21    less than 75% of the statewide average facility payment
22    rate made to a hospital for a normal baby; and
23        (4) additional fees for other services, medications,

 

 

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1    laboratory tests, and supplies provided.
2    Notwithstanding any other law to the contrary, all
3reimbursement rates set by the Department of Healthcare and
4Family Services for services provided at a birth center shall
5be equal to the reimbursement rates set by the Department of
6Healthcare and Family Services for the same services provided
7at a hospital licensed under the Hospital Licensing Act.
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(Source: P.A. 102-518, eff. 8-20-21.)
 
15    Section 10. The Illinois Insurance Code is amended by
16adding Section 356z.71 as follows:
 
17    (215 ILCS 5/356z.71 new)
18    Sec. 356z.71. Coverage for birth center and midwife
19services. A group or individual policy of accident and health
20insurance or a managed care plan that is amended, delivered,
21issued, or renewed on or after January 1, 2025 shall provide
22coverage for all services provided at a birth center by a
23certified nurse midwife or a licensed certified professional
24midwife, including, but not limited to, prenatal care, labor

 

 

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1and delivery care, care after birth, gynecological exams, and
2newborn care. As use in this Section:
3        "Birth center" means a facility licensed under the
4    Birth Center Licensing Act.
5        "Certified nurse midwife" means an individual who is
6    licensed under the Nurse Practice Act as an advanced
7    practice registered nurse and is certified as a nurse
8    midwife.
9        "Licensed certified professional midwife" means a
10    person who has successfully met the requirements under
11    Section 45 of the Licensed Certified Professional Midwife
12    Practice Act and holds an active license to practice as a
13    licensed certified professional midwife in Illinois.
 
14    Section 15. The Illinois Public Aid Code is amended by
15changing Sections 5-16.8, 5-18.3, and 5-18.5 as follows:
 
16    (305 ILCS 5/5-16.8)
17    Sec. 5-16.8. Required health benefits. The medical
18assistance program shall (i) provide the post-mastectomy care
19benefits required to be covered by a policy of accident and
20health insurance under Section 356t and the coverage required
21under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
22356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
23356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
24356z.61, 356z.64, 356z.67, and 356z.71 of the Illinois

 

 

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1Insurance Code, (ii) be subject to the provisions of Sections
2356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
3Illinois Insurance Code, and (iii) be subject to the
4provisions of subsection (d-5) of Section 10 of the Network
5Adequacy and Transparency Act.
6    The Department, by rule, shall adopt a model similar to
7the requirements of Section 356z.39 of the Illinois Insurance
8Code.
9    On and after July 1, 2012, the Department shall reduce any
10rate of reimbursement for services or other payments or alter
11any methodologies authorized by this Code to reduce any rate
12of reimbursement for services or other payments in accordance
13with Section 5-5e.
14    To ensure full access to the benefits set forth in this
15Section, on and after January 1, 2016, the Department shall
16ensure that provider and hospital reimbursement for
17post-mastectomy care benefits required under this Section are
18no lower than the Medicare reimbursement rate.
19(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
20102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
211-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
22eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
23102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
241-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
 
25    (305 ILCS 5/5-18.3 new)

 

 

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1    Sec. 5-18.3. Birth center and midwife services.
2Notwithstanding any other provision of this Code, all services
3provided at a birth center by a certified nurse midwife or a
4licensed certified professional midwife, including, but not
5limited to, prenatal care, labor and delivery care, care after
6birth, gynecological exams, and newborn care shall be covered
7under the medical assistance program for persons who are
8otherwise eligible for medical assistance under this Article.
9All reimbursement rates set by the Department for services
10provided at a birth center shall be equal to the reimbursement
11rates set by the Department for the same services provided at a
12hospital licensed under the Hospital Licensing Act. The
13Department shall seek a State Plan amendment or any federal
14waivers or approvals necessary to implement this Section.
15Implementation of the coverage and reimbursement rates under
16this Section shall be contingent on federal approval. As used
17in this Section:
18        "Birth center" means a facility licensed under the
19    Birth Center Licensing Act.
20        "Certified nurse midwife" means an individual who is
21    licensed under the Nurse Practice Act as an advanced
22    practice registered nurse and is certified as a nurse
23    midwife.
24        "Licensed certified professional midwife" means a
25    person who has successfully met the requirements under
26    Section 45 of the Licensed Certified Professional Midwife

 

 

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1    Practice Act and holds an active license to practice as a
2    licensed certified professional midwife in Illinois.
 
3    (305 ILCS 5/5-18.5)
4    Sec. 5-18.5. Perinatal doula and evidence-based home
5visiting services.
6    (a) As used in this Section:
7    "Home visiting" means a voluntary, evidence-based strategy
8used to support pregnant people, infants, and young children
9and their caregivers to promote infant, child, and maternal
10health, to foster educational development and school
11readiness, and to help prevent child abuse and neglect. Home
12visitors are trained professionals whose visits and activities
13focus on promoting strong parent-child attachment to foster
14healthy child development.
15    "Perinatal doula" means a trained provider who provides
16regular, voluntary physical, emotional, and educational
17support, but not medical or midwife care, to pregnant and
18birthing persons before, during, and after childbirth,
19otherwise known as the perinatal period.
20    "Perinatal doula training" means any doula training that
21focuses on providing support throughout the prenatal, labor
22and delivery, or postpartum period, and reflects the type of
23doula care that the doula seeks to provide.
24    (b) Notwithstanding any other provision of this Article,
25perinatal doula services and evidence-based home visiting

 

 

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1services shall be covered under the medical assistance
2program, subject to appropriation, for persons who are
3otherwise eligible for medical assistance under this Article.
4Perinatal doula services include regular visits beginning in
5the prenatal period and continuing into the postnatal period,
6inclusive of continuous support during labor and delivery,
7that support healthy pregnancies and positive birth outcomes.
8Perinatal doula services may be embedded in an existing
9program, such as evidence-based home visiting. Perinatal doula
10services provided during the prenatal period may be provided
11weekly, services provided during the labor and delivery period
12may be provided for the entire duration of labor and the time
13immediately following birth, and services provided during the
14postpartum period may be provided up to 12 months postpartum.
15    (b-5) (Blank). Notwithstanding any other provision of this
16Article, beginning January 1, 2023, licensed certified
17professional midwife services shall be covered under the
18medical assistance program, subject to appropriation, for
19persons who are otherwise eligible for medical assistance
20under this Article. The Department shall consult with midwives
21on reimbursement rates for midwifery services.
22    (c) The Department of Healthcare and Family Services shall
23adopt rules to administer this Section. In this rulemaking,
24the Department shall consider the expertise of and consult
25with doula program experts, doula training providers,
26practicing doulas, and home visiting experts, along with State

 

 

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1agencies implementing perinatal doula services and relevant
2bodies under the Illinois Early Learning Council. This body of
3experts shall inform the Department on the credentials
4necessary for perinatal doula and home visiting services to be
5eligible for Medicaid reimbursement and the rate of
6reimbursement for home visiting and perinatal doula services
7in the prenatal, labor and delivery, and postpartum periods.
8Every 2 years, the Department shall assess the rates of
9reimbursement for perinatal doula and home visiting services
10and adjust rates accordingly.
11    (d) The Department shall seek such State plan amendments
12or waivers as may be necessary to implement this Section and
13shall secure federal financial participation for expenditures
14made by the Department in accordance with this Section.
15(Source: P.A. 102-4, eff. 4-27-21; 102-1037, eff. 6-2-22.)
 
16    Section 99. Effective date. This Act takes effect January
171, 2025.