Bill Text: IL SB3665 | 2023-2024 | 103rd General Assembly | Introduced

---

Bill Title: Amends the Illinois Insurance Code. Provides that insurers shall cover all services for pregnancy, postpartum, and newborn care that are rendered by perinatal doulas or licensed certified professional midwives, including home births, home visits, and support during labor, abortion, or miscarriage. Provides that the required coverage includes the necessary equipment and medical supplies for a home birth. Provides that coverage for pregnancy, postpartum, and newborn care shall include home visits by lactation consultants and the purchase of breast pumps and breast pump supplies, including such breast pumps, breast pump supplies, breastfeeding supplies, and feeding aids as recommended by the lactation consultant. Provides that coverage for postpartum services shall apply for at least one year after birth. Provides that certain pregnancy and postpartum coverage shall be provided without cost-sharing requirements. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that post-parturition care benefits shall not be subject to any cost-sharing requirement. Provides that the medical assistance program shall cover home visits for lactation counseling and support services. Provides that the medical assistance program shall cover counselor-recommended or provider-recommended breast pumps as well as breast pump supplies, breastfeeding supplies, and feeding aids. Provides that nothing in the provisions shall limit the number of lactation encounters, visits, or services; breast pumps; breast pump supplies; breastfeeding supplies; or feeding aids a beneficiary is entitled to receive under the program. Makes other changes. Effective January 1, 2026.

Spectrum: Partisan Bill (Democrat 8-0)

Status: (Introduced) 2024-04-19 - Rule 2-10 Committee Deadline Established As May 3, 2024 [SB3665 Detail]

Download: Illinois-2023-SB3665-Introduced.html

---

103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3665 Introduced 2/9/2024, by Sen. Lakesia Collins SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.40
305 ILCS 5/5-16.7
305 ILCS 5/5-18.5
305 ILCS 5/5-18.10
Amends the Illinois Insurance Code. Provides that insurers shall cover all services for pregnancy, postpartum, and newborn care that are rendered by perinatal doulas or licensed certified professional midwives, including home births, home visits, and support during labor, abortion, or miscarriage. Provides that the required coverage includes the necessary equipment and medical supplies for a home birth. Provides that coverage for pregnancy, postpartum, and newborn care shall include home visits by lactation consultants and the purchase of breast pumps and breast pump supplies, including such breast pumps, breast pump supplies, breastfeeding supplies, and feeding aides as recommended by the lactation consultant. Provides that coverage for postpartum services shall apply for at least one year after birth. Provides that certain pregnancy and postpartum coverage shall be provided without cost-sharing requirements. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that post-parturition care benefits shall not be subject to any cost-sharing requirement. Provides that the medical assistance program shall cover home visits for lactation counseling and support services. Provides that the medical assistance program shall cover counselor-recommended or provider-recommended breast pumps as well as breast pump supplies, breastfeeding supplies, and feeding aides. Provides that nothing in the provisions shall limit the number of lactation encounters, visits, or services; breast pumps; breast pump supplies; breastfeeding supplies; or feeding aides a beneficiary is entitled to receive under the program. Makes other changes. Effective January 1, 2026.
LRB103 39479 RPS 69674 b
A BILL FOR
SB3665 LRB103 39479 RPS 69674 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 356z.40 as follows:
(215 ILCS 5/356z.40)
Sec. 356z.40. Pregnancy and postpartum coverage.
(a) An individual or group policy of accident and health
insurance or managed care plan amended, delivered, issued, or
renewed on or after the effective date of this amendatory Act
of the 103rd General Assembly this amendatory Act of the 102nd
General Assembly shall provide coverage for pregnancy,
postpartum, and newborn care in accordance with 42 U.S.C.
18022(b) regarding essential health benefits.
(b) Benefits under this Section shall be as follows:
(1) An individual who has been identified as
experiencing a high-risk pregnancy by the individual's
treating provider shall have access to clinically
appropriate case management programs. As used in this
subsection, "case management" means a mechanism to
coordinate and assure continuity of services, including,
but not limited to, health services, social services, and
educational services necessary for the individual. "Case

SB3665 - 2 - LRB103 39479 RPS 69674 b
management" involves individualized assessment of needs,
planning of services, referral, monitoring, and advocacy
to assist an individual in gaining access to appropriate
services and closure when services are no longer required.
"Case management" is an active and collaborative process
involving a single qualified case manager, the individual,
the individual's family, the providers, and the community.
This includes close coordination and involvement with all
service providers in the management plan for that
individual or family, including assuring that the
individual receives the services. As used in this
subsection, "high-risk pregnancy" means a pregnancy in
which the pregnant or postpartum individual or baby is at
an increased risk for poor health or complications during
pregnancy or childbirth, including, but not limited to,
hypertension disorders, gestational diabetes, and
hemorrhage.
(2) An individual shall have access to medically
necessary treatment of a mental, emotional, nervous, or
substance use disorder or condition consistent with the
requirements set forth in this Section and in Sections
370c and 370c.1 of this Code.
(3) The benefits provided for inpatient and outpatient
services for the treatment of a mental, emotional,
nervous, or substance use disorder or condition related to
pregnancy or postpartum complications shall be provided if

SB3665 - 3 - LRB103 39479 RPS 69674 b
determined to be medically necessary, consistent with the
requirements of Sections 370c and 370c.1 of this Code. The
facility or provider shall notify the insurer of both the
admission and the initial treatment plan within 48 hours
after admission or initiation of treatment. Nothing in
this paragraph shall prevent an insurer from applying
concurrent and post-service utilization review of health
care services, including review of medical necessity, case
management, experimental and investigational treatments,
managed care provisions, and other terms and conditions of
the insurance policy.
(4) The benefits for the first 48 hours of initiation
of services for an inpatient admission, detoxification or
withdrawal management program, or partial hospitalization
admission for the treatment of a mental, emotional,
nervous, or substance use disorder or condition related to
pregnancy or postpartum complications shall be provided
without post-service or concurrent review of medical
necessity, as the medical necessity for the first 48 hours
of such services shall be determined solely by the covered
pregnant or postpartum individual's provider. Nothing in
this paragraph shall prevent an insurer from applying
concurrent and post-service utilization review, including
the review of medical necessity, case management,
experimental and investigational treatments, managed care
provisions, and other terms and conditions of the

SB3665 - 4 - LRB103 39479 RPS 69674 b
insurance policy, of any inpatient admission,
detoxification or withdrawal management program admission,
or partial hospitalization admission services for the
treatment of a mental, emotional, nervous, or substance
use disorder or condition related to pregnancy or
postpartum complications received 48 hours after the
initiation of such services. If an insurer determines that
the services are no longer medically necessary, then the
covered person shall have the right to external review
pursuant to the requirements of the Health Carrier
External Review Act.
(5) If an insurer determines that continued inpatient
care, detoxification or withdrawal management, partial
hospitalization, intensive outpatient treatment, or
outpatient treatment in a facility is no longer medically
necessary, the insurer shall, within 24 hours, provide
written notice to the covered pregnant or postpartum
individual and the covered pregnant or postpartum
individual's provider of its decision and the right to
file an expedited internal appeal of the determination.
The insurer shall review and make a determination with
respect to the internal appeal within 24 hours and
communicate such determination to the covered pregnant or
postpartum individual and the covered pregnant or
postpartum individual's provider. If the determination is
to uphold the denial, the covered pregnant or postpartum

SB3665 - 5 - LRB103 39479 RPS 69674 b
individual and the covered pregnant or postpartum
individual's provider have the right to file an expedited
external appeal. An independent utilization review
organization shall make a determination within 72 hours.
If the insurer's determination is upheld and it is
determined that continued inpatient care, detoxification
or withdrawal management, partial hospitalization,
intensive outpatient treatment, or outpatient treatment is
not medically necessary, the insurer shall remain
responsible for providing benefits for the inpatient care,
detoxification or withdrawal management, partial
hospitalization, intensive outpatient treatment, or
outpatient treatment through the day following the date
the determination is made, and the covered pregnant or
postpartum individual shall only be responsible for any
applicable copayment, deductible, and coinsurance for the
stay through that date as applicable under the policy. The
covered pregnant or postpartum individual shall not be
discharged or released from the inpatient facility,
detoxification or withdrawal management, partial
hospitalization, intensive outpatient treatment, or
outpatient treatment until all internal appeals and
independent utilization review organization appeals are
exhausted. A decision to reverse an adverse determination
shall comply with the Health Carrier External Review Act.
(6) Except as otherwise stated in this subsection (b),

SB3665 - 6 - LRB103 39479 RPS 69674 b
the benefits and cost-sharing shall be provided to the
same extent as for any other medical condition covered
under the policy.
(7) The benefits required by paragraphs (2) and (6) of
this subsection (b) are to be provided to all covered
pregnant or postpartum individuals with a diagnosis of a
mental, emotional, nervous, or substance use disorder or
condition. The presence of additional related or unrelated
diagnoses shall not be a basis to reduce or deny the
benefits required by this subsection (b).
(8) Insurers shall cover all services for pregnancy,
postpartum, and newborn care that are rendered by
perinatal doulas or licensed certified professional
midwives, including home births, home visits, and support
during labor, abortion, or miscarriage. Coverage shall
include the necessary equipment and medical supplies for a
home birth.
(9) Coverage for pregnancy, postpartum, and newborn
care shall include home visits by lactation consultants
and the purchase of breast pumps and breast pump supplies,
including such breast pumps, breast pump supplies,
breastfeeding supplies, and feeding aides as recommended
by the lactation consultant.
(10) Coverage for postpartum services shall apply for
at least one year after birth.
(c) All coverage required under this Section shall be

SB3665 - 7 - LRB103 39479 RPS 69674 b
provided without cost sharing. This subsection does not apply
to the extent such coverage would disqualify a high-deductible
health plan from eligibility for a health savings account
pursuant to Section 223 of the Internal Revenue Code.
(Source: P.A. 102-665, eff. 10-8-21.)
Section 10. The Illinois Public Aid Code is amended by
changing Sections 5-16.7, 5-18.5, and 5-18.10 as follows:
(305 ILCS 5/5-16.7)
Sec. 5-16.7. Post-parturition care. The medical assistance
program shall provide the post-parturition care benefits
required to be covered by a policy of accident and health
insurance under Section 356s of the Illinois Insurance Code.
Benefits provided under this Section shall not be subject to
any cost-sharing requirement.
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.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-18.5)
Sec. 5-18.5. Perinatal doula and evidence-based home
visiting services.

SB3665 - 8 - LRB103 39479 RPS 69674 b
(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
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,

SB3665 - 9 - LRB103 39479 RPS 69674 b
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) 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. Midwifery services covered under
this subsection shall include home births and home prenatal,
labor and delivery, and postnatal care.
(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
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

SB3665 - 10 - LRB103 39479 RPS 69674 b
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.)
(305 ILCS 5/5-18.10)
Sec. 5-18.10. Reimbursement for postpartum visits.
(a) In this Section:
"Certified lactation counselor" means a health care
professional in lactation counseling who has demonstrated the
necessary skills, knowledge, and attitudes to provide clinical
breastfeeding counseling and management support to families
who are thinking about breastfeeding or who have questions or
problems during the course of breastfeeding.
"Certified nurse midwife" means a person who exceeds the
competencies for a midwife contained in the Essential
Competencies for Midwifery Practice, published by the
International Confederation of Midwives, and who qualifies as
an advanced practice registered nurse.

SB3665 - 11 - LRB103 39479 RPS 69674 b
"Community health worker" means a frontline public health
worker who is a trusted member or has an unusually close
understanding of the community served. This trusting
relationship enables the community health worker to serve as a
liaison, link, and intermediary between health and social
services and the community to facilitate access to services
and improve the quality and cultural competence of service
delivery.
"International board-certified lactation consultant"
means a health care professional who is certified by the
International Board of Lactation Consultant Examiners and
specializes in the clinical management of breastfeeding.
"Medical caseworker" means a health care professional who
assists in the planning, coordination, monitoring, and
evaluation of medical services for a patient with emphasis on
quality of care, continuity of services, and affordability.
"Perinatal doula" means a trained provider of regular and
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.
"Public health nurse" means a registered nurse who
promotes and protects the health of populations using
knowledge from nursing, social, and public health sciences.
(b) The Illinois Department shall establish a medical
assistance program to cover a universal postpartum visit

SB3665 - 12 - LRB103 39479 RPS 69674 b
within the first 3 weeks after childbirth and a comprehensive
visit within 4 to 12 weeks postpartum for persons who are
otherwise eligible for medical assistance under this Article.
In addition, postpartum care services rendered by perinatal
doulas, certified lactation counselors, international
board-certified lactation consultants, public health nurses,
certified nurse midwives, community health workers, and
medical caseworkers shall be covered under the medical
assistance program.
(c) The medical assistance program shall cover home visits
for lactation counseling and support services. Visits may
occur before birth and at any time within 12 months
postpartum.
(d) The medical assistance program shall cover
counselor-recommended or provider-recommended breast pumps as
well as breast pump supplies, breastfeeding supplies, and
feeding aides.
(e) Nothing in this Section shall limit the number of
lactation encounters, visits, or services; breast pumps;
breast pump supplies; breastfeeding supplies; or feeding aides
a beneficiary is entitled to receive under the medical
assistance program.
(Source: P.A. 102-665, eff. 10-8-21.)