HB 5013

Abstract

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that in order to maximize the accessibility of preventive prenatal and perinatal health care services, the Department of Healthcare and Family Services shall amend its managed care contracts such that an managed care organization must pay for preventive prenatal and perinatal healthcare services rendered by a non-affiliated provider, for which the health plan would pay if rendered by an affiliated provider, at the same rate the Department would pay for such services exclusive of disproportionate share payments and Medicaid percentage adjustments, unless a different rate was agreed upon by the health plan and the non-affiliated provider. Effective January 1, 2023. House Committee Amendment No. 2 Adds reference to: 210 ILCS 170/5 210 ILCS 170/25 Replaces everything after the enacting clause. Reinserts the provisions of the bill as amended by Senate Amendment No. 1 with the following changes. Amends the Birth Center Licensing Act. Provides that a licensed certified professional midwife may attend or be delegated to attend to each person in labor from the time of admission through birth and throughout the immediate postpartum period. Defines "licensed certified professional midwife". Makes a conforming change. Effective January 1, 2023. Senate Committee Amendment No. 1 Replaces everything after the enacting clause. Reinserts the provisions of the engrossed bill with the following changes: Further amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a managed care organization must pay for preventative prenatal services, perinatal healthcare services, and postpartum services rendered by a non-affiliated provider, for which the health plan would pay if rendered by an affiliated provider, at the rate paid (rather than at no less than the rate paid) under the Illinois Medicaid fee-for-service program methodology for such services. Provides that, in cases where a managed care organization must pay for preventive prenatal services, perinatal healthcare services, and postpartum services rendered by a non-affiliated provider, the payment rate requirements under the amendatory Act shall not apply if the services were not emergency services, as defined in a specified provision of the Code, and: (1) the non-affiliated provider is a perinatal hospital and has, within the 12 months preceding the date of service, rejected a contract that was offered in good faith by the health plan as determined by the Department of Healthcare and Family Services; or (2) the health plan has terminated a contract with the non-affiliated provider for cause, and the Department has not deemed the termination to have been without merit. Provides that the Department may deem that a determination for cause has merit if: (i) an institutional provider has repeatedly failed to conduct discharge planning; or (ii) the provider's conduct adversely and substantially impacts the health of Medicaid patients; or (iii) the provider's conduct constitutes fraud, waste, or abuse; or (iv) the provider's conduct violates the code of ethics governing his or her profession. Effective January 1, 2023.