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HB4364
SYNOPSIS AS INTRODUCED:
New Act
5 ILCS 80/4.37 new
225 ILCS 60/4
225 ILCS 65/50-15
305 ILCS 5/5-5
Creates the Home Birth Safety Act. Provides for the licensure of
midwives by the Department of Financial and Professional Regulation and for
certain limitations on the activities of licensed midwives. Creates the
Illinois Midwifery Board. Sets forth provisions concerning qualifications,
grounds for disciplinary action, and administrative procedures. Amends the
Regulatory Sunset Act to set a repeal date for the new Act of January 1,
2027. Amends the Medical Practice Act of 1987, the Nurse Practice Act, and
the Illinois Public Aid Code to make related changes. Effective July 1,
2016.
CORRECTIONAL
BUDGET AND
IMPACT NOTE ACT
MAY APPLY
A BILL FOR
HB4364
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5
Section
5.
Purpose.
The
practice
of
midwifery
in
public
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11
12
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15
settings
16
unprofessional
17
18
health,
in
safety,
this
and
State,
conduct
welfare
and
by
to
and
protect
persons
to
be
the
licensed
subject
public
to
to
from
practice
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20
(a) This Act does not prohibit a person licensed under any
21
other Act in this State from engaging in the practice for which
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HB4364
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freedom; and
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licensed midwife.
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this Act.
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who has met the standards for certification set by the North
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American
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22
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Registry
"Department"
of
Midwives
means
the
and
has
Department
been
of
awarded
the
Financial
and
Professional Regulation.
"International
Confederation
of
Midwives"
means
the
HB4364
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2
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4
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Bridge
Certificate"
means
the
certificate
education
Confederation of Midwives.
10
specific
to
content
in
emergency
skills
for
11
means
12
establishes
13
the
nationally-recognized
standards
for
the
accrediting
education
agency
of
that
direct-entry
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15
16
promotes the
17
growth and
development of
the
profession of
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"Practice
of
midwifery"
means
providing
the
necessary
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25
conducting
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newborn,
deliveries
with
such
independently,
care
including
and
caring
without
for
the
limitation
HB4364
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the
limited
screenings,
Rubella
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11
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13
mother
to
and
the
Pap
and
titer,
child,
tests,
the
sexually
preconception
urine
procurement
culture,
of
transmitted
screenings.
medical
infection
Preconception
blood-typing,
and
antibody
means
the
Secretary
of
Financial
and
Professional Regulation.
Section
20.
Unlicensed
practice.
Beginning
January
1,
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15
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18
19
L.M.
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with a client, provide a copy of the rules under this Act and
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HB4364
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following:
(2)
Whether
the
licensed
midwife
has
malpractice
such coverage.
emergencies,
10
including
transportation
to
hospital,
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12
13
14
15
16
Section
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shall
exempt
any
physician
licensed
to
practice
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(a) Any person licensed under this Act may advertise the
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HB4364
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midwife.
Act.
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this Act.
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of the Act and for the payment of fees connected to the Act and
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Act.
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(4)
following:
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permit
licensed
midwife
to
do
any
of
the
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circumcisions;
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(5)
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administer
prescription
pharmacological
agents
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factors:
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(A)
chronic
significant
maternal
cardiac,
(C)
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significant
hematological
disorders
or
known
maternal
congenital
abnormalities
affecting childbirth;
(F)
confirmed
isoimmunization, Rh
disease
with
positive titer;
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to labor or in labor;
(J)
pelvic
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normal
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malformations;
vaginal
or
uterine
births,
abnormalities
including
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(N)
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uncontrolled
current
serious
affecting
tumors
and
psychiatric
illness;
(O) social or familial conditions unsatisfactory
HB4364
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abnormalities
intervention.
(e)
With
regards
that
to
may
require
Medicaid
immediate
reimbursement,
medical
no
rules
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the Board and the Department shall review the Board's response
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(g) The Department may at any time seek the advice and the
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established
by
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Professional
Midwives
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the
National
or
Association
successor
of
Certified
organization
whose
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Section
41.
Midwife
requirements.
licensed
midwife
shall:
in
accordance
with
current
American
College
of
(2)
provide all
clients with
10
on-call
availability
by
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13
(3)
provide
clients
licensed
with
plan
for
midwife,
labor
24-hour,
certified
support,
fetal
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inspect
the
placenta
and
membranes
for
completeness;
(7) inspect the perineum and vagina postpartum for
lacerations and stabilize;
(8) observe mother and newborn postpartum until stable
HB4364
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hours;
and
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10
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precautions
for
both
mother
and
newborn
in
the
use
universal
precautions
with
all
biohazard
materials;
(12) ensure that a birth certificate is accurately
completed and filed in accordance with State law;
(13) offer to obtain and submit a blood sample in
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accordance
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with
the
recommendations
for
metabolic
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(16)
within
hours
after
the
birth,
offer
the
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physicians
and
licensed
certified
nurse-midwives
in
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administer
midwifery:
the
following
agents
during
the
practice
(2)
eye
prophylactics-0.5%
Erythromycin
of
ophthalmic
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(3)
Oxytocin
or
Pitocin
as
postpartum
Misoprostol
(Cytotec)
for
the
treatment
of
postpartum hemorrhage;
(6)
Vitamin
for
the
prophylaxis
of
hemorrhagic
intravenous fluids
for
maternal
stabilization,
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HB4364
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sterile
water
subcutaneous
injections
as
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Department
may
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procedures
based
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medications or agents.
approve
upon
additional
updated
medications,
evidence-based
agents,
or
obstetrical
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pregnancy and,
postpartum period.
(b)
if
consult with
the
licensed
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(1) Antepartum.
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(C)
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infection.
Persistent
symptoms
of
urinary
tract
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abortion.
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HB4364
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fetal movement.
(I)
gestation.
Non-vertex
presentation
after
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(K)
Isoimmunization,
Rh-negative
weeks
sensitized,
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dietary management.
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(O)
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Symptoms
of
malnutrition
or
anorexia
or
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(Y)
3
4
5
Abnormal
non-stress
test
or
abnormal
biophysical profile.
(Z)
Marked
or
severe
polyhydramnios
or
oligohydramnios.
(CC)
Gestation
confirmed dates.
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(2) Intrapartum.
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beyond
42
weeks
by
reliable
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Ruptured
membranes
without
onset
of
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labor.
(K)
Fetal
heart
tones
with
non-reassuring
patterns.
imminent.
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consultation or transfer.
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(3) Postpartum.
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sepsis.
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(c)
consult with
licensed
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factors:
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normal range.
(10) Failure to urinate within 24 hours of birth.
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(12) Edema.
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(15)
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instability.
Significant
clinical
evidence
of
glycemic
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(22)
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vital
Clinically
significant
color
abnormality,
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failure to thrive.
accessing
initiate
midwife's
until
medical
immediate
services.
transport
emergency
emergency
plan,
medical
The
licensed
according
provide
services
midwife
to
emergency
arrive
or
the
shall
licensed
stabilization
transfer
is
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record.
14
The
following
conditions
shall
require
immediate
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(4) Psychosis.
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HB4364
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labor.
(11) Chorioamnionitis.
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(13)
not
compatible
with
spontaneous
vaginal delivery.
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Presentation
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(18) Anaphylaxis.
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(20)
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vital signs.
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Sustained
instability
or
persistent
abnormal
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harm
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complication
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transport.
to
the
health
or
and
safety
condition
of
entails
the
client,
if
extraordinary
the
and
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appointed by
practice
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collaborating
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4 years, and 2 members shall serve for 2 years. The Board shall
23
of
the
Secretary, 3
midwifery
with
in
home
an
of
whom
shall
out-of-hospital
birth
provider
be
licensed
setting,
may
stand
be
in
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Board member may be reappointed for a term that would cause his
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5
(e) The Secretary may remove any member of the Board for
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(f)
Three Board
quorum. A
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(g)
The
Board
shall
provide
the
Department
with
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necessary
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to
carry
out
the
provisions
of
this
Act,
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HB4364
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withdrawal
of
approval
of
required
education
and
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of
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which
all
persons
participating
in
the
meeting
can
HB4364
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or
accredited by MEAC.
she
has
holds
valid
CPM
10
11
12
Bridge
13
certification.
Certificate
regardless
of
the
date
of
their
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midwife to
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maintain CPM
certification by
meeting all
the
HB4364
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license.
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licensed
midwife
requesting
restoration
from
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Department.
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Section
70.
Renewal,
reinstatement, or
restoration
of
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status
10
(d)
may
The
have
his
or
Department
her
shall
license
restored
determine,
by
an
by
making
evaluation
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12
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restoration.
restoration of
license under
this
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15
she was (i) in federal service on active duty with the Armed
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after
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honorable
termination
of
service,
training,
or
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HB4364
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required fee.
without
limitation
original
licensure,
renewal,
and
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that
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fees
and
fines
shall
be
paid
to
the
Department by
HB4364
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necessary
or
issuance of the license and pay all fees and fines due to the
Department.
defray
Secretary may
she
remittance,
shall
all
apply
The
the
to
Department
the
Department
expenses
waive
of
Department for
may
establish
processing
the
shall
fines
due
the
automatically
restoration or
fee
for
application.
under
this
Section
the
The
in
10
individual cases where the Secretary finds that the fines would
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midwife
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each
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the effective date of the order imposing the civil penalty. The
24
order
25
without
offense, as
shall
being
licensed
determined by
constitute
under
the
judgment
this
Act
shall,
Department. The
and
may
be
in
civil
filed
and
HB4364
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any
unlicensed activity.
court
of
record.
The
Department
may
investigate
any
disciplinary
action
as
the
Department
may
deem
proper,
10
11
12
the Department.
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Engaging
in
dishonorable,
unethical,
or
HB4364
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(11)
Discipline
by
another
U.S.
jurisdiction
or
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11
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remunerations
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18
use
19
of
paid
to
an
space, owned or
individual,
partnership,
controlled by
the
or
individual,
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21
22
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(15)
Willfully
making
or
filing
false
records
or
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HB4364
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departments.
or safety.
7
8
9
Conviction
by
any
court
of
competent
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14
conviction
of
15
Department
determines,
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felony
in
after
federal
court,
investigation,
if
the
that
the
20
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under the Abused and Neglected Child Reporting Act and upon
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child,
26
Reporting Act.
as
defined
in
the
Abused
and
Neglected
Child
HB4364
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this Act.
as
sexual
abuse,
sexual
misconduct,
or
sexual
10
11
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15
Department.
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as
21
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required by
any
tax
Act
administered by
the
Illinois
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26
HB4364
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the
issuance of
an
order
so
finding
and
discharging the
10
11
12
those
13
Department
14
15
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17
communications
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19
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21
22
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specifically
may
designated
order
between
an
the
by
examining
licensee
the
Department.
physician
or
to
applicant
The
present
and
the
HB4364
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license
complaint
was
to
immediately
granted,
suspend,
reinstated,
revoke,
renewed,
or
otherwise
disciplined,
or
10
11
and
12
restrictions
13
14
15
Department.
who
fails
to
shall
comply
be
with
such
referred
to
terms,
the
conditions, or
Secretary
for
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HB4364
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this Act who has been certified by court order as not having
10
Criminal
11
12
Code
of
2012.
person
whose
license
or
other
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21
bond,
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and
may
preliminarily
and
permanently
enjoin
the
HB4364
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in addition to, and not in lieu of, all other remedies and
10
11
rule to show cause why an order to cease and desist should not
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13
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or
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exempt
under
this
Act
shall
be
guilty
of
Class
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25
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federal
statute,
Section
including,
115.
but
not
Investigation;
limited
notice;
to,
property
hearing.
The
10
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12
shall, at least 30 days prior to the date set for the hearing,
13
14
any
15
designated.
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17
within 20 days after the service of the notice and inform the
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to
charges and
the
The
that a
hearing shall be
Department
respondent
at
the
shall
direct
address
of
held on
the
his
date
applicant
or
her
or
last
HB4364
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on
disciplinary
this Act. At the time and place fixed in the notice, the Board
10
11
12
statements,
13
14
probationary
status,
action
or
deemed
testimony,
the
Department
proper,
evidence,
may
including
and
argument
take
any
limiting
the
as
may
be
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HB4364
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designee
contempt.
or
of
the
applicant
or
licensee
against
whom
10
11
12
13
with the same fees and mileage and in the same manner as
14
15
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18
other
19
20
21
22
order
23
24
books,
oaths
authorized
requiring
and
the
records
in
any
attendance
in
Act
of
connection
administered
witnesses
with
any
and
by
the
their
hearing
or
HB4364
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required under this Act. The Board shall specify the nature of
10
the
11
12
violation
or
failure
to
comply
and
shall
make
its
13
recommendations of
14
15
with the report of the Board, the Secretary may issue an order
16
17
in
18
brought for the violation of this Act, but the hearing and
19
20
the
Board
shall
person in
be
the
basis
for
the
criminal prosecution
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22
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24
refusal
to
issue,
renew,
or
license
an
applicant or
for
HB4364
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10
11
12
or
13
recommendation.
she
may
issue
an
order
in
contravention
of
that
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HB4364
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and pays for a transcript of the record within the time for
the motion may be filed shall commence upon the delivery of the
Section
150.
Rehearing.
Whenever
the
Secretary
is
10
11
12
13
following:
14
15
Secretary;
16
(2)
17
18
that
such
Secretary
is
duly
appointed
and
qualified; and
(3) that the Board and its members are qualified to
19
act.
20
21
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HB4364
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license.
Section
170.
Summary
suspension.
The
Secretary
may
without a
10
11
Secretary
12
13
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16
has occurred.
finds
that
evidence
in
his
or
her
possession
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22
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HB4364
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Section
180.
Administrative
Review
Law.
All
final
Illinois
adopted
Administrative Procedure
and
incorporated
in
Act
this
is
Act
as
hereby
if
expressly
all
of
the
10
11
the
12
13
hearings the licensee has the right to show compliance with all
14
15
16
the
17
18
19
provision of
notice
subsection (d)
required
Section 190.
Home
under
rule.
of
Section
Section
10-25
Pursuant to
of
10-65
the
of
the
Illinois
paragraph (h)
of
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21
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23
HB4364
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3
4
10
11
12
13
14
15
Sec.
16
17
4.
Exemptions.
This
Act
does
not
apply
to
the
following:
(1)
persons
lawfully
carrying
on
their
particular
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21
HB4364
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(3)
persons
treating
human
ailments
by
prayer
or
freedom.
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14
person
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21
22
23
24
practicing
or
offering
to
practice
advanced,
HB4364
- 47 -
this Act.
10
(3)
11
emergency.
The
furnishing
of
nursing
assistance
in
an
12
13
14
15
16
17
18
19
(6)
Persons
from
being
employed
as
homes,
long
unlicensed
20
assistive
21
personnel
in
private
term
care
22
23
24
25
26
HB4364
- 48 -
satisfactory
to
the
Department,
for
license
as
an
10
11
12
13
14
15
16
17
18
19
satisfactory
20
21
22
23
24
to
the
Department,
for
license
as
25
26
HB4364
- 49 -
territory
occurs.
of
the
United
States
or
foreign
country,
10
11
12
13
14
15
(12)
Delegation
to
authorized
direct
care
staff
16
trained
17
18
19
under
Section
15.4
of
the
Mental
Health
and
20
practicing
21
22
23
24
25
the
26
2016
the
specified
Olympic
and
occupations
Paralympic
set
Games
forth
in
Professional
HB4364
- 50 -
(14)
prepackaged
Nothing
County
in
correctional personnel
medication
this
Act
for
shall
from
delivering
self-administration
be
construed to
to
limit
an
the
9
10
11
12
13
14
rule, shall determine the quantity and quality of and the rate
15
16
17
18
19
laboratory
20
21
22
23
care
24
and
furnished
X-ray
by
services;
licensed
(4)
skilled
practitioners,
nursing
including
home
the
HB4364
- 51 -
to the Home Birth Safety Act; (7) home health care services;
dental
services"
10
11
12
13
whichever
14
15
to
16
17
18
determined
19
20
21
22
includes
23
24
instrument, tool,
25
26
services,
means
the
ensure that
an
including
prevention
diagnostic,
person
the
using
may
(13)
individual's need
appropriate
or
preventive,
select;
uniform
treatment
or
other
for
screening,
evaluation
not
and
and,
of
corrective
diagnostic,
intervention or
assessment,
as
mean
the
use
process that
all
must
and
warranted,
of
singular
utilize; (14)
HB4364
- 52 -
in
assault,
arising
care, and any other type of remedial care recognized under the
10
11
12
13
14
15
16
17
18
wilful and wanton manner upon a woman who was not pregnant at
19
the time such abortion procedure was performed. The term "any
20
21
22
23
Section
1a
of
including
from
the
the
Sexual
Assault
examinations
sexual
and
assault;
Survivors
laboratory
(16)
the
Emergency
tests
diagnosis
to
and
24
comprehensive tobacco
25
26
use
cessation
program
that
includes
HB4364
- 53 -
Article.
10
documentation.
11
12
Illinois Title XIX State Plan for this purpose, the Department
13
14
15
16
17
medical
18
19
school within the CPS system. Under any contract procured under
20
this
21
22
23
24
25
KIDS
26
assistance
provision,
Health
program
the
Insurance
vendor
and
in
or
Program
any
vendors
shall
be
capitated
must
Medicaid
serve
submitted
to
only
the
HB4364
- 54 -
eligible
9
10
for
(1)
assistance
dental
under
services
this
provided
Article
by
or
who
under
are
the
11
12
13
14
Notwithstanding
any
other
provision
of
this
Code
and
15
16
17
cost
18
19
20
21
22
23
24
25
26
this provision.
to
render
dental
services
through
an
enrolled
HB4364
- 55 -
provide
10
coverage
and
reimbursement
for
amino
acid-based
11
12
and
13
14
35
15
16
17
18
19
shall
years
authorize
of
age
or
payment
older
for,
who
screening
are
eligible
by
for
low-dose
medical
20
21
22
23
24
25
26
or
breasts
if
mammogram
demonstrates
HB4364
- 56 -
heterogeneous
(E)
or
dense
screening
MRI
breast
when
tissue,
when
medically
medically
necessary,
as
All
screenings
shall
include
physical
breast
exam,
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
HB4364
- 57 -
representatives
of
hospitals,
free-standing
mammography
by
10
the
Department
shall
be
reimbursed
for
breast
cancer
11
representatives of
12
13
doctors,
14
15
16
including
Subject
to
hospitals,
breast
federal
free
surgeons,
approval,
standing
breast
reconstructive
the
Department
cancer
breast
shall
17
18
19
These clinics or
20
21
22
centers may
also
collaborate with
other
23
24
25
26
HB4364
- 58 -
The
shall
effectiveness
evaluation.
Department
shall
establish
and
work
with
methodology
modifying
the
experts
for
in
breast
evaluating
methodology
based
cancer
their
on
the
10
11
12
13
14
15
16
17
18
19
20
21
22
23
health outcomes and cost of care for those served by the pilot
24
25
26
The
networks of
care
to
HB4364
- 59 -
in
patients
commission
navigation
to
and
community
comprehensive
on
outreach
care
in
cancer-accredited
to
navigate
timely
cancer
cancer
fashion.
program
as
The
an
10
11
12
13
14
15
16
17
addiction
18
19
Human Services.
20
All
for
pregnant
medical
recipients
providers
in
providing
accordance
medical
with
assistance
the
to
21
22
23
24
case
25
26
management
services
for
addicted
women,
including
HB4364
1
- 60 -
for addiction.
The
Illinois
Department,
in
cooperation
with
the
medical assistance.
10
11
nor
12
the
Department
of
Human
Services
shall
sanction
the
13
14
15
16
17
18
19
information
20
medical
21
and
dissemination
health
care
and
educational
providers,
and
activities
for
consistency
in
22
23
24
for
25
26
in
persons
certain
eligible
geographic
under
areas.
Section
The
5-2
of
Partnership
this
Code.
shall
be
HB4364
- 61 -
medical
10
11
obstetrical
12
13
14
15
providers
(1)
care.
for
The
physician
Illinois
Physicians
services,
Department
participating
in
inpatient
shall
and
reimburse
Partnership
and
16
17
18
19
services.
20
21
financial
22
23
(3)
incentives
Persons
to
receiving
24
Partnerships
25
services
26
may
above
encourage
receive
the
level
the
medical
development
services
medical
and
case
usually
offered
of
through
management
through
the
HB4364
1
- 62 -
Medical
providers
shall
be
to
meet
certain
delivery
Department
10
of
high
and
may
quality
be
medical
higher
than
services.
These
qualifications
for
11
practitioners,
12
13
14
all rules and take all other necessary actions so that provided
15
services
16
17
18
providers.
may
hospitals,
be
accessed
and
other
from
providers
of
therapeutically
medical
certified
19
20
21
22
The
Illinois
Department
shall
require
health
care
23
24
25
26
HB4364
- 63 -
require
health
care
providers
to
make
available,
when
10
to
11
12
13
14
15
16
of
17
18
19
20
21
22
23
24
25
26
is
maintain
and
prescription
being
made
retain
drugs,
are
business
dentures,
actually
and
professional
prosthetic
being
received
records
devices
by
and
eligible
HB4364
- 64 -
recipients. Within 90
items
recognized
as
days
medical
equipment
and
1984
(the
supplies
10
11
12
13
14
15
16
17
Department shall, within 365 days after July 22, 2013 (the
18
19
20
21
purposes.
22
23
new
24
25
26
home claims.
Following
system
and
development
implement
any
of
these
necessary
procedures,
operational
the
or
HB4364
- 65 -
Department shall, within 365 days after August 15, 2014 (the
Act and MC/DD facilities licensed under the MC/DD Act to submit
additional 365 days to test the viability of the new system and
10
11
12
13
14
15
16
17
18
19
20
21
medical
22
23
24
25
26
services
desiring
to
participate
in
the
medical
HB4364
1
- 66 -
period and shall be conditional for one year. During the period
disenrollment
10
is
not
subject
to
the
Department's
hearing
penalty.
11
12
13
the vendor.
14
15
16
17
18
19
20
which may include, but need not be limited to: criminal and
21
financial
22
23
24
25
26
background
checks;
fingerprinting;
license,
HB4364
- 67 -
each type of vendor, which shall take into account the level of
10
To
be
eligible
for
payment
consideration,
vendor's
11
12
13
14
later than 180 days after the latest date on the claim on which
15
16
exceptions:
17
18
19
shall not begin until the date on the written notice from
20
21
complete.
22
23
24
which
25
26
result in
an
inability to
receive, process, or
HB4364
1
2
- 68 -
10
applicant is
11
12
13
eligible. For
claims for
which
the
Illinois
14
15
16
17
Electronic
18
19
within
20
prescreening
21
22
23
forms.
24
including
25
through MEDI
26
15
Data
days
of
receipt
information,
Effective
all
Interchange
September
prescreening
or
REV.
(MEDI)
by
the
admission
1,
2014,
or
the
facility
of
documents
admission
information,
must
Recipient
be
required
shall
be
documents,
submitted
an
HB4364
- 69 -
timely
submittal.
Once
an
admission
transaction
has
been
10
11
12
13
14
Illinois
15
limited
16
17
reporting;
18
employment;
19
numbers;
20
21
22
Department
to:
functions.
information
unearned
and
supplemental
National
This
pertaining
earned
security
Provider
includes,
income;
income;
Identifier
to
but
is
not
licensure;
pension
income;
social
security
(NPI)
numbers;
the
23
24
25
26
HB4364
- 70 -
applicable
extent
federal
necessary
laws
to
and
regulations,
provide
data
appropriate
sharing,
the
and
Illinois
10
the
11
12
Secretary
of
State;
the
Department
of
Revenue;
the
13
14
15
16
17
18
19
20
21
clinical
22
23
24
25
26
code
editing;
and
link
(iii)
pre-pay,
analysis. Such
pre-
or
request for
HB4364
1
- 71 -
The
Illinois
Department
shall
establish
policies,
10
11
12
recipient
13
substitute
14
15
to
temporarily
devices
or
acquire
and
equipment
use
alternative
pending
repairs
or
or
16
17
18
19
effect
20
eligibility
21
22
23
24
25
26
the
following:
criteria
(i)
for
intake
those
procedures
persons
who
and
are
common
receiving
HB4364
- 72 -
utilization
(iv)
eligibility
1,
no
controls
later
2013,
than
criteria
establish
or
changes
July
1,
for
in
2013,
benefit
minimum
level
institutional
procedures
to
permit
packages
and
long
to
of
care
home
and
term
care
10
11
12
13
14
15
stakeholders
16
17
18
care
19
representing
eligibility
the
criteria
for
institutional
and
home
community-based services
and
in
20
21
22
compliance
23
24
25
26
with
applicable
federal
laws
and
regulations,
HB4364
1
- 73 -
The
Illinois
Department
shall
annually
to
the
4
5
6
7
8
9
10
11
Illinois Department.
12
13
14
15
16
Speaker, one copy with the Minority Leader and one copy with
17
18
President, one copy with the Minority Leader and one copy with
19
20
Research Unit,
21
22
23
24
Section.
and
such
the
State
25
26
HB4364
- 74 -
Section 5-5e.
10
11
effective
12
13
14
15
16
17
this
18
19
20
21
22
23
24
25
kidney transplantation.
26
Code,
alternative
and
who
to
would
renal
dialysis
otherwise
meet
when
the
medically
financial
HB4364
- 75 -
covered under both fee for service and managed care medical
under
10
the
American
Society
of
Addiction
Medicine
patient
11
12
13
14
15
16
17
18
19
20
21
other similarly acting drug approved by the U.S. Food and Drug
22
Administration.
23
24
25
26
eff.
7-16-14;
98-963,
eff.
8-15-14;
99-78,
eff.
7-20-15;
HB4364
- 76 -
99-180,
eff.
7-29-15;
99-236,
eff.
8-3-15;
99-433,
eff.
rule, shall determine the quantity and quality of and the rate
10
laboratory
11
12
13
14
care
15
16
to the Home Birth Safety Act; (7) home health care services;
17
18
dental
19
20
21
22
services"
23
24
25
and
furnished
X-ray
by
services,
means
services;
licensed
including
diagnostic,
(4)
skilled
practitioners,
prevention
and
preventive,
nursing
including
treatment
or
home
the
of
corrective
HB4364
- 77 -
whichever
to
determined
10
11
12
includes
13
14
instrument, tool,
15
16
17
in
18
19
assault,
20
21
arising
22
23
care, and any other type of remedial care recognized under the
24
25
26
the
person
ensure that
the
using
an
Section
may
of
including
from
the
(13)
individual's need
uniform
appropriate
1a
select;
or
for
screening,
evaluation
and,
assessment,
as
the
use
process that
all
must
Sexual
Assault
examinations
sexual
and
assault;
diagnostic,
intervention or
mean
the
not
other
warranted,
of
laboratory
the
singular
utilize; (14)
Survivors
(16)
and
Emergency
tests
diagnosis
to
and
HB4364
- 78 -
wilful and wanton manner upon a woman who was not pregnant at
the time such abortion procedure was performed. The term "any
10
11
12
13
14
comprehensive tobacco
15
16
17
18
19
Article.
use
cessation
program
that
includes
20
21
22
23
24
25
26
documentation.
HB4364
- 79 -
Illinois Title XIX State Plan for this purpose, the Department
medical
school within the CPS system. Under any contract procured under
assistance
program
and
in
any
capitated
Medicaid
10
this
11
12
13
14
15
KIDS
16
17
18
provision,
Health
the
vendor
Insurance
or
Program
vendors
shall
be
must
serve
submitted
to
only
the
19
20
21
eligible
22
23
24
25
26
for
(1)
assistance
dental
under
services
this
provided
Article
by
or
who
under
are
the
HB4364
- 80 -
Notwithstanding
any
other
provision
of
this
Code
and
cost
10
11
12
13
14
15
16
this provision.
to
render
dental
services
through
an
enrolled
17
18
19
20
21
provide
22
23
24
25
26
coverage
and
reimbursement
for
amino
acid-based
HB4364
1
- 81 -
and
35
shall
years
6
7
of
age
or
payment
older
for,
who
screening
are
by
eligible
low-dose
for
medical
8
9
authorize
10
11
12
13
14
15
16
breast
17
heterogeneous
18
19
20
(E)
or
breasts
or
if
dense
screening
MRI
mammogram
breast
when
tissue,
demonstrates
when
medically
medically
necessary,
as
21
22
23
All
screenings
shall
include
physical
breast
exam,
24
25
26
HB4364
- 82 -
includes
tomosynthesis. As
10
11
the breast.
digital
mammography
used
in
this
and
includes
Section, the
term
breast
"breast
12
13
14
15
16
17
18
19
20
21
22
representatives
23
24
of
hospitals,
free-standing
mammography
25
26
HB4364
- 83 -
by
the
Department
shall
be
reimbursed
for
breast
cancer
representatives of
doctors,
10
including
hospitals,
breast
free
standing
surgeons,
breast
cancer
reconstructive
breast
11
Subject
to
federal
approval,
the
Department
shall
12
13
14
These clinics or
15
16
17
centers may
also
collaborate with
other
18
19
20
21
22
The
23
24
shall
25
effectiveness
26
evaluation.
Department
shall
establish
and
work
with
methodology
modifying
the
experts
for
in
breast
evaluating
methodology
based
cancer
their
on
the
HB4364
- 84 -
10
11
12
13
14
15
16
17
18
health outcomes and cost of care for those served by the pilot
19
20
21
The
networks of
care
to
22
23
in
24
patients
25
26
navigation
to
and
community
comprehensive
outreach
care
in
to
navigate
timely
cancer
fashion.
The
HB4364
- 85 -
commission
on
cancer-accredited
cancer
program
as
an
10
11
12
addiction
13
14
Human Services.
15
All
for
pregnant
medical
recipients
providers
in
providing
accordance
medical
with
assistance
the
to
16
17
18
19
case
20
21
22
for addiction.
23
management
The
Illinois
services
for
Department,
addicted
in
women,
cooperation
including
with
the
24
25
26
HB4364
- 86 -
medical assistance.
nor
the
Department
of
Human
Services
shall
sanction
the
10
11
12
13
14
information
15
medical
16
and
dissemination
health
care
and
educational
providers,
and
activities
for
consistency
in
17
18
19
for
20
21
in
22
23
24
25
26
persons
certain
eligible
geographic
under
areas.
Section
The
5-2
of
Partnership
this
Code.
shall
be
HB4364
- 87 -
medical
obstetrical
10
providers
care.
(1)
for
The
physician
Illinois
Physicians
services,
Department
participating
in
inpatient
shall
and
reimburse
Partnership
and
11
12
13
14
services.
15
16
financial
17
18
(3)
incentives
Persons
to
receiving
19
Partnerships
20
services
21
22
Medical
may
above
encourage
receive
the
providers
level
shall
the
medical
development
services
medical
and
usually
offered
be
required
case
to
of
through
management
through
meet
the
certain
23
24
delivery
25
26
Department
of
and
high
may
quality
be
higher
medical
than
services.
qualifications
These
for
HB4364
- 88 -
practitioners,
all rules and take all other necessary actions so that provided
hospitals,
and
other
providers
of
medical
10
services
11
12
13
providers.
may
be
accessed
from
therapeutically
certified
14
15
16
17
The
Illinois
Department
shall
require
health
care
18
19
20
21
22
23
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26
require
health
care
providers
to
make
available,
when
HB4364
- 89 -
to
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11
of
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21
is
22
recipients. Within 90
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26
items
maintain
and
retain
prescription
being
made
drugs,
are
recognized
business
dentures,
actually
as
days
and
professional
prosthetic
being
received
devices
by
medical
equipment
records
and
and
eligible
1984
(the
supplies
HB4364
- 90 -
10
11
12
Department shall, within 365 days after July 22, 2013 (the
13
14
15
16
purposes.
17
18
new
19
20
21
home claims.
Following
system
and
development
implement
any
of
these
necessary
procedures,
operational
the
or
22
23
Department shall, within 365 days after August 15, 2014 (the
24
25
26
Act and MC/DD facilities licensed under the MC/DD Act to submit
HB4364
- 91 -
additional 365 days to test the viability of the new system and
10
11
12
13
14
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16
medical
17
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20
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22
services
desiring
to
participate
in
the
medical
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24
period and shall be conditional for one year. During the period
25
26
HB4364
- 92 -
disenrollment
penalty.
is
not
subject
to
the
Department's
hearing
the vendor.
10
11
12
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15
which may include, but need not be limited to: criminal and
16
financial
17
18
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20
background
checks;
fingerprinting;
license,
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23
each type of vendor, which shall take into account the level of
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26
HB4364
- 93 -
To
be
eligible
for
payment
consideration,
vendor's
later than 180 days after the latest date on the claim on which
10
11
exceptions:
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14
shall not begin until the date on the written notice from
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16
complete.
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19
which
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23
result in
an
inability to
receive, process, or
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25
26
HB4364
- 94 -
applicant is
eligible. For
claims for
which
the
Illinois
10
11
12
Electronic
13
14
within
15
prescreening
16
17
18
forms.
19
including
20
through MEDI
21
22
timely
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25
26
15
Data
days
of
receipt
information,
Effective
all
Interchange
September
prescreening
or
submittal.
REV.
Once
(MEDI)
by
the
or
facility
admission
1,
the
of
documents
2014,
admission
information,
must
Recipient
be
required
shall
be
documents,
submitted
an
admission
transaction
has
an
been
HB4364
- 95 -
Illinois
Department
functions.
This
includes,
but
is
not
10
limited
11
12
reporting;
13
employment;
14
numbers;
15
16
17
to:
information
unearned
and
supplemental
National
pertaining
earned
security
Provider
income;
income;
Identifier
to
licensure;
pension
income;
social
security
(NPI)
numbers;
the
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20
21
22
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24
25
applicable
26
federal
laws
and
regulations,
appropriate
and
HB4364
- 96 -
extent
the
necessary
Secretary
to
of
provide
State;
data
the
sharing,
Department
the
of
Illinois
Revenue;
the
10
11
12
13
14
15
16
clinical
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18
19
20
21
22
The
code
editing;
Illinois
and
link
Department
(iii)
pre-pay,
analysis. Such
shall
pre-
or
request for
establish
policies,
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24
25
26
HB4364
- 97 -
recipient
substitute
10
to
temporarily
devices
or
acquire
and
equipment
use
alternative
pending
repairs
or
or
11
12
13
14
effect
15
eligibility
16
17
18
19
20
21
22
23
24
25
utilization
26
the
following:
criteria
controls
(i)
for
or
intake
those
procedures
persons
changes
in
who
benefit
and
are
common
receiving
packages
to
HB4364
- 98 -
1,
minimum
(iv)
eligibility
1,
no
later
2013,
than
criteria
establish
July
for
2013,
level
institutional
procedures
to
and
permit
long
of
care
home
and
term
care
10
stakeholders
11
12
13
care
14
representing
eligibility
the
criteria
for
institutional
and
home
community-based services
and
in
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17
compliance
18
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20
21
22
The
with
Illinois
applicable
Department
federal
shall
laws
report
and
regulations,
annually
to
the
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25
26
HB4364
1
2
3
4
5
- 99 -
Illinois Department.
10
11
Speaker, one copy with the Minority Leader and one copy with
12
13
President, one copy with the Minority Leader and one copy with
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15
Research Unit,
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19
Section.
and
such
the
State
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24
25
26
HB4364
- 100 -
Section 5-5e.
effective
10
11
12
this
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14
15
16
17
18
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20
kidney transplantation.
Code,
alternative
and
who
to
would
renal
dialysis
otherwise
meet
when
the
medically
financial
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24
25
covered under both fee for service and managed care medical
26
HB4364
- 101 -
under
the
American
Society
of
Addiction
Medicine
patient
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11
12
13
14
15
16
other similarly acting drug approved by the U.S. Food and Drug
17
Administration.
18
19
20
21
eff.
22
23
99
24
25
of
7-16-14;
P.A.
98-963,
99-407
for
eff.
its
8-15-14;
99-78,
effective date);
eff.
7-20-15;
99-433,
eff.
HB4364
- 102 -
Public Act.
7
8