Bill Text: IL HB4824 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: 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.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-05-31 - House Committee Amendment No. 1 Rule 19(c) / Re-referred to Rules Committee [HB4824 Detail]

Download: Illinois-2023-HB4824-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4824 Introduced , 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
HB4824 LRB103 37229 KTG 67348 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Birth Center Licensing Act is amended by
changing Section 40 as follows:
(210 ILCS 170/40)
Sec. 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
equal to no less than 75% of the statewide average
facility payment rate made to a hospital for an
uncomplicated vaginal birth;
(3) a facility fee for the baby that is equal to 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,

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laboratory tests, and supplies provided.
Notwithstanding any other law to the contrary, 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 of
Healthcare and Family Services for the same services provided
at a hospital licensed under the Hospital Licensing Act.
(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.
(Source: P.A. 102-518, eff. 8-20-21.)
Section 10. The Illinois Insurance Code is amended by
adding Section 356z.71 as follows:
(215 ILCS 5/356z.71 new)
Sec. 356z.71. Coverage for birth center and midwife
services. 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 birth center by a
certified nurse midwife or a licensed certified professional
midwife, including, but not limited to, prenatal care, labor

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

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

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Sec. 5-18.3. Birth center and midwife services.
Notwithstanding any other provision of this 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 under this Article.
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 licensed under the Hospital Licensing Act. The
Department shall seek a State Plan amendment or any federal
waivers or approvals necessary to implement this Section.
Implementation of the coverage and reimbursement rates under
this Section shall be contingent on federal approval. As used
in this Section:
"Birth center" means a facility licensed under the
Birth Center Licensing Act.
"Certified nurse midwife" means an individual who is
licensed under the Nurse Practice Act as an advanced
practice registered nurse and is certified as a nurse
midwife.
"Licensed certified professional midwife" means a
person who has successfully met the requirements under
Section 45 of the Licensed Certified Professional Midwife

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

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

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agencies implementing perinatal doula services and relevant
bodies under the Illinois Early Learning Council. This body of
experts shall inform the Department on the credentials
necessary for perinatal doula and home visiting services to be
eligible for Medicaid reimbursement and the rate of
reimbursement for home visiting and perinatal doula services
in the prenatal, labor and delivery, and postpartum periods.
Every 2 years, the Department shall assess the rates of
reimbursement for perinatal doula and home visiting services
and adjust rates accordingly.
(d) The Department shall seek such State plan amendments
or waivers as may be necessary to implement this Section and
shall secure federal financial participation for expenditures
made by the Department in accordance with this Section.
(Source: P.A. 102-4, eff. 4-27-21; 102-1037, eff. 6-2-22.)