Rep. Robyn Gabel

Filed: 4/15/2021





10200HB3995ham002LRB102 14648 CPF 25198 a


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;
16        (4) that offers prenatal care and community education



10200HB3995ham002- 2 -LRB102 14648 CPF 25198 a

1    services and coordinates these services with other health
2    care services available in the community; and
3        (5) that does not provide general anesthesia or
4    surgery.
5    "Certified nurse midwife" means an advanced practice
6registered nurse licensed in Illinois under the Nurse Practice
7Act with full practice authority or who is delegated such
8authority as part of a written collaborative agreement with a
9physician who is associated with the birthing center or who
10has privileges at a nearby birthing hospital.
11    "Department" means the Illinois Department of Public
13    "Hospital" does not include places where pregnant females
14are received, cared for, or treated during delivery if it is in
15a licensed birth center, nor include any facility required to
16be licensed as a birth center.
17    "Physician" means a physician licensed to practice
18medicine in all its branches in Illinois.
19    Section 10. License required. Except as provided by this
20Act, no person shall open, manage, conduct, offer, maintain,
21or advertise as a birth center without a valid license issued
22by the Department. All birth centers in existence as of the
23effective date of this Act shall obtain a valid license to
24operate within 2 years after the adoption of rules by the
25Department to implement this Act under Section 60.



10200HB3995ham002- 3 -LRB102 14648 CPF 25198 a

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



10200HB3995ham002- 4 -LRB102 14648 CPF 25198 a

1the Department under this Act.
2    (b) If, after obtaining an initial certificate of need
3under subsection (a), a birth center seeks to increase the bed
4capacity of the birth center, the birth center must obtain a
5certificate of need from the Health Facilities and Services
6Review Board before increasing the bed capacity.
7    (c) A birth center in a medically underserved area, as
8determined by the U.S. Department of Health and Human
9Services, shall receive priority in obtaining a certificate of
10need under this Section.
11    Section 20. Linkages.
12    (a) A birth center shall link and integrate its services
13with at least one birthing hospital with a minimum of a Level 1
14perinatal designation.
15    (b) A birth center shall have an established agreement
16with a nearby receiving birthing hospital with policies and
17procedures for timely transfer of maternal and neonatal
18patients. The agreement shall include a determination of
19maternal and neonatal conditions necessitating consultation
20and referral. This should include plans for communication with
21the receiving hospital before and after transfer.
22    Section 25. Staffing.
23    (a) A birth center shall have a clinical director, who may



10200HB3995ham002- 5 -LRB102 14648 CPF 25198 a

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



10200HB3995ham002- 6 -LRB102 14648 CPF 25198 a

1    attendance;
2        (2) has specialized training in labor and delivery
3    techniques and care of newborns; and
4        (3) receives planned and ongoing training as needed to
5    perform assigned duties effectively.
6    Section 30. Minimum standards.
7    (a) The Department's rules adopted pursuant to Section 60
8of this Act shall contain minimum standards to protect the
9health and safety of a patient of a birth center. In adopting
10rules for birth centers, the Department shall consider:
11        (1) the Commission for the Accreditation of Birth
12    Centers' Standards for Freestanding Birth Centers;
13        (2) the American Academy of Pediatrics and American
14    College of Obstetricians and Gynecologists Guidelines for
15    Perinatal Care; and
16        (3) the Regionalized Perinatal Health Care Code.
17    Section 35. Quality of care. The Department's rules shall
18provide for a time period within which each birth center must
19become accredited by either the Commission for the
20Accreditation of Freestanding Birth Centers or The Joint
22    A birth center shall implement a quality improvement
23program consistent with the requirements of the accrediting
24body and is encouraged to participate in quality improvement



10200HB3995ham002- 7 -LRB102 14648 CPF 25198 a

1projects implemented by the Department's Administrative
2Perinatal Centers and other Department-supported perinatal
3quality improvement projects. Clinicians, or their clinical
4representative, attending persons in labor at the birth center
5shall attend morbidity and mortality reviews that occur at the
6receiving birthing hospital on their patients, when invited,
7at a mutually agreeable time. This includes, but is not
8limited to, maternal and neonatal patients transferred to the
9receiving birthing hospital.
10    Section 40. Reimbursement requirements.
11    (a) A birth center shall seek certification under Titles
12XVIII and XIX of the federal Social Security Act.
13    (b) Reimbursement rates set by the Department of
14Healthcare and Family Services should be based on all types of
15medically necessary covered services provided to both the
16birthing person and the baby, including:
17        (1) a professional fee for both the birthing person
18    and baby;
19        (2) a facility fee for the birthing person that is no
20    less than 75% of the statewide average facility payment
21    rate made to a hospital for an uncomplicated vaginal
22    birth;
23        (3) a facility fee for the baby that is no less than
24    75% of the statewide average facility payment rate made to
25    a hospital for a normal baby; and



10200HB3995ham002- 8 -LRB102 14648 CPF 25198 a

1        (4) additional fees for other services, medications,
2    laboratory tests, and supplies provided.
3    (c) A birth center shall provide charitable care
4consistent with that provided by comparable health care
5providers in the geographic area.
6    (d) A birth center may not discriminate against any
7patient requiring treatment because of the source of payment
8for services, including Medicare and Medicaid recipients.
9    Section 45. Reporting requirements. The Department shall
10by rule require each birth center to report information every
11year that is consistent with the birth center's license
12renewal schedule, which the Department shall make publicly
13available and which shall include the following:
14        (1) utilization data involving patient length of stay;
15        (2) admissions and discharges;
16        (3) complications;
17        (4) transfers;
18        (5) deaths;
19        (6) any other publicly reported data required under
20    the Consumer Guide to Health Care; and
21        (7) post-discharge patient status data where patients
22    are followed for 14 days after discharge from the birth
23    center to determine whether the mother or baby developed a
24    complication or infection.



10200HB3995ham002- 9 -LRB102 14648 CPF 25198 a

1    Section 50. Training. A birth center shall, in
2consultation with the clinical director, establish and
3implement a policy to ensure appropriate training and
4competency of individuals employed within the birth center.
5The policy shall, at a minimum, define the acts and practices
6that are allowed or prohibited for such employees, establish
7how training will be conducted, and illustrate how initial
8competency will be established.
9    Section 55. Inspections; special inspections; reports.
10    (a) The Department, whenever it determines necessary, may
11conduct a special inspection, survey, or evaluation of a birth
12center to assess compliance with licensure requirements and
13standards or a plan of correction submitted as a result of
14deficiencies cited by the Department or an accrediting body.
15    (b) Upon the Department's completion of any special
16inspection, survey, or evaluation, the appropriate Department
17personnel who conducted the special inspection, survey, or
18evaluation shall submit a copy of his or her report to the
19licensee upon exiting the birth center, and shall submit the
20actual report to the appropriate regional office.
21    (c) The Department's report and any recommendation for
22action under this Act shall be sent to the Department's
23central office together with a plan of correction from the
24birth center.
25    (d) The plan of correction may contain related comments or



10200HB3995ham002- 10 -LRB102 14648 CPF 25198 a

1documentation provided by the birth center that may refute
2findings in the report, explain extenuating circumstances that
3the birth center could not reasonably have prevented, or
4indicate methods and timetables for correction of deficiencies
5described in the report.
6    (e) A birth center has 10 days after the date of the
7Department's special inspection, survey, or evaluation to
8submit a plan of correction. The Department shall determine
9whether a birth center is in violation of this Section no later
10than 60 days after completion of each special inspection,
11survey, evaluation, or plan of correction.
12    (f) The Department shall maintain all special inspection,
13survey, or evaluation reports for at least 5 years in a manner
14accessible to the public.
15    Section 60. Rules.
16    (a) The Department shall adopt rules for the
17administration and enforcement of this Act.
18    (b) Rules adopted by the Department under this Act shall
20        (1) the eligibility criteria for birth center
21    admission that are consistent with accreditation standards
22    and the certified nurse midwife's or physician's scope of
23    practice;
24        (2) the necessary equipment for emergency care
25    according to the Commission for Accreditation of Birth



10200HB3995ham002- 11 -LRB102 14648 CPF 25198 a

1    Centers' standards;
2        (3) the minimum elements required in the transfer
3    agreement between a birth center and a receiving birth
4    hospital with at least a Level 1 perinatal designation,
5    including the amount of travel time between facilities in
6    rural and nonrural areas, the staff required to transfer
7    patients, and the mode of emergency transportation between
8    facilities; and
9        (4) the equipment used by the birth center to ensure
10    that it is compatible with the health and safety of the
11    patients.
12    Section 99. Effective date. This Act takes effect upon
13becoming law.".