Bill Amendment: IL HB4824 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: MEDICAID-BIRTH CENTER RATES
Status: 2024-05-31 - House Committee Amendment No. 1 Rule 19(c) / Re-referred to Rules Committee [HB4824 Detail]
Download: Illinois-2023-HB4824-House_Amendment_001.html
Bill Title: MEDICAID-BIRTH CENTER RATES
Status: 2024-05-31 - House Committee Amendment No. 1 Rule 19(c) / Re-referred to Rules Committee [HB4824 Detail]
Download: Illinois-2023-HB4824-House_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 4824 | ||||||
2 | AMENDMENT NO. ______. Amend House Bill 4824 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Birth Center Licensing Act is amended by | ||||||
5 | changing Section 40 as follows:
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6 | (210 ILCS 170/40) | ||||||
7 | Sec. 40. Reimbursement requirements. | ||||||
8 | (a) A birth center shall seek certification under Titles | ||||||
9 | XVIII and XIX of the federal Social Security Act. | ||||||
10 | (b) Reimbursement rates set by the Department of | ||||||
11 | Healthcare and Family Services should be based on all types of | ||||||
12 | medically necessary covered services provided to both the | ||||||
13 | birthing 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 |
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1 | equal to no less than 75% of the statewide average | ||||||
2 | facility payment rate made to a hospital for an | ||||||
3 | uncomplicated vaginal birth; | ||||||
4 | (3) a facility fee for the baby that is equal to no | ||||||
5 | less than 75% of the statewide average facility payment | ||||||
6 | rate made to a hospital for a normal baby; and | ||||||
7 | (4) additional fees for other services, medications, | ||||||
8 | laboratory tests, and supplies provided. | ||||||
9 | Notwithstanding any other law to the contrary, all | ||||||
10 | reimbursement rates set by the Department of Healthcare and | ||||||
11 | Family Services for services provided at a birth center shall | ||||||
12 | be equal to the reimbursement rates set by the Department of | ||||||
13 | Healthcare and Family Services for the same services provided | ||||||
14 | at a hospital licensed under the Hospital Licensing Act. | ||||||
15 | (c) A birth center shall provide charitable care | ||||||
16 | consistent with that provided by comparable health care | ||||||
17 | providers in the geographic area. | ||||||
18 | (d) A birth center may not discriminate against any | ||||||
19 | patient requiring treatment because of the source of payment | ||||||
20 | for services, including Medicare and Medicaid recipients. | ||||||
21 | (Source: P.A. 102-518, eff. 8-20-21.)
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22 | Section 10. The Illinois Insurance Code is amended by | ||||||
23 | adding Section 356z.71 as follows:
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24 | (215 ILCS 5/356z.71 new) |
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1 | Sec. 356z.71. Coverage for birth center and midwife | ||||||
2 | services. A group or individual policy of accident and health | ||||||
3 | insurance or a managed care plan that is amended, delivered, | ||||||
4 | issued, or renewed on or after January 1, 2025 shall provide | ||||||
5 | coverage for all services provided at a birth center by a | ||||||
6 | certified nurse midwife or a licensed certified professional | ||||||
7 | midwife, including, but not limited to, prenatal care, labor | ||||||
8 | and delivery care, care after birth, gynecological exams, and | ||||||
9 | newborn care. As use in this Section: | ||||||
10 | "Birth center" means a facility licensed under the | ||||||
11 | Birth Center Licensing Act. | ||||||
12 | "Certified nurse midwife" means an individual who is | ||||||
13 | licensed under the Nurse Practice Act as an advanced | ||||||
14 | practice registered nurse and is certified as a nurse | ||||||
15 | midwife. | ||||||
16 | "Licensed certified professional midwife" means a | ||||||
17 | person who has successfully met the requirements under | ||||||
18 | Section 45 of the Licensed Certified Professional Midwife | ||||||
19 | Practice Act and holds an active license to practice as a | ||||||
20 | licensed certified professional midwife in Illinois.
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21 | Section 15. The Illinois Public Aid Code is amended by | ||||||
22 | changing Sections 5-16.8, 5-18.3, and 5-18.5 as follows:
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23 | (305 ILCS 5/5-16.8) | ||||||
24 | Sec. 5-16.8. Required health benefits. The medical |
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1 | assistance program shall (i) provide the post-mastectomy care | ||||||
2 | benefits required to be covered by a policy of accident and | ||||||
3 | health insurance under Section 356t and the coverage required | ||||||
4 | under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, | ||||||
5 | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, | ||||||
6 | 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and | ||||||
7 | 356z.61 , 356z.64, 356z.67, and 356z.71 of the Illinois | ||||||
8 | Insurance Code, (ii) be subject to the provisions of Sections | ||||||
9 | 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the | ||||||
10 | Illinois Insurance Code, and (iii) be subject to the | ||||||
11 | provisions of subsection (d-5) of Section 10 of the Network | ||||||
12 | Adequacy and Transparency Act. | ||||||
13 | The Department, by rule, shall adopt a model similar to | ||||||
14 | the requirements of Section 356z.39 of the Illinois Insurance | ||||||
15 | Code. | ||||||
16 | On and after July 1, 2012, the Department shall reduce any | ||||||
17 | rate of reimbursement for services or other payments or alter | ||||||
18 | any methodologies authorized by this Code to reduce any rate | ||||||
19 | of reimbursement for services or other payments in accordance | ||||||
20 | with Section 5-5e. | ||||||
21 | To ensure full access to the benefits set forth in this | ||||||
22 | Section, on and after January 1, 2016, the Department shall | ||||||
23 | ensure that provider and hospital reimbursement for | ||||||
24 | post-mastectomy care benefits required under this Section are | ||||||
25 | no lower than the Medicare reimbursement rate. | ||||||
26 | (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; |
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1 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. | ||||||
2 | 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, | ||||||
3 | eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||||||
4 | 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | ||||||
5 | 1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
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6 | (305 ILCS 5/5-18.3 new) | ||||||
7 | Sec. 5-18.3. Birth center and midwife services. | ||||||
8 | Notwithstanding any other provision of this Code, all services | ||||||
9 | provided at a birth center by a certified nurse midwife or a | ||||||
10 | licensed certified professional midwife, including, but not | ||||||
11 | limited to, prenatal care, labor and delivery care, care after | ||||||
12 | birth, gynecological exams, and newborn care shall be covered | ||||||
13 | under the medical assistance program for persons who are | ||||||
14 | otherwise eligible for medical assistance under this Article. | ||||||
15 | All reimbursement rates set by the Department for services | ||||||
16 | provided at a birth center shall be equal to the reimbursement | ||||||
17 | rates set by the Department for the same services provided at a | ||||||
18 | hospital licensed under the Hospital Licensing Act. The | ||||||
19 | Department shall seek a State Plan amendment or any federal | ||||||
20 | waivers or approvals necessary to implement this Section. | ||||||
21 | Implementation of the coverage and reimbursement rates under | ||||||
22 | this Section shall be contingent on federal approval. As used | ||||||
23 | in this Section: | ||||||
24 | "Birth center" means a facility licensed under the | ||||||
25 | Birth Center Licensing Act. |
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1 | "Certified nurse midwife" means an individual who is | ||||||
2 | licensed under the Nurse Practice Act as an advanced | ||||||
3 | practice registered nurse and is certified as a nurse | ||||||
4 | midwife. | ||||||
5 | "Licensed certified professional midwife" means a | ||||||
6 | person who has successfully met the requirements under | ||||||
7 | Section 45 of the Licensed Certified Professional Midwife | ||||||
8 | Practice Act and holds an active license to practice as a | ||||||
9 | licensed certified professional midwife in Illinois.
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10 | (305 ILCS 5/5-18.5) | ||||||
11 | Sec. 5-18.5. Perinatal doula and evidence-based home | ||||||
12 | visiting services. | ||||||
13 | (a) As used in this Section: | ||||||
14 | "Home visiting" means a voluntary, evidence-based strategy | ||||||
15 | used to support pregnant people, infants, and young children | ||||||
16 | and their caregivers to promote infant, child, and maternal | ||||||
17 | health, to foster educational development and school | ||||||
18 | readiness, and to help prevent child abuse and neglect. Home | ||||||
19 | visitors are trained professionals whose visits and activities | ||||||
20 | focus on promoting strong parent-child attachment to foster | ||||||
21 | healthy child development. | ||||||
22 | "Perinatal doula" means a trained provider who provides | ||||||
23 | regular, voluntary physical, emotional, and educational | ||||||
24 | support, but not medical or midwife care, to pregnant and | ||||||
25 | birthing persons before, during, and after childbirth, |
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1 | otherwise known as the perinatal period. | ||||||
2 | "Perinatal doula training" means any doula training that | ||||||
3 | focuses on providing support throughout the prenatal, labor | ||||||
4 | and delivery, or postpartum period, and reflects the type of | ||||||
5 | doula care that the doula seeks to provide. | ||||||
6 | (b) Notwithstanding any other provision of this Article, | ||||||
7 | perinatal doula services and evidence-based home visiting | ||||||
8 | services shall be covered under the medical assistance | ||||||
9 | program, subject to appropriation, for persons who are | ||||||
10 | otherwise eligible for medical assistance under this Article. | ||||||
11 | Perinatal doula services include regular visits beginning in | ||||||
12 | the prenatal period and continuing into the postnatal period, | ||||||
13 | inclusive of continuous support during labor and delivery, | ||||||
14 | that support healthy pregnancies and positive birth outcomes. | ||||||
15 | Perinatal doula services may be embedded in an existing | ||||||
16 | program, such as evidence-based home visiting. Perinatal doula | ||||||
17 | services provided during the prenatal period may be provided | ||||||
18 | weekly, services provided during the labor and delivery period | ||||||
19 | may be provided for the entire duration of labor and the time | ||||||
20 | immediately following birth, or and services provided during | ||||||
21 | the postpartum period may be provided up to 12 months | ||||||
22 | postpartum. | ||||||
23 | (b-5) (Blank). Notwithstanding any other provision of this | ||||||
24 | Article, beginning January 1, 2023, licensed certified | ||||||
25 | professional midwife services shall be covered under the | ||||||
26 | medical assistance program, subject to appropriation, for |
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1 | persons who are otherwise eligible for medical assistance | ||||||
2 | under this Article. The Department shall consult with midwives | ||||||
3 | on reimbursement rates for midwifery services. | ||||||
4 | (c) The Department of Healthcare and Family Services shall | ||||||
5 | adopt rules to administer this Section. In this rulemaking, | ||||||
6 | the Department shall consider the expertise of and consult | ||||||
7 | with doula program experts, doula training providers, | ||||||
8 | practicing doulas, and home visiting experts, along with State | ||||||
9 | agencies implementing perinatal doula services and relevant | ||||||
10 | bodies under the Illinois Early Learning Council. This body of | ||||||
11 | experts shall inform the Department on the credentials | ||||||
12 | necessary for perinatal doula and home visiting services to be | ||||||
13 | eligible for Medicaid reimbursement and the rate of | ||||||
14 | reimbursement for home visiting and perinatal doula services | ||||||
15 | in the prenatal, labor and delivery, and postpartum periods. | ||||||
16 | Every 2 years, the Department shall assess the rates of | ||||||
17 | reimbursement for perinatal doula and home visiting services | ||||||
18 | and adjust rates accordingly. | ||||||
19 | (d) The Department shall seek such State plan amendments | ||||||
20 | or waivers as may be necessary to implement this Section and | ||||||
21 | shall secure federal financial participation for expenditures | ||||||
22 | made by the Department in accordance with this Section. | ||||||
23 | (Source: P.A. 102-4, eff. 4-27-21; 102-1037, eff. 6-2-22.)
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