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



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1authority as part of a written collaborative agreement with a
2physician who is associated with the birthing center or who
3has privileges at a nearby birthing hospital.
4    "Department" means the Illinois Department of Public
6    "Hospital" does not include places where pregnant females
7are received, cared for, or treated during delivery if it is in
8a licensed birth center, nor include any facility required to
9be licensed as a birth center.
10    "Physician" means a physician licensed to practice
11medicine in all its branches in Illinois.
12    Section 10. License required. Except as provided by this
13Act, no person shall open, manage, conduct, offer, maintain,
14or advertise as a birth center without a valid license issued
15by the Department. All birth centers in existence as of the
16effective date of this Act shall obtain a valid license to
17operate within 2 years after the adoption of rules by the
18Department to implement this Act under Section 60.
19    Section 15. Issuance and renewal of license.
20    (a) An applicant for a license under this Act shall submit
21an application on forms prescribed by the Department. Each
22application shall be accompanied by a nonrefundable license
23fee, as established by rule by the Department under Section



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



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1determined by the U.S. Department of Health and Human
2Services, shall receive priority in obtaining a certificate of
3need under this Section.
4    Section 20. Linkages.
5    (a) A birth center shall link and integrate its services
6with at least one birthing hospital with a minimum of a Level 1
7perinatal designation.
8    (b) A birth center shall have an established agreement
9with a nearby receiving birthing hospital with policies and
10procedures for timely transfer of maternal and neonatal
11patients. The agreement shall include a determination of
12maternal and neonatal conditions necessitating consultation
13and referral. This should include plans for communication with
14the receiving hospital before and after transfer.
15    Section 25. Staffing.
16    (a) A birth center shall have a clinical director, who may
18        (1) a physician who is either certified or eligible
19    for certification by the American College of Obstetricians
20    and Gynecologists or the American Board of Osteopathic
21    Obstetricians and Gynecologists or has hospital
22    obstetrical privileges; or
23        (2) a certified nurse midwife.
24    (b) The clinical director shall be responsible for:



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1        (1) the development of policies and procedures for
2    services as provided by Department rules;
3        (2) coordinating the clinical staff and overall
4    provision of patient care;
5        (3) developing and approving policies defining the
6    criteria to determine which pregnancies are accepted as
7    normal, uncomplicated, and low-risk; and
8        (4) developing and approving policing regarding the
9    anesthesia services available at the center.
10    (c) An obstetrician, family practitioner, or certified
11nurse midwife shall attend each person in labor from the time
12of admission through birth and throughout the immediate
13postpartum period. Attendance may be delegated only to another
14physician or a certified nurse midwife.
15    (d) A second staff person shall be present at each birth
17        (1) is licensed or certified in Illinois in a
18    health-related field and under the supervision of a
19    physician or a certified nurse midwife who is in
20    attendance;
21        (2) has specialized training in labor and delivery
22    techniques and care of newborns; and
23        (3) receives planned and ongoing training as needed to
24    perform assigned duties effectively.
25    Section 30. Minimum standards.



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1    (a) The Department's rules adopted pursuant to Section 60
2of this Act shall contain minimum standards to protect the
3health and safety of a patient of a birth center. In adopting
4rules for birth centers, the Department shall consider:
5        (1) the Commission for the Accreditation of Birth
6    Centers' Standards for Freestanding Birth Centers;
7        (2) the American Academy of Pediatrics and American
8    College of Obstetricians and Gynecologists Guidelines for
9    Perinatal Care; and
10        (3) the Regionalized Perinatal Health Care Code.
11    Section 35. Quality of care. The Department's rules shall
12provide for a time period within which each birth center must
13become accredited by either the Commission for the
14Accreditation of Freestanding Birth Centers or The Joint
16    A birth center shall implement a quality improvement
17program consistent with the requirements of the accrediting
18body and is encouraged to participate in quality improvement
19projects implemented by the Department's Administrative
20Perinatal Centers and other Department-supported perinatal
21quality improvement projects. Clinicians, or their clinical
22representative, attending persons in labor at the birth center
23shall attend morbidity and mortality reviews that occur at the
24receiving birthing hospital on their patients, when invited,
25at a mutually agreeable time. This includes, but is not



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1limited to, maternal and neonatal patients transferred to the
2receiving birthing hospital.
3    Section 40. Reimbursement requirements.
4    (a) A birth center shall seek certification under Titles
5XVIII and XIX of the federal Social Security Act.
6    (b) Reimbursement rates set by the Department of
7Healthcare and Family Services should be based on all types of
8medically necessary covered services provided to both the
9birthing person and the baby, including:
10        (1) a professional fee for both the birthing person
11    and baby;
12        (2) a facility fee for the birthing person that is no
13    less than 75% of the statewide average facility payment
14    rate made to a hospital for an uncomplicated vaginal
15    birth;
16        (3) a facility fee for the baby that is no less than
17    75% of the statewide average facility payment rate made to
18    a hospital for a normal baby; and
19        (4) additional fees for other services, medications,
20    laboratory tests, and supplies provided.
21    (c) A birth center shall provide charitable care
22consistent with that provided by comparable health care
23providers in the geographic area.
24    (d) A birth center may not discriminate against any
25patient requiring treatment because of the source of payment



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1for services, including Medicare and Medicaid recipients.
2    Section 45. Reporting requirements. The Department shall
3by rule require each birth center to report information every
4year that is consistent with the birth center's license
5renewal schedule, which the Department shall make publicly
6available and which shall include the following:
7        (1) utilization data involving patient length of stay;
8        (2) admissions and discharges;
9        (3) complications;
10        (4) transfers;
11        (5) deaths;
12        (6) any other publicly reported data required under
13    the Consumer Guide to Health Care; and
14        (7) post-discharge patient status data where patients
15    are followed for 14 days after discharge from the birth
16    center to determine whether the mother or baby developed a
17    complication or infection.
18    Section 50. Training. A birth center shall, in
19consultation with the clinical director, establish and
20implement a policy to ensure appropriate training and
21competency of individuals employed within the birth center.
22The policy shall, at a minimum, define the acts and practices
23that are allowed or prohibited for such employees, establish
24how training will be conducted, and illustrate how initial



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1competency will be established.
2    Section 55. Inspections; special inspections; reports.
3    (a) The Department, whenever it determines necessary, may
4conduct a special inspection, survey, or evaluation of a birth
5center to assess compliance with licensure requirements and
6standards or a plan of correction submitted as a result of
7deficiencies cited by the Department or an accrediting body.
8    (b) Upon the Department's completion of any special
9inspection, survey, or evaluation, the appropriate Department
10personnel who conducted the special inspection, survey, or
11evaluation shall submit a copy of his or her report to the
12licensee upon exiting the birth center, and shall submit the
13actual report to the appropriate regional office.
14    (c) The Department's report and any recommendation for
15action under this Act shall be sent to the Department's
16central office together with a plan of correction from the
17birth center.
18    (d) The plan of correction may contain related comments or
19documentation provided by the birth center that may refute
20findings in the report, explain extenuating circumstances that
21the birth center could not reasonably have prevented, or
22indicate methods and timetables for correction of deficiencies
23described in the report.
24    (e) A birth center has 10 days after the date of the
25Department's special inspection, survey, or evaluation to



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1submit a plan of correction. The Department shall determine
2whether a birth center is in violation of this Section no later
3than 60 days after completion of each special inspection,
4survey, evaluation, or plan of correction.
5    (f) The Department shall maintain all special inspection,
6survey, or evaluation reports for at least 5 years in a manner
7accessible to the public.
8    Section 60. Rules.
9    (a) The Department shall adopt rules for the
10administration and enforcement of this Act.
11    (b) Rules adopted by the Department under this Act shall
13        (1) the eligibility criteria for birth center
14    admission that are consistent with accreditation standards
15    and the certified nurse midwife's or physician's scope of
16    practice;
17        (2) the necessary equipment for emergency care
18    according to the Commission for Accreditation of Birth
19    Centers' standards;
20        (3) the minimum elements required in the transfer
21    agreement between a birth center and a receiving birth
22    hospital with at least a Level 1 perinatal designation,
23    including the amount of travel time between facilities in
24    rural and nonrural areas, the staff required to transfer
25    patients, and the mode of emergency transportation between



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1    facilities; and
2        (4) the equipment used by the birth center to ensure
3    that it is compatible with the health and safety of the
4    patients.
5    Section 99. Effective date. This Act takes effect upon
6becoming law.