Public Act 102-0518
HB3995 EnrolledLRB102 14648 CPF 21906 b

    AN ACT concerning regulation.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 1. Short title. This Act may be cited as the Birth
Center Licensing Act.
    Section 5. Definitions. In this Act:
    "Birth center" means a designated site, other than a
        (1) in which births are planned to occur following a
    normal, uncomplicated, and low-risk pregnancy;
        (2) that is not the pregnant person's usual place of
        (3) that is exclusively dedicated to serving the
    childbirth-related needs of pregnant persons and their
    newborns, and has no more than 10 beds;
        (4) that offers prenatal care and community education
    services and coordinates these services with other health
    care services available in the community; and
        (5) that does not provide general anesthesia or
    "Certified nurse midwife" means an advanced practice
registered nurse licensed in Illinois under the Nurse Practice
Act with full practice authority or who is delegated such
authority as part of a written collaborative agreement with a
physician who is associated with the birthing center or who
has privileges at a nearby birthing hospital.
    "Department" means the Illinois Department of Public
    "Hospital" does not include places where pregnant females
are received, cared for, or treated during delivery if it is in
a licensed birth center, nor include any facility required to
be licensed as a birth center.
    "Physician" means a physician licensed to practice
medicine in all its branches in Illinois.
    Section 10. License required. Except as provided by this
Act, no person shall open, manage, conduct, offer, maintain,
or advertise as a birth center without a valid license issued
by the Department. All birth centers in existence as of the
effective date of this Act shall obtain a valid license to
operate within 2 years after the adoption of rules by the
Department to implement this Act under Section 60.
    Section 15. Issuance and renewal of license.
    (a) An applicant for a license under this Act shall submit
an application on forms prescribed by the Department. Each
application shall be accompanied by a nonrefundable license
fee, as established by rule by the Department under Section
    (b) The Department may grant a temporary initial license
to an applicant. A temporary initial license expires on the
earlier of the date the Department denies the license or the
date 6 months after the temporary initial license was issued.
    (c) The Department shall issue a license under this Act
if, after application, inspection, and investigation, it finds
the applicant meets the requirements of this Act and the rules
and standards adopted pursuant to this Act.
    (d) A license is renewable every year upon submission of:
(i) the renewal application and fee and (ii) a report on a form
prescribed by the Department that includes information related
to quality of care at a birth center. The report must be in the
form and documented by evidence as required by the Department
by rule under Section 60.
    Section 17. Certificate of need; licenses.
    (a) A birth center shall obtain a certificate of need from
the Health Facilities and Services Review Board under the
Health Facilities Planning Act before receiving a license by
the Department under this Act.
    (b) If, after obtaining an initial certificate of need
under subsection (a), a birth center seeks to increase the bed
capacity of the birth center, the birth center must obtain a
certificate of need from the Health Facilities and Services
Review Board before increasing the bed capacity.
    (c) A birth center in a medically underserved area, as
determined by the U.S. Department of Health and Human
Services, shall receive priority in obtaining a certificate of
need under this Section.
    Section 20. Linkages.
    (a) A birth center shall link and integrate its services
with at least one birthing hospital with a minimum of a Level 1
perinatal designation.
    (b) A birth center shall have an established agreement
with a nearby receiving birthing hospital with policies and
procedures for timely transfer of maternal and neonatal
patients. The agreement shall include a determination of
maternal and neonatal conditions necessitating consultation
and referral. This should include plans for communication with
the receiving hospital before and after transfer.
    Section 25. Staffing.
    (a) A birth center shall have a clinical director, who may
        (1) a physician who is either certified or eligible
    for certification by the American College of Obstetricians
    and Gynecologists or the American Board of Osteopathic
    Obstetricians and Gynecologists or has hospital
    obstetrical privileges; or
        (2) a certified nurse midwife.
    (b) The clinical director shall be responsible for:
        (1) the development of policies and procedures for
    services as provided by Department rules;
        (2) coordinating the clinical staff and overall
    provision of patient care;
        (3) developing and approving policies defining the
    criteria to determine which pregnancies are accepted as
    normal, uncomplicated, and low-risk; and
        (4) developing and approving policing regarding the
    anesthesia services available at the center.
    (c) An obstetrician, family practitioner, or certified
nurse midwife shall attend each person in labor from the time
of admission through birth and throughout the immediate
postpartum period. Attendance may be delegated only to another
physician or a certified nurse midwife.
    (d) A second staff person shall be present at each birth
        (1) is licensed or certified in Illinois in a
    health-related field and under the supervision of a
    physician or a certified nurse midwife who is in
        (2) has specialized training in labor and delivery
    techniques and care of newborns; and
        (3) receives planned and ongoing training as needed to
    perform assigned duties effectively.
    Section 30. Minimum standards.
    (a) The Department's rules adopted pursuant to Section 60
of this Act shall contain minimum standards to protect the
health and safety of a patient of a birth center. In adopting
rules for birth centers, the Department shall consider:
        (1) the Commission for the Accreditation of Birth
    Centers' Standards for Freestanding Birth Centers;
        (2) the American Academy of Pediatrics and American
    College of Obstetricians and Gynecologists Guidelines for
    Perinatal Care; and
        (3) the Regionalized Perinatal Health Care Code.
    Section 35. Quality of care. The Department's rules shall
provide for a time period within which each birth center must
become accredited by either the Commission for the
Accreditation of Freestanding Birth Centers or The Joint
    A birth center shall implement a quality improvement
program consistent with the requirements of the accrediting
body and is encouraged to participate in quality improvement
projects implemented by the Department's Administrative
Perinatal Centers and other Department-supported perinatal
quality improvement projects. Clinicians, or their clinical
representative, attending persons in labor at the birth center
shall attend morbidity and mortality reviews that occur at the
receiving birthing hospital on their patients, when invited,
at a mutually agreeable time. This includes, but is not
limited to, maternal and neonatal patients transferred to the
receiving birthing hospital.
    Section 40. Reimbursement requirements.
    (a) A birth center shall seek certification under Titles
XVIII and XIX of the federal Social Security Act.
    (b) Reimbursement rates set by the Department of
Healthcare and Family Services should be based on all types of
medically necessary covered services provided to both the
birthing person and the baby, including:
        (1) a professional fee for both the birthing person
    and baby;
        (2) a facility fee for the birthing person that is no
    less than 75% of the statewide average facility payment
    rate made to a hospital for an uncomplicated vaginal
        (3) a facility fee for the baby that is no less than
    75% of the statewide average facility payment rate made to
    a hospital for a normal baby; and
        (4) additional fees for other services, medications,
    laboratory tests, and supplies provided.
    (c) A birth center shall provide charitable care
consistent with that provided by comparable health care
providers in the geographic area.
    (d) A birth center may not discriminate against any
patient requiring treatment because of the source of payment
for services, including Medicare and Medicaid recipients.
    Section 45. Reporting requirements. The Department shall
by rule require each birth center to report information every
year that is consistent with the birth center's license
renewal schedule, which the Department shall make publicly
available and which shall include the following:
        (1) utilization data involving patient length of stay;
        (2) admissions and discharges;
        (3) complications;
        (4) transfers;
        (5) deaths;
        (6) any other publicly reported data required under
    the Consumer Guide to Health Care; and
        (7) post-discharge patient status data where patients
    are followed for 14 days after discharge from the birth
    center to determine whether the mother or baby developed a
    complication or infection.
    Section 50. Training. A birth center shall, in
consultation with the clinical director, establish and
implement a policy to ensure appropriate training and
competency of individuals employed within the birth center.
The policy shall, at a minimum, define the acts and practices
that are allowed or prohibited for such employees, establish
how training will be conducted, and illustrate how initial
competency will be established.
    Section 55. Inspections; special inspections; reports.
    (a) The Department, whenever it determines necessary, may
conduct a special inspection, survey, or evaluation of a birth
center to assess compliance with licensure requirements and
standards or a plan of correction submitted as a result of
deficiencies cited by the Department or an accrediting body.
    (b) Upon the Department's completion of any special
inspection, survey, or evaluation, the appropriate Department
personnel who conducted the special inspection, survey, or
evaluation shall submit a copy of his or her report to the
licensee upon exiting the birth center, and shall submit the
actual report to the appropriate regional office.
    (c) The Department's report and any recommendation for
action under this Act shall be sent to the Department's
central office together with a plan of correction from the
birth center.
    (d) The plan of correction may contain related comments or
documentation provided by the birth center that may refute
findings in the report, explain extenuating circumstances that
the birth center could not reasonably have prevented, or
indicate methods and timetables for correction of deficiencies
described in the report.
    (e) A birth center has 10 days after the date of the
Department's special inspection, survey, or evaluation to
submit a plan of correction. The Department shall determine
whether a birth center is in violation of this Section no later
than 60 days after completion of each special inspection,
survey, evaluation, or plan of correction.
    (f) The Department shall maintain all special inspection,
survey, or evaluation reports for at least 5 years in a manner
accessible to the public.
    Section 60. Rules.
    (a) The Department shall adopt rules for the
administration and enforcement of this Act.
    (b) Rules adopted by the Department under this Act shall
        (1) the eligibility criteria for birth center
    admission that are consistent with accreditation standards
    and the certified nurse midwife's or physician's scope of
        (2) the necessary equipment for emergency care
    according to the Commission for Accreditation of Birth
    Centers' standards;
        (3) the minimum elements required in the transfer
    agreement between a birth center and a receiving birth
    hospital with at least a Level 1 perinatal designation,
    including the amount of travel time between facilities in
    rural and nonrural areas, the staff required to transfer
    patients, and the mode of emergency transportation between
    facilities; and
        (4) the equipment used by the birth center to ensure
    that it is compatible with the health and safety of the
    Section 99. Effective date. This Act takes effect upon
becoming law.