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Illinois House Bill HB4824

Illinois 2023-2024 Regular Session

Illinois House Bill HB4824 Compare Versions

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11 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4824 Introduced , by Rep. Kevin John Olickal SYNOPSIS AS INTRODUCED: 210 ILCS 170/40215 ILCS 5/356z.71 new305 ILCS 5/5-16.8305 ILCS 5/5-18.3 new305 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 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4824 Introduced , by Rep. Kevin John Olickal SYNOPSIS AS INTRODUCED: 210 ILCS 170/40215 ILCS 5/356z.71 new305 ILCS 5/5-16.8305 ILCS 5/5-18.3 new305 ILCS 5/5-18.5 210 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 LRB103 37229 KTG 67348 b A BILL FOR
22 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4824 Introduced , by Rep. Kevin John Olickal SYNOPSIS AS INTRODUCED:
33 210 ILCS 170/40215 ILCS 5/356z.71 new305 ILCS 5/5-16.8305 ILCS 5/5-18.3 new305 ILCS 5/5-18.5 210 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
44 210 ILCS 170/40
55 215 ILCS 5/356z.71 new
66 305 ILCS 5/5-16.8
77 305 ILCS 5/5-18.3 new
88 305 ILCS 5/5-18.5
99 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.
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1515 1 AN ACT concerning public aid.
1616 2 Be it enacted by the People of the State of Illinois,
1717 3 represented in the General Assembly:
1818 4 Section 5. The Birth Center Licensing Act is amended by
1919 5 changing Section 40 as follows:
2020 6 (210 ILCS 170/40)
2121 7 Sec. 40. Reimbursement requirements.
2222 8 (a) A birth center shall seek certification under Titles
2323 9 XVIII and XIX of the federal Social Security Act.
2424 10 (b) Reimbursement rates set by the Department of
2525 11 Healthcare and Family Services should be based on all types of
2626 12 medically necessary covered services provided to both the
2727 13 birthing person and the baby, including:
2828 14 (1) a professional fee for both the birthing person
2929 15 and baby;
3030 16 (2) a facility fee for the birthing person that is
3131 17 equal to no less than 75% of the statewide average
3232 18 facility payment rate made to a hospital for an
3333 19 uncomplicated vaginal birth;
3434 20 (3) a facility fee for the baby that is equal to no
3535 21 less than 75% of the statewide average facility payment
3636 22 rate made to a hospital for a normal baby; and
3737 23 (4) additional fees for other services, medications,
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4141 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4824 Introduced , by Rep. Kevin John Olickal SYNOPSIS AS INTRODUCED:
4242 210 ILCS 170/40215 ILCS 5/356z.71 new305 ILCS 5/5-16.8305 ILCS 5/5-18.3 new305 ILCS 5/5-18.5 210 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
4343 210 ILCS 170/40
4444 215 ILCS 5/356z.71 new
4545 305 ILCS 5/5-16.8
4646 305 ILCS 5/5-18.3 new
4747 305 ILCS 5/5-18.5
4848 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.
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5151 A BILL FOR
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6060 305 ILCS 5/5-18.3 new
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8080 1 laboratory tests, and supplies provided.
8181 2 Notwithstanding any other law to the contrary, all
8282 3 reimbursement rates set by the Department of Healthcare and
8383 4 Family Services for services provided at a birth center shall
8484 5 be equal to the reimbursement rates set by the Department of
8585 6 Healthcare and Family Services for the same services provided
8686 7 at a hospital licensed under the Hospital Licensing Act.
8787 8 (c) A birth center shall provide charitable care
8888 9 consistent with that provided by comparable health care
8989 10 providers in the geographic area.
9090 11 (d) A birth center may not discriminate against any
9191 12 patient requiring treatment because of the source of payment
9292 13 for services, including Medicare and Medicaid recipients.
9393 14 (Source: P.A. 102-518, eff. 8-20-21.)
9494 15 Section 10. The Illinois Insurance Code is amended by
9595 16 adding Section 356z.71 as follows:
9696 17 (215 ILCS 5/356z.71 new)
9797 18 Sec. 356z.71. Coverage for birth center and midwife
9898 19 services. A group or individual policy of accident and health
9999 20 insurance or a managed care plan that is amended, delivered,
100100 21 issued, or renewed on or after January 1, 2025 shall provide
101101 22 coverage for all services provided at a birth center by a
102102 23 certified nurse midwife or a licensed certified professional
103103 24 midwife, including, but not limited to, prenatal care, labor
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114114 1 and delivery care, care after birth, gynecological exams, and
115115 2 newborn care. As use in this Section:
116116 3 "Birth center" means a facility licensed under the
117117 4 Birth Center Licensing Act.
118118 5 "Certified nurse midwife" means an individual who is
119119 6 licensed under the Nurse Practice Act as an advanced
120120 7 practice registered nurse and is certified as a nurse
121121 8 midwife.
122122 9 "Licensed certified professional midwife" means a
123123 10 person who has successfully met the requirements under
124124 11 Section 45 of the Licensed Certified Professional Midwife
125125 12 Practice Act and holds an active license to practice as a
126126 13 licensed certified professional midwife in Illinois.
127127 14 Section 15. The Illinois Public Aid Code is amended by
128128 15 changing Sections 5-16.8, 5-18.3, and 5-18.5 as follows:
129129 16 (305 ILCS 5/5-16.8)
130130 17 Sec. 5-16.8. Required health benefits. The medical
131131 18 assistance program shall (i) provide the post-mastectomy care
132132 19 benefits required to be covered by a policy of accident and
133133 20 health insurance under Section 356t and the coverage required
134134 21 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
135135 22 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
136136 23 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
137137 24 356z.61, 356z.64, 356z.67, and 356z.71 of the Illinois
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148148 1 Insurance Code, (ii) be subject to the provisions of Sections
149149 2 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
150150 3 Illinois Insurance Code, and (iii) be subject to the
151151 4 provisions of subsection (d-5) of Section 10 of the Network
152152 5 Adequacy and Transparency Act.
153153 6 The Department, by rule, shall adopt a model similar to
154154 7 the requirements of Section 356z.39 of the Illinois Insurance
155155 8 Code.
156156 9 On and after July 1, 2012, the Department shall reduce any
157157 10 rate of reimbursement for services or other payments or alter
158158 11 any methodologies authorized by this Code to reduce any rate
159159 12 of reimbursement for services or other payments in accordance
160160 13 with Section 5-5e.
161161 14 To ensure full access to the benefits set forth in this
162162 15 Section, on and after January 1, 2016, the Department shall
163163 16 ensure that provider and hospital reimbursement for
164164 17 post-mastectomy care benefits required under this Section are
165165 18 no lower than the Medicare reimbursement rate.
166166 19 (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
167167 20 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
168168 21 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
169169 22 eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
170170 23 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
171171 24 1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
172172 25 (305 ILCS 5/5-18.3 new)
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183183 1 Sec. 5-18.3. Birth center and midwife services.
184184 2 Notwithstanding any other provision of this Code, all services
185185 3 provided at a birth center by a certified nurse midwife or a
186186 4 licensed certified professional midwife, including, but not
187187 5 limited to, prenatal care, labor and delivery care, care after
188188 6 birth, gynecological exams, and newborn care shall be covered
189189 7 under the medical assistance program for persons who are
190190 8 otherwise eligible for medical assistance under this Article.
191191 9 All reimbursement rates set by the Department for services
192192 10 provided at a birth center shall be equal to the reimbursement
193193 11 rates set by the Department for the same services provided at a
194194 12 hospital licensed under the Hospital Licensing Act. The
195195 13 Department shall seek a State Plan amendment or any federal
196196 14 waivers or approvals necessary to implement this Section.
197197 15 Implementation of the coverage and reimbursement rates under
198198 16 this Section shall be contingent on federal approval. As used
199199 17 in this Section:
200200 18 "Birth center" means a facility licensed under the
201201 19 Birth Center Licensing Act.
202202 20 "Certified nurse midwife" means an individual who is
203203 21 licensed under the Nurse Practice Act as an advanced
204204 22 practice registered nurse and is certified as a nurse
205205 23 midwife.
206206 24 "Licensed certified professional midwife" means a
207207 25 person who has successfully met the requirements under
208208 26 Section 45 of the Licensed Certified Professional Midwife
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219219 1 Practice Act and holds an active license to practice as a
220220 2 licensed certified professional midwife in Illinois.
221221 3 (305 ILCS 5/5-18.5)
222222 4 Sec. 5-18.5. Perinatal doula and evidence-based home
223223 5 visiting services.
224224 6 (a) As used in this Section:
225225 7 "Home visiting" means a voluntary, evidence-based strategy
226226 8 used to support pregnant people, infants, and young children
227227 9 and their caregivers to promote infant, child, and maternal
228228 10 health, to foster educational development and school
229229 11 readiness, and to help prevent child abuse and neglect. Home
230230 12 visitors are trained professionals whose visits and activities
231231 13 focus on promoting strong parent-child attachment to foster
232232 14 healthy child development.
233233 15 "Perinatal doula" means a trained provider who provides
234234 16 regular, voluntary physical, emotional, and educational
235235 17 support, but not medical or midwife care, to pregnant and
236236 18 birthing persons before, during, and after childbirth,
237237 19 otherwise known as the perinatal period.
238238 20 "Perinatal doula training" means any doula training that
239239 21 focuses on providing support throughout the prenatal, labor
240240 22 and delivery, or postpartum period, and reflects the type of
241241 23 doula care that the doula seeks to provide.
242242 24 (b) Notwithstanding any other provision of this Article,
243243 25 perinatal doula services and evidence-based home visiting
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254254 1 services shall be covered under the medical assistance
255255 2 program, subject to appropriation, for persons who are
256256 3 otherwise eligible for medical assistance under this Article.
257257 4 Perinatal doula services include regular visits beginning in
258258 5 the prenatal period and continuing into the postnatal period,
259259 6 inclusive of continuous support during labor and delivery,
260260 7 that support healthy pregnancies and positive birth outcomes.
261261 8 Perinatal doula services may be embedded in an existing
262262 9 program, such as evidence-based home visiting. Perinatal doula
263263 10 services provided during the prenatal period may be provided
264264 11 weekly, services provided during the labor and delivery period
265265 12 may be provided for the entire duration of labor and the time
266266 13 immediately following birth, and services provided during the
267267 14 postpartum period may be provided up to 12 months postpartum.
268268 15 (b-5) (Blank). Notwithstanding any other provision of this
269269 16 Article, beginning January 1, 2023, licensed certified
270270 17 professional midwife services shall be covered under the
271271 18 medical assistance program, subject to appropriation, for
272272 19 persons who are otherwise eligible for medical assistance
273273 20 under this Article. The Department shall consult with midwives
274274 21 on reimbursement rates for midwifery services.
275275 22 (c) The Department of Healthcare and Family Services shall
276276 23 adopt rules to administer this Section. In this rulemaking,
277277 24 the Department shall consider the expertise of and consult
278278 25 with doula program experts, doula training providers,
279279 26 practicing doulas, and home visiting experts, along with State
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290290 1 agencies implementing perinatal doula services and relevant
291291 2 bodies under the Illinois Early Learning Council. This body of
292292 3 experts shall inform the Department on the credentials
293293 4 necessary for perinatal doula and home visiting services to be
294294 5 eligible for Medicaid reimbursement and the rate of
295295 6 reimbursement for home visiting and perinatal doula services
296296 7 in the prenatal, labor and delivery, and postpartum periods.
297297 8 Every 2 years, the Department shall assess the rates of
298298 9 reimbursement for perinatal doula and home visiting services
299299 10 and adjust rates accordingly.
300300 11 (d) The Department shall seek such State plan amendments
301301 12 or waivers as may be necessary to implement this Section and
302302 13 shall secure federal financial participation for expenditures
303303 14 made by the Department in accordance with this Section.
304304 15 (Source: P.A. 102-4, eff. 4-27-21; 102-1037, eff. 6-2-22.)
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