Bill Text: IL SB3851 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Creates the Certified Professional Midwives Practice 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 application, 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, 2031. Amends the Illinois Insurance Code, the Medical Practice Act of 1987, the Nurse Practice Act, and the Illinois Public Aid Code to make related changes.

Spectrum: Slight Partisan Bill (Democrat 7-4)

Status: (Failed) 2021-01-13 - Session Sine Die [SB3851 Detail]

Download: Illinois-2019-SB3851-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 SB3851 Introduced 2/14/2020, by Sen. Iris Y. Martinez SYNOPSIS AS INTRODUCED:
New Act
5 ILCS 80/4.41 new
215 ILCS 5/356z.43 new
225 ILCS 60/4 from Ch. 111, par. 4400-4
225 ILCS 65/50-15 was 225 ILCS 65/5-15
305 ILCS 5/5-5 from Ch. 23, par. 5-5
Creates the Certified Professional Midwives Practice 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 application, 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, 2031. Amends the Illinois Insurance Code, the Medical Practice Act of 1987, the Nurse Practice Act, and the Illinois Public Aid Code to make related changes.
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CORRECTIONAL BUDGET AND IMPACT NOTE ACT MAY APPLY FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Short title. This Act may be cited as the
Certified Professional Midwives Practice Act.
Section 5. Purpose. The practice of midwifery in
out-of-hospital settings is hereby declared to affect the
public health, safety, and welfare and to be subject to
regulation in the public interest. The purpose of this Act is
to protect and benefit the public by setting standards for the
qualifications, education, training, and experience of those
who seek to obtain licensure and hold the title of licensed
certified professional midwife, to promote high standards of
professional performance for those licensed to practice
midwifery in out-of-hospital settings in this State, to promote
a collaborative and integrated maternity care delivery system
in Illinois, and to protect the public from unprofessional
conduct by persons licensed to practice midwifery, as defined
in this Act. This Act shall be liberally construed to best
carry out these purposes.
Section 10. Exemptions.
(a) This Act does not prohibit a person licensed under any

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other Act in this State from engaging in the practice for which
they are licensed or from delegating services as provided for
under that other Act.
(b) Nothing in this Act shall be construed to prohibit or
require licensing under this Act, with regard to:
(1) the gratuitous rendering of services;
(2) the rendering of services by a birth attendant, if
such attendance is in accordance with the birth attendant's
religious faith or cultural group and is rendered only to
women and families in a distinct cultural or religious
group as an exercise and enjoyment of their religious or
cultural freedom; and
(3) a student midwife or midwife's assistant working
under the supervision of a licensed midwife.
(c) Nothing in this Act abridges, limits, or changes in any
way the right of parents to deliver their baby where, when,
how, and with whom they choose, regardless of licensure under
this Act.
Section 15. Definitions. In this Act:
"Board" means the Illinois Midwifery Board.
"Certified professional midwife" means a person who has met
the standards for certification set by the North American
Registry of Midwives and has been awarded the Certified
Professional Midwife credential.
"Department" means the Department of Financial and

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Professional Regulation.
"International Confederation of Midwives" means the
organization that sets global standards for the education and
autonomous practice of midwifery.
"Licensed certified professional midwife" means a person
who has been granted a license under this Act to engage in the
practice of midwifery.
"Midwifery Bridge Certificate" means the certificate
issued by NARM based upon completion of accredited continuing
education specific to content in emergency skills for
pregnancy, birth, and newborn care, along with other midwifery
topics addressing the core competencies of the International
Confederation of Midwives.
"Midwifery Education and Accreditation Council" or "MEAC"
means the nationally recognized accrediting agency, or its
successor, that establishes standards for the education of
direct-entry midwives in the United States.
"National Association of Certified Professional Midwives"
means the professional organization, or its successor, that
promotes the growth and development of the profession of
certified professional midwives.
"North American Registry of Midwives" or "NARM" means the
accredited international agency, or its successor, that has
established and has continued to administer certification for
the credentialing of certified professional midwives.
"Practice of midwifery" means providing the necessary

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supervision, care, education, and advice to pregnant people
during the antepartum, intrapartum, and postpartum period,
conducting deliveries independently, and caring for the
newborn, with such care including, without limitation,
preventative measures, breastfeeding assistance, and
education, the detection of abnormal conditions in the
childbearing individual and the child, the procurement of
medical assistance, and the execution of emergency measures in
the absence of medical help. "Practice of midwifery" includes
nonprescriptive family planning and basic well-woman care
limited to Pap tests, sexually transmitted infection
screenings, and preconception screenings. "Practice of
midwifery" does not constitute the practice of medicine.
"Secretary" means the Secretary of Financial and
Professional Regulation.
Section 20. Unlicensed practice. Beginning January 1,
2021, no person may practice, attempt to practice, or hold
themselves out to practice as a licensed certified professional
midwife unless they are licensed under this Act.
Section 25. Title. A licensed certified professional
midwife may identify themselves as a "licensed certified
professional midwife" and may use the abbreviation "LCPM".
Section 30. Informed Consent.

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(a) A licensed certified professional midwife shall, at an
initial consultation with a prospective client, provide a copy
of the rules under this Act and an informational brochure
developed in cooperation by the Illinois chapters of the
National Association of Certified Professional Midwives and
the American College of Obstetricians and Gynecologists, or
their successors, detailing the benefits and risks of having an
out-of-hospital birth with a licensed certified professional
midwife, and disclose to the client orally and in writing
(informed consent documentation), all of the following:
(1) The licensed certified professional midwife's
experience, training, and current licensure status.
(2) Whether the licensed certified professional
midwife has malpractice liability insurance coverage and
the policy limits of any such coverage.
(3) A written protocol for the handling of medical
emergencies, including transportation to a hospital,
particular to each client.
(b) The informed consent documentation must be signed and
dated by the client and the licensed certified professional
midwife. A copy must be provided to the client and the original
must be kept in the client's chart.
Section 35. Vicarious liability. Nothing in this Act is
intended to expand the malpractice liability of physicians,
advanced practice registered nurses, certified professional

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midwives, or other health care providers beyond the limits
existing in current Illinois statutory and common law.
Section 40. Advertising.
(a) Any person licensed under this Act may advertise the
availability of professional midwifery services in the public
media or on premises where professional services are rendered
if the advertising is truthful and not misleading and is in
conformity with any rules regarding the practice of a licensed
certified professional midwife.
(b) A licensee must include in every advertisement for
midwifery services regulated under this Act their title as it
appears on the license or the initials "LCPM" as authorized
under this Act.
Section 45. Powers and duties of the Department; rules.
(a) The Department shall exercise the powers and duties
prescribed by the Civil Administrative Code of Illinois for the
administration of licensing Acts and shall exercise such other
powers and duties necessary for effectuating the purposes of
this Act.
(b) The Secretary shall adopt rules consistent with the
provisions of this Act for the administration and enforcement
of this Act and for the payment of fees connected to this Act
and may prescribe forms that shall be issued in connection with
this Act.

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(c) Rules adopted by the Department must address the scope
of practice and services provided and the use of equipment,
procedures, medications, and other agents that are determined
by the Department to be necessarily available in order to
ensure the health and safety of the childbearing individual and
her newborn.
(d) The rules adopted by the Department under this Section
may not:
(1) require a licensed certified professional midwife
to practice midwifery under the supervision of another
health care provider;
(2) require a licensed certified professional midwife
to enter into a written agreement with another health care
provider;
(3) limit the location where a licensed certified
professional midwife may practice midwifery;
(4) permit a licensed certified professional midwife
to do any of the following:
(A) administer prescription pharmacological agents
intended to induce or augment labor;
(B) administer prescription pharmacological agents
to provide pain management;
(C) use vacuum extractors or forceps;
(D) prescribe medications;
(E) perform surgical procedures, including, but
not limited to, abortions, cesarean sections, and

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circumcisions; or
(F) provide out-of-hospital care to a woman who has
had a vertical uterine incision cesarean section.
(5) Permit the licensed certified professional midwife
to knowingly accept responsibility for prenatal or
intrapartum care of a client with any of the following risk
factors:
(A) chronic significant maternal cardiac,
pulmonary, renal, or hepatic disease;
(B) malignant disease in an active phase;
(C) significant hematological disorders or
coagulopathies or pulmonary embolism;
(D) insulin-requiring diabetes mellitus;
(E) confirmed isoimmunization, Rh disease, with
positive titer;
(F) active tuberculosis;
(G) active syphilis or gonorrhea;
(H) active genital herpes infection 2 weeks prior
to labor or in labor;
(I) pelvic or uterine abnormalities affecting
normal vaginal births, including tumors and
malformations;
(J) alcoholism or abuse;
(K) drug addiction or abuse;
(L) confirmed AIDS status;
(M) uncontrolled current serious psychiatric

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illness;
(N) social or familial conditions unsatisfactory
for out-of-hospital maternity care services; or
(O) fetus with suspected or diagnosed congenital
abnormalities that may require immediate medical
intervention.
(e) With regards to Medicaid reimbursement, no rules
prescribed by the Department shall require the licensed midwife
to carry liability insurance in order to be reimbursed by the
State as a Medicaid provider.
(f) The Department shall consult with the Board in adopting
rules. Notice of proposed rulemaking shall be transmitted to
the Board and the Department shall review the Board's response
and any recommendations made. The Department shall notify the
Board in writing with proper explanation of deviations from the
Board's recommendations and responses.
(g) The Department may at any time seek the advice and the
expert knowledge of the Board on any matter relating to the
administration of this Act.
(h) The Department shall issue a quarterly report to the
Board of the status of all complaints related to the profession
filed with the Department.
(i) Rules adopted by the Department regarding the practice
of midwifery must be consistent with the standards regarding
the practice of midwifery established by the National
Association of Certified Professional Midwives, or a successor

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organization whose essential documents include, without
limitation, subject matter concerning scope of practice,
standards of practice, informed consent, appropriate
consultation, collaboration or referral, and acknowledgment of
a woman's right to self-determination concerning her maternity
care.
Section 50. Drugs and screenings.
(a) A licensed certified professional midwife may not
prescribe medications, but may, in the course of providing care
within their scope of practice, as defined in the rules,
administer those medications and vaccines approved by the
Department and listed in the rules. The medication indications,
dose, route of administration, and duration of treatment
relating to the administration of drugs and procedures
identified under this Section shall be determined by rule as
the Department deems necessary to be in keeping with current
evidence-based practice standards. The Department may approve
additional medications, agents, or procedures based upon
limited availability of standard medications or agents.
(b) A licensed certified professional midwife may obtain
appropriate screenings and testing for clients, including, but
not limited to, ultrasounds and non-stress tests.
(c) In addition to the drugs, devices, and procedures
identified in rules, a licensed certified professional midwife
may administer any other prescription drug, use any other

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device, or perform any other procedure as an authorized agent
of a licensed practitioner with prescriptive authority.
(d) Nothing in this Act is intended to restrict the
licensed certified professional midwife's ability to
administer herbal or homeopathic remedies in keeping with the
client's usual home practices or in keeping with the licensed
certified professional midwife's midwifery education or
continuing education programs.
Section 55. Consultation and referral.
(a) A licensed certified professional midwife shall
consult with a physician licensed to practice medicine in all
of its branches or a licensed certified nurse midwife providing
obstetrical care whenever there are significant deviations,
including abnormal laboratory results, relative to a client's
pregnancy or to a neonate. If a referral to health care
provider trained in high risk pregnancy is needed, the licensed
certified professional midwife shall refer the client to a
physician or certified nurse midwife and, if possible, remain
in consultation with the physician or certified nurse midwife
until resolution of the concern. Consultation does not preclude
the possibility of an out-of-hospital birth. It is appropriate
for the licensed certified professional midwife to maintain
care of the client to the greatest degree possible, in
accordance with the client's wishes, during the pregnancy and,
if possible, during labor, birth, and the postpartum period.

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(b) Specific parameters for required consultation shall be
determined by the Department by rule.
Section 60. Transfer.
(a) The licensed certified professional midwife shall
provide all clients with information, in writing, regarding the
potential benefits of filing prenatal records prior to the
birth with the emergency transport hospital identified in the
informed consent documentation.
(b) The licensed certified professional midwife shall file
the client's prenatal records with the emergency hospital at 36
weeks of pregnancy or shall document the client's refusal using
standard forms provided by the Department.
(c) The licensed certified professional midwife shall, in
case of emergency, initiate immediate transport according to
the licensed certified professional midwife's emergency plan,
provide emergency stabilization until emergency medical
services arrive or transfer is completed, accompany the client
or follow the client to a hospital in a timely fashion, provide
pertinent information to the receiving facility, and complete
an emergency transport record. Transport via private vehicle is
an acceptable method of transport if it is the most expedient
and safest method for accessing medical services.
(d) Specific parameters for required transfer shall be
determined by the Department by rule.
(e) A licensed certified professional midwife may deliver a

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client's infant with any of the complications or conditions set
forth in by the Department by rule if no physician or other
equivalent medical services are available and the situation
presents immediate harm to the health and safety of the client,
if the complication or condition entails extraordinary and
unnecessary human suffering, or if delivery occurs during
transport.
Section 65. Reporting requirements. All licensed certified
professional midwives must file such reports as are required in
rules, at such times as are designated by the Department using
forms developed by the Department. These reports shall, at a
minimum, detail any serious adverse outcomes for or death of
the childbearing individual or the neonate.
Section 70. Illinois Midwifery Board.
(a) There is created under the authority of the Department
the Illinois Midwifery Board, which shall consist of 7 members
appointed by the Secretary, 4 of whom shall be licensed
certified professional midwives, except that initial
appointees must have at least 3 years of experience in the
practice of midwifery in an out-of-hospital setting, be
certified by the North American Registry of Midwives, and meet
the qualifications for licensure set forth in this Act; one of
whom shall be a licensed obstetrician or a family practice
physician who has a minimum of 2 years experience providing

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home birth services; one of whom shall be a licensed certified
nurse midwife who has a minimum of 2 years experience providing
home birth services; and one of whom shall be a knowledgeable
public member who has given birth with the assistance of a
certified professional midwife in an out-of-hospital birth
setting. A physician or certified nurse midwife who has a
minimum or 2 years experience consulting or collaborating with
a home birth provider may stand in substitution if the criteria
for physician or certified nurse midwife board members cannot
be met. Board members shall serve 4-year terms, except that in
the case of initial appointments, terms shall be staggered as
follows: 3 members shall serve for 4 years, 2 members shall
serve for 3 years, and 2 members shall serve for 2 years. The
Board shall annually elect a chairperson and vice chairperson.
(b) Any appointment made to fill a vacancy shall be for the
unexpired portion of the term. Appointments to fill vacancies
shall be made in the same manner as original appointments. No
Board member may be reappointed for a term that would cause his
or her continuous service on the Board to exceed 9 years.
(c) Board membership must have a reasonable representation
from different geographic areas of this State, if possible.
(d) The members of the Board may be reimbursed for all
legitimate, necessary, and authorized expenses incurred in
attending the meetings of the Board.
(e) The Secretary may remove any member of the Board for
misconduct, incapacity, or neglect of duty at any time prior to

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the expiration of their term.
(f) Four Board members shall constitute a quorum. A vacancy
in the membership of the Board shall not impair the right of a
quorum to perform all of the duties of the Board.
(g) The Board shall provide the Department with
recommendations concerning the administration of this Act and
may perform each of the following duties:
(1) Recommend to the Department the prescription and,
from time to time, the revision of any rules that may be
necessary to carry out the provisions of this Act,
including those that are designed to protect the health,
safety, and welfare of the public.
(2) Recommend changes to the medication formulary list
as standards and drug availability change.
(3) Conduct hearing and disciplinary conferences on
disciplinary charges of licensees.
(4) Report to the Department, upon completion of a
hearing, the disciplinary actions recommended to be taken
against a person found in violation of this Act.
(5) Recommend the approval, denial of approval, and
withdrawal of approval of required education and
continuing educational programs.
(6) Assist the Department in drafting forms and
informational handouts relative to this Act.
(h) The Secretary shall give due consideration to all
recommendations of the Board. If the Secretary takes action

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contrary to a recommendation of the Board, the Secretary must
promptly provide a written explanation of that action.
(i) The Board may recommend to the Secretary that one or
more licensed midwives be selected by the Secretary to assist
in any investigation under this Act. Compensation shall be
provided to any licensee who provides assistance under this
subsection in an amount determined by the Secretary.
(j) Members of the Board shall be immune from suit in an
action based upon a disciplinary proceeding or other activity
performed in good faith as a member of the Board, except for
willful or wanton misconduct.
(k) Members of the Board may participate in and act at any
meeting of the Illinois Midwifery Board through the use of any
real-time Internet or telephone communications media, by means
of which all persons participating in the meeting can
communicate with each other. Participation in such meeting
shall constitute attendance and presence in person at the
meetings of the person or persons so participating.
Section 75. Qualifications for licensed certified
professional midwives.
(a) Each applicant who successfully meets the requirements
of this Section shall be licensed as a licensed certified
professional midwife.
(b) An applicant for licensure as a licensed certified
professional midwife must:

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(1) submit a completed written application, on forms
provided by the Department, and fees as established by the
Department;
(2) be at least 21 years old;
(3) be a high school graduate or have completed
equivalent education;
(4) successfully complete one of the following formal
midwifery education and training programs:
(A) Accredited Educational Pathway:
(i) applicants who are certified professional
midwives and who have successfully completed an
educational program or pathway accredited by the
MEAC;
(ii) after January 1, 2022, all new applicants
for licensure as a licensed certified professional
midwife must have graduated from an educational
program or pathway that is accredited by MEAC;
(B) Non-Accredited Educational Pathway:
(i) applicants who are certified professional
midwives before January 1, 2022, and who have
completed non-accredited educational pathways will
be required to obtain a Midwifery Bridge
Certificate in order to become a licensed
certified professional midwife;
(ii) applicants who have maintained licensure
in a state that does not require MEAC-accredited

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education, regardless of the date of their
certification, shall obtain the Midwifery Bridge
Certificate to be eligible for licensure;
(5) hold a current valid Certified Professional
Midwife Credential granted by NARM or its successor
organization;
(6) hold current cardiopulmonary resuscitation or
basic life support certification for health care
professionals or providers issued by the American Red Cross
or the American Heart Association;
(7) within the last 2 years, have successfully
completed the American Academy of Pediatrics/American
Heart Association Neonatal Resuscitation Program;
(8) not have violated the provisions of this Act
concerning the grounds for disciplinary action; the
Department may take into consideration any felony
conviction of the applicant, but such a conviction may not
operate as an absolute bar to licensure as a licensed
certified professional midwife; and
(9) meet all other requirements established by the
Department by rule.
Section 80. Social Security Number on application. In
addition to any other information required to be contained in
the application, every application for an original, renewal,
reinstated, or restored license under this Act shall include

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the applicant's Social Security Number.
Section 85. Renewal of licensure.
(a) Licensed certified professional midwives shall renew
their license every 2 years at the discretion of the
Department.
(b) Rules adopted under this Act shall require the licensed
certified professional midwife to maintain certified
professional midwife certification by meeting all continuing
education requirements and other requirements set forth by the
North American Registry of Midwives and current
cardiopulmonary resuscitation or basic life support
certification as required under Section 75.
Section 90. Inactive status.
(a) A licensed certified professional midwife who notifies
the Department in writing on forms prescribed by the Department
may elect to place his or her license on inactive status and
shall be excused from payment of renewal fees until he or she
notifies the Department in writing of his or her intent to
restore the license.
(b) A licensed certified professional midwife whose
license is on inactive status may not practice licensed
certified professional midwifery in the State of Illinois.
(c) A licensed certified professional midwife requesting
restoration from inactive status shall be required to pay the

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current renewal fee, as provided by the Department, to restore
his or her license.
(d) Any licensee who engages in the practice of midwifery
while his or her license is lapsed or on inactive status shall
be considered to be practicing without a license, which shall
be grounds for discipline.
Section 95. Restoration of licensure; military service.
(a) Any licensed certified professional midwife who has
permitted his or her license to expire or who has had his or
her license on inactive status may have the license restored by
making application to the Department and filing proof
acceptable to the Department of fitness to have the license
restored and by paying the required fees. Proof of fitness may
include evidence attesting to active lawful practice in another
jurisdiction.
(b) The Department shall determine, by an evaluation
program, fitness for restoration of a license under this
Section and shall establish procedures and requirements for
restoration.
(c) A licensed certified professional midwife whose
license expired while they were:
(i) in federal service on active duty with the Armed
Forces of the United States or the State Militia and called
into service or training; or
(ii) received education under the supervision of the

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United States preliminary to induction into the military
service;
may have the license restored without paying any lapsed
renewal fees if, within 2 years after honorable termination of
service, training, or education, they furnish the Department
with satisfactory evidence to the effect that they have been so
engaged.
Section 100. Roster. The Department shall maintain a roster
of the names and addresses of all licensees and of all persons
whose licenses have been suspended or revoked. This roster
shall be available upon written request and payment of the
required fee.
Section 105. Fees.
(a) The Department shall provide for a schedule of fees for
the administration and enforcement of this Act, including
without limitation original licensure, renewal, and
restoration, which fees shall be nonrefundable.
(b) All fees collected under this Act shall be deposited
into the General Professions Dedicated Fund and appropriated to
the Department for the ordinary and contingent expenses of the
Department in the administration of this Act.
Section 110. Returned checks; fines. Any person who
delivers a check or other payment to the Department that is

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returned to the Department unpaid by the financial institution
upon which it is drawn shall pay to the Department, in addition
to the amount already owed to the Department, a fine of $50.
The fines imposed by this Section are in addition to any other
discipline provided under this Act for unlicensed practice or
practice on a non-renewed license. The Department shall notify
the person that fees and fines shall be paid to the Department
by certified check or money order within 30 calendar days after
the notification. If, after the expiration of 30 days from the
date of the notification, the person has failed to submit the
necessary remittance, the Department shall automatically
terminate the license or deny the application, without hearing.
If, after termination or denial, the person seeks a license, he
or she shall apply to the Department for restoration or
issuance of the license and pay all fees and fines due to the
Department. The Department may establish a fee for the
processing of an application for restoration of a license to
defray all expenses of processing the application. The
Secretary may waive the fines due under this Section in
individual cases where the Secretary finds that the fines would
be unreasonable or unnecessarily burdensome.
Section 115. Unlicensed practice; civil penalty. Any
person who practices, offers to practice, attempts to practice,
or holds himself or herself out to practice certified
professional midwifery or as a midwife without being licensed

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under this Act shall, in addition to any other penalty provided
by law, pay a civil penalty to the Department in an amount not
to exceed $5,000 for each offense, as determined by the
Department. The civil penalty shall be assessed by the
Department after a hearing is held in accordance with the
provisions set forth in this Act regarding the provision of a
hearing for the discipline of a licensee. The civil penalty
shall be paid within 60 days after the effective date of the
order imposing the civil penalty. The order shall constitute a
judgment and may be filed and execution had thereon in the same
manner as any judgment from any court of record. The Department
may investigate any unlicensed activity.
Section 120. Grounds for disciplinary action.
(a) The Department may refuse to issue or to renew or may
revoke, suspend, place on probation, reprimand, or take other
disciplinary action as the Department may deem proper,
including fines not to exceed $5,000 for each violation, with
regard to any licensee or license for any one or combination of
the following causes:
(1) Violations of this Act or its rules.
(2) Material misstatement in furnishing information to
the Department.
(3) Conviction of any crime under the laws of any U.S.
jurisdiction that is (i) a felony, (ii) a misdemeanor, an
essential element of which is dishonesty, (iii) directly

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related to the practice of the profession.
(4) Making any misrepresentation for the purpose of
obtaining a license.
(5) Professional incompetence or gross negligence.
(6) Gross malpractice.
(7) Aiding or assisting another person in violating any
provision of this Act or its rules.
(8) Failing to provide information within 60 days in
response to a written request made by the Department.
(9) Engaging in dishonorable, unethical, or
unprofessional conduct of a character likely to deceive,
defraud, or harm the public.
(10) Habitual or excessive use or addiction to alcohol,
narcotics, stimulants, or any other chemical agent or drug
that results in the inability to practice with reasonable
judgment, skill, or safety.
(11) Discipline by another U.S. jurisdiction or
foreign nation if at least one of the grounds for the
discipline is the same or substantially equivalent to those
set forth in this Act.
(12) Directly or indirectly giving to or receiving from
any person, firm, corporation, partnership, or association
any fee, commission, rebate, or other form of compensation
for any professional services not actually or personally
rendered. This shall not be deemed to include rent or other
remunerations paid to an individual, partnership, or

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corporation by a licensed certified professional midwife
for the lease, rental, or use of space, owned or controlled
by the individual, partnership, corporation, association.
(13) A finding by the Department that the licensee,
after having his or her license placed on probationary
status, has violated the terms of probation.
(14) Abandonment of a patient.
(15) Willfully making or filing false records or
reports relating to a licensee's practice, including, but
not limited to, false records filed with State agencies or
departments.
(16) Physical illness or mental illness, including,
but not limited to, deterioration through the aging process
or loss of motor skill that results in the inability to
practice the profession with reasonable judgment, skill,
or safety.
(17) Failure to provide a patient with a copy of his or
her record upon the written request of the patient.
(18) Conviction by any court of competent
jurisdiction, either within or without this State, of any
violation of any law governing the practice of licensed
certified professional midwifery or conviction in this or
another state of any crime that is a felony under the laws
of this State or conviction of a felony in a federal court,
if the Department determines, after investigation, that
the person has not been sufficiently rehabilitated to

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warrant the public trust.
(19) A finding that licensure has been applied for or
obtained by fraudulent means.
(20) Being named as a perpetrator in an indicated
report by the Department of Children and Family Services
under the Abused and Neglected Child Reporting Act and upon
proof by clear and convincing evidence that the licensee
has caused a child to be an abused child or a neglected
child, as defined in Section 3 of the Abused and Neglected
Child Reporting Act.
(21) Practicing or attempting to practice under a name
other than the full name shown on a license issued under
this Act.
(22) Immoral conduct in the commission of any act, such
as sexual abuse, sexual misconduct, or sexual
exploitation, related to the licensee's practice.
(23) Maintaining a professional relationship with any
person, firm, or corporation when the licensed certified
professional midwife knows or should know that a person,
firm, or corporation is violating this Act.
(24) Failure to provide satisfactory proof of having
participated in approved continuing education programs as
determined by the Board and approved by the Secretary.
Exceptions for extreme hardships are to be defined by the
Department.
(b) The Department may refuse to issue or may suspend the

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license of any person who fails to:
(i) file a tax return or to pay the tax, penalty, or
interest shown in a filed return; or
(ii) pay any final assessment of the tax, penalty, or
interest, as required by any tax Act administered by the
Illinois Department of Revenue, until the time that the
requirements of that tax Act are satisfied.
(c) The determination by a circuit court that a licensee is
subject to involuntary admission or judicial admission as
provided in the Mental Health and Developmental Disabilities
Code operates as an automatic suspension. The suspension shall
end only upon a finding by a court that the patient is no
longer subject to involuntary admission or judicial admission,
the issuance of an order so finding and discharging the
patient, and the recommendation of the Board to the Secretary
that the licensee be allowed to resume their practice.
(d) In enforcing this Section, the Department, upon a
showing of a possible violation, may compel any person licensed
to practice under this Act or who has applied for licensure or
certification pursuant to this Act to submit to a mental or
physical examination, or both, as required by and at the
expense of the Department. The examining physicians shall be
those specifically designated by the Department. The
Department may order an examining physician to present
testimony concerning the mental or physical examination of the
licensee or applicant. No information shall be excluded by

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reason of any common law or statutory privilege relating to
communications between the licensee or applicant and the
examining physician. The person to be examined may have, at his
or her own expense, another physician of his or her choice
present during all aspects of the examination. Failure of any
person to submit to a mental or physical examination when
directed shall be grounds for suspension of a license until the
person submits to the examination if the Department finds,
after notice and hearing, that the refusal to submit to the
examination was without reasonable cause. If the Department
finds an individual unable to practice because of the reasons
set forth in this subsection (d), the Department may require
that individual to submit to care, counseling, or treatment by
physicians approved or designated by the Department, as a
condition, term, or restriction for continued, reinstated, or
renewed licensure to practice or, in lieu of care, counseling,
or treatment, the Department may file a complaint to
immediately suspend, revoke, or otherwise discipline the
license of the individual. Any person whose license was
granted, reinstated, renewed, disciplined, or supervised
subject to such terms, conditions, or restrictions and who
fails to comply with such terms, conditions, or restrictions
shall be referred to the Secretary for a determination as to
whether or not the person shall have his or her license
suspended immediately, pending a hearing by the Department. If
the Secretary immediately suspends a person's license under

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this Section, a hearing on that person's license must be
convened by the Department within 15 days after the suspension
and completed without appreciable delay. The Department may
review the person's record of treatment and counseling
regarding the impairment to the extent permitted by applicable
federal statutes and regulations safeguarding the
confidentiality of medical records. A person licensed under
this Act and affected under this subsection (d) shall be
afforded an opportunity to demonstrate to the Department that
he or she can resume practice in compliance with acceptable and
prevailing standards under the provisions of his or her
license.
Section 125. Failure to pay restitution. The Department,
without further process or hearing, shall suspend the license
or other authorization to practice of any person issued under
this Act who has been certified by court order as not having
paid restitution to a person under Section 8A-3.5 of the
Illinois Public Aid Code, under Section 46-1 of the Criminal
Code of 1961, or under Sections 17-8.5 or 17-10.5 of the
Criminal Code of 2012. A person whose license or other
authorization to practice is suspended under this Section is
prohibited from practicing until restitution is paid in full.
Section 130. Injunction; cease and desist order.
(a) If a person violates any provision of this Act, the

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Secretary may, in the name of the People of the State of
Illinois, through the Attorney General or the State's Attorney
of any county in which the action is brought, petition for an
order enjoining the violation or enforcing compliance with this
Act. Upon the filing of a verified petition in court, the court
may issue a temporary restraining order, without notice or
bond, and may preliminarily and permanently enjoin the
violation. If it is established that the person has violated or
is violating the injunction, the court may punish the offender
for contempt of court. Proceedings under this Section shall be
in addition to, and not in lieu of, all other remedies and
penalties provided by this Act.
(b) If any person practices as a licensed certified
professional midwife or holds himself or herself out as a
licensed certified professional midwife without being licensed
under the provisions of this Act, then any licensed certified
professional midwife, any interested party, or any person
injured thereby may, in addition to the Secretary, petition for
relief as provided in subsection (a) of this Section.
(c) Whenever, in the opinion of the Department, any person
violates any provision of this Act, the Department may issue a
rule to show cause why an order to cease and desist should not
be entered against that person. The rule shall clearly set
forth the grounds relied upon by the Department and shall
provide a period of 7 days after the date of the rule to file an
answer to the satisfaction of the Department. Failure to answer

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to the satisfaction of the Department shall cause an order to
cease and desist to be issued immediately.
Section 135. Violation; criminal penalty.
(a) Whoever knowingly practices or offers to practice
midwifery in this State without being licensed for that purpose
or exempt under this Act shall be guilty of a Class A
misdemeanor; and shall be guilty of a Class 4 felony for a
second or subsequent violation.
(b) Notwithstanding any other provision of this Act, all
criminal fines, moneys, or other property collected or received
by the Department under this Section or any other State or
federal statute, including, but not limited to, property
forfeited to the Department under Section 505 of the Illinois
Controlled Substances Act or Section 85 of the Methamphetamine
Control and Community Protection Act, shall be deposited into
the Professional Regulation Evidence Fund.
Section 140. Investigation; notice; hearing. The
Department may investigate the actions of any applicant or of
any person or persons holding or claiming to hold a license
under this Act. Before refusing to issue or to renew or taking
any disciplinary action regarding a license, the Department
shall, at least 30 days prior to the date set for the hearing,
notify in writing the applicant or licensee of the nature of
any charges and that a hearing shall be held on a date

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designated. The Department shall direct the applicant or
licensee to file a written answer with the Board under oath
within 20 days after the service of the notice and inform the
applicant or licensee that failure to file an answer shall
result in default being taken against the applicant or licensee
and that the license may be suspended, revoked, or placed on
probationary status or that other disciplinary action may be
taken, including limiting the scope, nature, or extent of
practice, as the Secretary may deem proper. Written notice may
be served by personal delivery or certified or registered mail
to the respondent at the address of his or her last
notification to the Department. If the person fails to file an
answer after receiving notice, his or her license may, in the
discretion of the Department, be suspended, revoked, or placed
on probationary status, or the Department may take any
disciplinary action deemed proper, including limiting the
scope, nature, or extent of the person's practice or the
imposition of a fine, without a hearing, if the act or acts
charged constitute sufficient grounds for such action under
this Act. At the time and place fixed in the notice, the Board
shall proceed to hear the charges and the parties or their
counsel shall be accorded ample opportunity to present such
statements, testimony, evidence, and argument as may be
pertinent to the charges or to their defense. The Board may
continue a hearing from time to time.

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Section 145. Formal hearing; preservation of record. The
Department, at its expense, shall preserve a record of all
proceedings at the formal hearing of any case. The notice of
hearing, complaint, and all other documents in the nature of
pleadings and written motions filed in the proceedings, the
transcript of testimony, the report of the Board or hearing
officer, and order of the Department shall be the record of the
proceeding. The Department shall furnish a transcript of the
record to any person interested in the hearing upon payment of
the fee required under Section 2105-115 of the Department of
Professional Regulation Law.
Section 150. Witnesses; production of documents; contempt.
Any circuit court may upon application of the Department or its
designee or of the applicant or licensee against whom
proceedings under Section 95 of this Act are pending, enter an
order requiring the attendance of witnesses and their testimony
and the production of documents, papers, files, books, and
records in connection with any hearing or investigation. The
court may compel obedience to its order by proceedings for
contempt.
Section 155. Subpoena; oaths. The Department shall have the
power to subpoena and bring before it any person in this State
and to take testimony either orally or by deposition or both
with the same fees and mileage and in the same manner as

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prescribed in civil cases in circuit courts of this State. The
Secretary, the designated hearing officer, and every member of
the Board has the power to administer oaths to witnesses at any
hearing that the Department is authorized to conduct and any
other oaths authorized in any Act administered by the
Department. Any circuit court may, upon application of the
Department or its designee or upon application of the person
against whom proceedings under this Act are pending, enter an
order requiring the attendance of witnesses and their
testimony, and the production of documents, papers, files,
books, and records in connection with any hearing or
investigation. The court may compel obedience to its order by
proceedings for contempt.
Section 160. Findings of fact, conclusions of law, and
recommendations. At the conclusion of the hearing, the Board
shall present to the Secretary a written report of its findings
of fact, conclusions of law, and recommendations. The report
shall contain a finding as to whether or not the accused person
violated this Act or failed to comply with the conditions
required under this Act. The Board shall specify the nature of
the violation or failure to comply and shall make its
recommendations to the Secretary. The findings of fact,
conclusions of law, and recommendations of the Board shall be
the basis for the Department's order. If the Secretary
disagrees in any regard with the report of the Board, the

SB3851 - 35 - LRB101 20758 SPS 70445 b
Secretary may issue an order in contravention of the report.
The finding is not admissible in evidence against the person in
a criminal prosecution brought for the violation of this Act,
but the hearing and findings are not a bar to a criminal
prosecution brought for the violation of this Act.
Section 165. Hearing officer. The Secretary may appoint any
attorney duly licensed to practice law in the State of Illinois
to serve as the hearing officer in any action for departmental
refusal to issue, renew, or license an applicant or for
disciplinary action against a licensee. The hearing officer
shall have full authority to conduct the hearing. The hearing
officer shall report his or her findings of fact, conclusions
of law, and recommendations to the Board and the Secretary. The
Board shall have 60 calendar days after receipt of the report
to review the report of the hearing officer and present its
findings of fact, conclusions of law, and recommendations to
the Secretary. If the Board fails to present its report within
the 60-day period, the Secretary may issue an order based on
the report of the hearing officer. If the Secretary disagrees
with the recommendation of the Board or the hearing officer,
the Secretary may issue an order in contravention of that
recommendation.
Section 170. Service of report; motion for rehearing. In
any case involving the discipline of a license, a copy of the

SB3851 - 36 - LRB101 20758 SPS 70445 b
Board's report shall be served upon the respondent by the
Department, either personally or as provided in this Act for
the service of the notice of hearing. Within 20 days after the
service, the respondent may present to the Department a motion
in writing for a rehearing that shall specify the particular
grounds for rehearing. If no motion for rehearing is filed,
then upon the expiration of the time specified for filing a
motion, or if a motion for rehearing is denied, then upon the
denial, the Secretary may enter an order in accordance with
this Act. If the respondent orders from the reporting service
and pays for a transcript of the record within the time for
filing a motion for rehearing, the 20-day period within which
the motion may be filed shall commence upon the delivery of the
transcript to the respondent.
Section 175. Rehearing. Whenever the Secretary is
satisfied that substantial justice has not been done in the
revocation, suspension, or refusal to issue or renew a license,
the Secretary may order a rehearing by the same or another
hearing officer or by the Board.
Section 180. Prima facie proof. An order or a certified
copy thereof, over the seal of the Department and purporting to
be signed by the Secretary, shall be prima facie proof of the
following:
(1) that the signature is the genuine signature of the

SB3851 - 37 - LRB101 20758 SPS 70445 b
Secretary;
(2) that such Secretary is duly appointed and
qualified;
(3) that the Board and its members are qualified to
act; and
(4) that the findings and conclusions set forth therein
are prima facie true and correct.
Section 185. Restoration of license. At any time after the
suspension or revocation of any license, the Department may
restore the license to the accused person, unless after an
investigation and a hearing the Department determines that
restoration is not in the public interest.
Section 190. Surrender of license. Upon the revocation or
suspension of any license, the licensee shall immediately
surrender the license to the Department. If the licensee fails
to do so, the Department shall have the right to seize the
license.
Section 195. Summary suspension. The Secretary may
summarily suspend the license of a licensee under this Act
without a hearing, simultaneously with the institution of
proceedings for a hearing provided for in this Act if the
Secretary finds that evidence in his or her possession
indicates that continuation in practice would constitute an

SB3851 - 38 - LRB101 20758 SPS 70445 b
imminent danger to the public. If the Secretary summarily
suspends a license without a hearing, a hearing by the
Department must be held within 30 days after the suspension has
occurred.
Section 200. Certificate of record. The Department shall
not be required to certify any record to the court or file any
answer in court or otherwise appear in any court in a judicial
review proceeding, unless there is filed in the court, with the
complaint, a receipt from the Department acknowledging payment
of the costs of furnishing and certifying the record. Failure
on the part of the plaintiff to file a receipt in court shall
be grounds for dismissal of the action.
Section 205. Administrative Review Law. All final
administrative decisions of the Department are subject to
judicial review under the Administrative Review Law and its
rules. The term "administrative decision" is defined as in
Section 3-101 of the Code of Civil Procedure.
Section 210. Illinois Administrative Procedure Act. The
Illinois Administrative Procedure Act is hereby expressly
adopted and incorporated in this Act as if all of the
provisions of such Act were included in this Act, except that
the provision of subsection (d) of Section 10-65 of the
Illinois Administrative Procedure Act that provides that at

SB3851 - 39 - LRB101 20758 SPS 70445 b
hearings the licensee has the right to show compliance with all
lawful requirements for retention, continuation, or renewal of
the license is specifically excluded. For purposes of this Act,
the notice required under Section 10-25 of the Illinois
Administrative Procedure Act is deemed sufficient when mailed
to the last known address of a party.
Section 215. Home rule. The regulation and licensing of
midwives are exclusive powers and functions of the State. A
home rule unit may not regulate or license midwives. This
Section is a denial and limitation of home rule powers and
functions under subsection (h) of Section 6 of Article VII of
the Illinois Constitution.
Section 220. Severability. The provisions of this Act are
severable under Section 1.31 of the Statute on Statutes.
Section 225. The Regulatory Sunset Act is amended by adding
Section 4.41 as follows:
(5 ILCS 80/4.41 new)
Sec. 4.41. Act repealed on January 1, 2031. The following
Act is repealed on January 1, 2031:
The Certified Professional Midwives Practice Act.
Section 230. The Illinois Insurance Code is amended by

SB3851 - 40 - LRB101 20758 SPS 70445 b
adding Section 356z.43 as follows:
(215 ILCS 5/356z.43 new)
Sec. 356z.43. Licensed certified professional midwife
care. Notwithstanding anything in this Section, An individual
or group policy of accident and health insurance that provides
maternity coverage and is amended, delivered, issued, or
renewed after the effective date of this amendatory Act of the
101st General Assembly, and which provides maternity benefits,
which are not limited to complications of pregnancy, or newborn
care benefits, shall provide coverage for maternity services
rendered by a licensed certified professional midwife licensed
pursuant to this Amendatory Act of the 101st General Assembly,
regardless of the site of services, in accordance with
guidelines adopted by rule by the commissioner.
Section 235. The Medical Practice Act of 1987 is amended by
changing Section 4 as follows:
(225 ILCS 60/4) (from Ch. 111, par. 4400-4)
(Section scheduled to be repealed on January 1, 2022)
Sec. 4. Exemptions. This Act does not apply to the
following:
(1) persons lawfully carrying on their particular
profession or business under any valid existing regulatory
Act of this State, including, without limitation, persons

SB3851 - 41 - LRB101 20758 SPS 70445 b
engaged in the practice of midwifery who are licensed under
the Certified Professional Midwives Practice Act;
(2) persons rendering gratuitous services in cases of
emergency; or
(3) persons treating human ailments by prayer or
spiritual means as an exercise or enjoyment of religious
freedom.
(Source: P.A. 96-7, eff. 4-3-09; 97-622, eff. 11-23-11.)
Section 240. The Nurse Practice Act is amended by changing
Section 50-15 as follows:
(225 ILCS 65/50-15) (was 225 ILCS 65/5-15)
(Section scheduled to be repealed on January 1, 2028)
Sec. 50-15. Policy; application of Act.
(a) For the protection of life and the promotion of health,
and the prevention of illness and communicable diseases, any
person practicing or offering to practice advanced,
professional, or practical nursing in Illinois shall submit
evidence that he or she is qualified to practice, and shall be
licensed as provided under this Act. No person shall practice
or offer to practice advanced, professional, or practical
nursing in Illinois or use any title, sign, card or device to
indicate that such a person is practicing professional or
practical nursing unless such person has been licensed under
the provisions of this Act.

SB3851 - 42 - LRB101 20758 SPS 70445 b
(b) This Act does not prohibit the following:
(1) The practice of nursing in Federal employment in
the discharge of the employee's duties by a person who is
employed by the United States government or any bureau,
division or agency thereof and is a legally qualified and
licensed nurse of another state or territory and not in
conflict with Sections 50-50, 55-10, 60-10, and 70-5 of
this Act.
(2) Nursing that is included in the program of study by
students enrolled in programs of nursing or in current
nurse practice update courses approved by the Department.
(3) The furnishing of nursing assistance in an
emergency.
(4) The practice of nursing by a nurse who holds an
active license in another state when providing services to
patients in Illinois during a bonafide emergency or in
immediate preparation for or during interstate transit.
(5) The incidental care of the sick by members of the
family, domestic servants or housekeepers, or care of the
sick where treatment is by prayer or spiritual means.
(6) Persons from being employed as unlicensed
assistive personnel in private homes, long term care
facilities, nurseries, hospitals or other institutions.
(7) The practice of practical nursing by one who is a
licensed practical nurse under the laws of another U.S.
jurisdiction and has applied in writing to the Department,

SB3851 - 43 - LRB101 20758 SPS 70445 b
in form and substance satisfactory to the Department, for a
license as a licensed practical nurse and who is qualified
to receive such license under this Act, until (i) the
expiration of 6 months after the filing of such written
application, (ii) the withdrawal of such application, or
(iii) the denial of such application by the Department.
(8) The practice of advanced practice registered
nursing by one who is an advanced practice registered nurse
under the laws of another United States jurisdiction or a
foreign jurisdiction and has applied in writing to the
Department, in form and substance satisfactory to the
Department, for a license as an advanced practice
registered nurse and who is qualified to receive such
license under this Act, until (i) the expiration of 6
months after the filing of such written application, (ii)
the withdrawal of such application, or (iii) the denial of
such application by the Department.
(9) The practice of professional nursing by one who is
a registered professional nurse under the laws of another
United States jurisdiction or a foreign jurisdiction and
has applied in writing to the Department, in form and
substance satisfactory to the Department, for a license as
a registered professional nurse and who is qualified to
receive such license under Section 55-10, until (1) the
expiration of 6 months after the filing of such written
application, (2) the withdrawal of such application, or (3)

SB3851 - 44 - LRB101 20758 SPS 70445 b
the denial of such application by the Department.
(10) The practice of professional nursing that is
included in a program of study by one who is a registered
professional nurse under the laws of another United States
jurisdiction or a foreign jurisdiction and who is enrolled
in a graduate nursing education program or a program for
the completion of a baccalaureate nursing degree in this
State, which includes clinical supervision by faculty as
determined by the educational institution offering the
program and the health care organization where the practice
of nursing occurs.
(11) Any person licensed in this State under any other
Act from engaging in the practice for which she or he is
licensed, including, without limitation, any person
engaged in the practice of midwifery who is licensed under
the Certified Professional Midwives Practice Act.
(12) Delegation to authorized direct care staff
trained under Section 15.4 of the Mental Health and
Developmental Disabilities Administrative Act consistent
with the policies of the Department.
(13) (Blank).
(14) County correctional personnel from delivering
prepackaged medication for self-administration to an
individual detainee in a correctional facility.
Nothing in this Act shall be construed to limit the
delegation of tasks or duties by a physician, dentist, or

SB3851 - 45 - LRB101 20758 SPS 70445 b
podiatric physician to a licensed practical nurse, a registered
professional nurse, or other persons.
(Source: P.A. 100-513, eff. 1-1-18.)
Section 245. The Illinois Public Aid Code is amended by
changing Section 5-5 as follows:
(305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
Sec. 5-5. Medical services. The Illinois Department, by
rule, shall determine the quantity and quality of and the rate
of reimbursement for the medical assistance for which payment
will be authorized, and the medical services to be provided,
which may include all or part of the following: (1) inpatient
hospital services; (2) outpatient hospital services; (3) other
laboratory and X-ray services; (4) skilled nursing home
services; (5) physicians' services whether furnished in the
office, the patient's home, a hospital, a skilled nursing home,
or elsewhere; (6) medical care, or any other type of remedial
care furnished by licensed practitioners, including the
services of licensed certified professional midwives pursuant
to the Certified Professional Midwives Practice Act; (7) home
health care services; (8) private duty nursing service; (9)
clinic services; (10) dental services, including prevention
and treatment of periodontal disease and dental caries disease
for pregnant women, provided by an individual licensed to
practice dentistry or dental surgery; for purposes of this item

SB3851 - 46 - LRB101 20758 SPS 70445 b
(10), "dental services" means diagnostic, preventive, or
corrective procedures provided by or under the supervision of a
dentist in the practice of his or her profession; (11) physical
therapy and related services; (12) prescribed drugs, dentures,
and prosthetic devices; and eyeglasses prescribed by a
physician skilled in the diseases of the eye, or by an
optometrist, whichever the person may select; (13) other
diagnostic, screening, preventive, and rehabilitative
services, including to ensure that the individual's need for
intervention or treatment of mental disorders or substance use
disorders or co-occurring mental health and substance use
disorders is determined using a uniform screening, assessment,
and evaluation process inclusive of criteria, for children and
adults; for purposes of this item (13), a uniform screening,
assessment, and evaluation process refers to a process that
includes an appropriate evaluation and, as warranted, a
referral; "uniform" does not mean the use of a singular
instrument, tool, or process that all must utilize; (14)
transportation and such other expenses as may be necessary;
(15) medical treatment of sexual assault survivors, as defined
in Section 1a of the Sexual Assault Survivors Emergency
Treatment Act, for injuries sustained as a result of the sexual
assault, including examinations and laboratory tests to
discover evidence which may be used in criminal proceedings
arising from the sexual assault; (16) the diagnosis and
treatment of sickle cell anemia; and (17) any other medical

SB3851 - 47 - LRB101 20758 SPS 70445 b
care, and any other type of remedial care recognized under the
laws of this State. The term "any other type of remedial care"
shall include nursing care and nursing home service for persons
who rely on treatment by spiritual means alone through prayer
for healing.
Notwithstanding any other provision of this Section, a
comprehensive tobacco use cessation program that includes
purchasing prescription drugs or prescription medical devices
approved by the Food and Drug Administration shall be covered
under the medical assistance program under this Article for
persons who are otherwise eligible for assistance under this
Article.
Notwithstanding any other provision of this Code,
reproductive health care that is otherwise legal in Illinois
shall be covered under the medical assistance program for
persons who are otherwise eligible for medical assistance under
this Article.
Notwithstanding any other provision of this Code, the
Illinois Department may not require, as a condition of payment
for any laboratory test authorized under this Article, that a
physician's handwritten signature appear on the laboratory
test order form. The Illinois Department may, however, impose
other appropriate requirements regarding laboratory test order
documentation.
Upon receipt of federal approval of an amendment to the
Illinois Title XIX State Plan for this purpose, the Department

SB3851 - 48 - LRB101 20758 SPS 70445 b
shall authorize the Chicago Public Schools (CPS) to procure a
vendor or vendors to manufacture eyeglasses for individuals
enrolled in a school within the CPS system. CPS shall ensure
that its vendor or vendors are enrolled as providers in the
medical assistance program and in any capitated Medicaid
managed care entity (MCE) serving individuals enrolled in a
school within the CPS system. Under any contract procured under
this provision, the vendor or vendors must serve only
individuals enrolled in a school within the CPS system. Claims
for services provided by CPS's vendor or vendors to recipients
of benefits in the medical assistance program under this Code,
the Children's Health Insurance Program, or the Covering ALL
KIDS Health Insurance Program shall be submitted to the
Department or the MCE in which the individual is enrolled for
payment and shall be reimbursed at the Department's or the
MCE's established rates or rate methodologies for eyeglasses.
On and after July 1, 2012, the Department of Healthcare and
Family Services may provide the following services to persons
eligible for assistance under this Article who are
participating in education, training or employment programs
operated by the Department of Human Services as successor to
the Department of Public Aid:
(1) dental services provided by or under the
supervision of a dentist; and
(2) eyeglasses prescribed by a physician skilled in the
diseases of the eye, or by an optometrist, whichever the

SB3851 - 49 - LRB101 20758 SPS 70445 b
person may select.
On and after July 1, 2018, the Department of Healthcare and
Family Services shall provide dental services to any adult who
is otherwise eligible for assistance under the medical
assistance program. As used in this paragraph, "dental
services" means diagnostic, preventative, restorative, or
corrective procedures, including procedures and services for
the prevention and treatment of periodontal disease and dental
caries disease, provided by an individual who is licensed to
practice dentistry or dental surgery or who is under the
supervision of a dentist in the practice of his or her
profession.
On and after July 1, 2018, targeted dental services, as set
forth in Exhibit D of the Consent Decree entered by the United
States District Court for the Northern District of Illinois,
Eastern Division, in the matter of Memisovski v. Maram, Case
No. 92 C 1982, that are provided to adults under the medical
assistance program shall be established at no less than the
rates set forth in the "New Rate" column in Exhibit D of the
Consent Decree for targeted dental services that are provided
to persons under the age of 18 under the medical assistance
program.
Notwithstanding any other provision of this Code and
subject to federal approval, the Department may adopt rules to
allow a dentist who is volunteering his or her service at no
cost to render dental services through an enrolled

SB3851 - 50 - LRB101 20758 SPS 70445 b
not-for-profit health clinic without the dentist personally
enrolling as a participating provider in the medical assistance
program. A not-for-profit health clinic shall include a public
health clinic or Federally Qualified Health Center or other
enrolled provider, as determined by the Department, through
which dental services covered under this Section are performed.
The Department shall establish a process for payment of claims
for reimbursement for covered dental services rendered under
this provision.
The Illinois Department, by rule, may distinguish and
classify the medical services to be provided only in accordance
with the classes of persons designated in Section 5-2.
The Department of Healthcare and Family Services must
provide coverage and reimbursement for amino acid-based
elemental formulas, regardless of delivery method, for the
diagnosis and treatment of (i) eosinophilic disorders and (ii)
short bowel syndrome when the prescribing physician has issued
a written order stating that the amino acid-based elemental
formula is medically necessary.
The Illinois Department shall authorize the provision of,
and shall authorize payment for, screening by low-dose
mammography for the presence of occult breast cancer for women
35 years of age or older who are eligible for medical
assistance under this Article, as follows:
(A) A baseline mammogram for women 35 to 39 years of
age.

SB3851 - 51 - LRB101 20758 SPS 70445 b
(B) An annual mammogram for women 40 years of age or
older.
(C) A mammogram at the age and intervals considered
medically necessary by the woman's health care provider for
women under 40 years of age and having a family history of
breast cancer, prior personal history of breast cancer,
positive genetic testing, or other risk factors.
(D) A comprehensive ultrasound screening and MRI of an
entire breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue or when medically
necessary as determined by a physician licensed to practice
medicine in all of its branches.
(E) A screening MRI when medically necessary, as
determined by a physician licensed to practice medicine in
all of its branches.
(F) A diagnostic mammogram when medically necessary,
as determined by a physician licensed to practice medicine
in all its branches, advanced practice registered nurse, or
physician assistant.
The Department shall not impose a deductible, coinsurance,
copayment, or any other cost-sharing requirement on the
coverage provided under this paragraph; except that this
sentence does not apply to coverage of diagnostic mammograms 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 (26 U.S.C.

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223).
All screenings shall include a physical breast exam,
instruction on self-examination and information regarding the
frequency of self-examination and its value as a preventative
tool.
For purposes of this Section:
"Diagnostic mammogram" means a mammogram obtained using
diagnostic mammography.
"Diagnostic mammography" means a method of screening that
is designed to evaluate an abnormality in a breast, including
an abnormality seen or suspected on a screening mammogram or a
subjective or objective abnormality otherwise detected in the
breast.
"Low-dose mammography" means the x-ray examination of the
breast using equipment dedicated specifically for mammography,
including the x-ray tube, filter, compression device, and image
receptor, with an average radiation exposure delivery of less
than one rad per breast for 2 views of an average size breast.
The term also includes digital mammography and includes breast
tomosynthesis.
"Breast tomosynthesis" means a radiologic procedure that
involves the acquisition of projection images over the
stationary breast to produce cross-sectional digital
three-dimensional images of the breast.
If, at any time, the Secretary of the United States
Department of Health and Human Services, or its successor

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agency, promulgates rules or regulations to be published in the
Federal Register or publishes a comment in the Federal Register
or issues an opinion, guidance, or other action that would
require the State, pursuant to any provision of the Patient
Protection and Affordable Care Act (Public Law 111-148),
including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
successor provision, to defray the cost of any coverage for
breast tomosynthesis outlined in this paragraph, then the
requirement that an insurer cover breast tomosynthesis is
inoperative other than any such coverage authorized under
Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
the State shall not assume any obligation for the cost of
coverage for breast tomosynthesis set forth in this paragraph.
On and after January 1, 2016, the Department shall ensure
that all networks of care for adult clients of the Department
include access to at least one breast imaging Center of Imaging
Excellence as certified by the American College of Radiology.
On and after January 1, 2012, providers participating in a
quality improvement program approved by the Department shall be
reimbursed for screening and diagnostic mammography at the same
rate as the Medicare program's rates, including the increased
reimbursement for digital mammography.
The Department shall convene an expert panel including
representatives of hospitals, free-standing mammography
facilities, and doctors, including radiologists, to establish
quality standards for mammography.

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On and after January 1, 2017, providers participating in a
breast cancer treatment quality improvement program approved
by the Department shall be reimbursed for breast cancer
treatment at a rate that is no lower than 95% of the Medicare
program's rates for the data elements included in the breast
cancer treatment quality program.
The Department shall convene an expert panel, including
representatives of hospitals, free-standing breast cancer
treatment centers, breast cancer quality organizations, and
doctors, including breast surgeons, reconstructive breast
surgeons, oncologists, and primary care providers to establish
quality standards for breast cancer treatment.
Subject to federal approval, the Department shall
establish a rate methodology for mammography at federally
qualified health centers and other encounter-rate clinics.
These clinics or centers may also collaborate with other
hospital-based mammography facilities. By January 1, 2016, the
Department shall report to the General Assembly on the status
of the provision set forth in this paragraph.
The Department shall establish a methodology to remind
women who are age-appropriate for screening mammography, but
who have not received a mammogram within the previous 18
months, of the importance and benefit of screening mammography.
The Department shall work with experts in breast cancer
outreach and patient navigation to optimize these reminders and
shall establish a methodology for evaluating their

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effectiveness and modifying the methodology based on the
evaluation.
The Department shall establish a performance goal for
primary care providers with respect to their female patients
over age 40 receiving an annual mammogram. This performance
goal shall be used to provide additional reimbursement in the
form of a quality performance bonus to primary care providers
who meet that goal.
The Department shall devise a means of case-managing or
patient navigation for beneficiaries diagnosed with breast
cancer. This program shall initially operate as a pilot program
in areas of the State with the highest incidence of mortality
related to breast cancer. At least one pilot program site shall
be in the metropolitan Chicago area and at least one site shall
be outside the metropolitan Chicago area. On or after July 1,
2016, the pilot program shall be expanded to include one site
in western Illinois, one site in southern Illinois, one site in
central Illinois, and 4 sites within metropolitan Chicago. An
evaluation of the pilot program shall be carried out measuring
health outcomes and cost of care for those served by the pilot
program compared to similarly situated patients who are not
served by the pilot program.
The Department shall require all networks of care to
develop a means either internally or by contract with experts
in navigation and community outreach to navigate cancer
patients to comprehensive care in a timely fashion. The

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Department shall require all networks of care to include access
for patients diagnosed with cancer to at least one academic
commission on cancer-accredited cancer program as an
in-network covered benefit.
Any medical or health care provider shall immediately
recommend, to any pregnant woman who is being provided prenatal
services and is suspected of having a substance use disorder as
defined in the Substance Use Disorder Act, referral to a local
substance use disorder treatment program licensed by the
Department of Human Services or to a licensed hospital which
provides substance abuse treatment services. The Department of
Healthcare and Family Services shall assure coverage for the
cost of treatment of the drug abuse or addiction for pregnant
recipients in accordance with the Illinois Medicaid Program in
conjunction with the Department of Human Services.
All medical providers providing medical assistance to
pregnant women under this Code shall receive information from
the Department on the availability of services under any
program providing case management services for addicted women,
including information on appropriate referrals for other
social services that may be needed by addicted women in
addition to treatment for addiction.
The Illinois Department, in cooperation with the
Departments of Human Services (as successor to the Department
of Alcoholism and Substance Abuse) and Public Health, through a
public awareness campaign, may provide information concerning

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treatment for alcoholism and drug abuse and addiction, prenatal
health care, and other pertinent programs directed at reducing
the number of drug-affected infants born to recipients of
medical assistance.
Neither the Department of Healthcare and Family Services
nor the Department of Human Services shall sanction the
recipient solely on the basis of her substance abuse.
The Illinois Department shall establish such regulations
governing the dispensing of health services under this Article
as it shall deem appropriate. The Department should seek the
advice of formal professional advisory committees appointed by
the Director of the Illinois Department for the purpose of
providing regular advice on policy and administrative matters,
information dissemination and educational activities for
medical and health care providers, and consistency in
procedures to the Illinois Department.
The Illinois Department may develop and contract with
Partnerships of medical providers to arrange medical services
for persons eligible under Section 5-2 of this Code.
Implementation of this Section may be by demonstration projects
in certain geographic areas. The Partnership shall be
represented by a sponsor organization. The Department, by rule,
shall develop qualifications for sponsors of Partnerships.
Nothing in this Section shall be construed to require that the
sponsor organization be a medical organization.
The sponsor must negotiate formal written contracts with

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medical providers for physician services, inpatient and
outpatient hospital care, home health services, treatment for
alcoholism and substance abuse, and other services determined
necessary by the Illinois Department by rule for delivery by
Partnerships. Physician services must include prenatal and
obstetrical care. The Illinois Department shall reimburse
medical services delivered by Partnership providers to clients
in target areas according to provisions of this Article and the
Illinois Health Finance Reform Act, except that:
(1) Physicians participating in a Partnership and
providing certain services, which shall be determined by
the Illinois Department, to persons in areas covered by the
Partnership may receive an additional surcharge for such
services.
(2) The Department may elect to consider and negotiate
financial incentives to encourage the development of
Partnerships and the efficient delivery of medical care.
(3) Persons receiving medical services through
Partnerships may receive medical and case management
services above the level usually offered through the
medical assistance program.
Medical providers shall be required to meet certain
qualifications to participate in Partnerships to ensure the
delivery of high quality medical services. These
qualifications shall be determined by rule of the Illinois
Department and may be higher than qualifications for

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participation in the medical assistance program. Partnership
sponsors may prescribe reasonable additional qualifications
for participation by medical providers, only with the prior
written approval of the Illinois Department.
Nothing in this Section shall limit the free choice of
practitioners, hospitals, and other providers of medical
services by clients. In order to ensure patient freedom of
choice, the Illinois Department shall immediately promulgate
all rules and take all other necessary actions so that provided
services may be accessed from therapeutically certified
optometrists to the full extent of the Illinois Optometric
Practice Act of 1987 without discriminating between service
providers.
The Department shall apply for a waiver from the United
States Health Care Financing Administration to allow for the
implementation of Partnerships under this Section.
The Illinois Department shall require health care
providers to maintain records that document the medical care
and services provided to recipients of Medical Assistance under
this Article. Such records must be retained for a period of not
less than 6 years from the date of service or as provided by
applicable State law, whichever period is longer, except that
if an audit is initiated within the required retention period
then the records must be retained until the audit is completed
and every exception is resolved. The Illinois Department shall
require health care providers to make available, when

SB3851 - 60 - LRB101 20758 SPS 70445 b
authorized by the patient, in writing, the medical records in a
timely fashion to other health care providers who are treating
or serving persons eligible for Medical Assistance under this
Article. All dispensers of medical services shall be required
to maintain and retain business and professional records
sufficient to fully and accurately document the nature, scope,
details and receipt of the health care provided to persons
eligible for medical assistance under this Code, in accordance
with regulations promulgated by the Illinois Department. The
rules and regulations shall require that proof of the receipt
of prescription drugs, dentures, prosthetic devices and
eyeglasses by eligible persons under this Section accompany
each claim for reimbursement submitted by the dispenser of such
medical services. No such claims for reimbursement shall be
approved for payment by the Illinois Department without such
proof of receipt, unless the Illinois Department shall have put
into effect and shall be operating a system of post-payment
audit and review which shall, on a sampling basis, be deemed
adequate by the Illinois Department to assure that such drugs,
dentures, prosthetic devices and eyeglasses for which payment
is being made are actually being received by eligible
recipients. Within 90 days after September 16, 1984 (the
effective date of Public Act 83-1439), the Illinois Department
shall establish a current list of acquisition costs for all
prosthetic devices and any other items recognized as medical
equipment and supplies reimbursable under this Article and

SB3851 - 61 - LRB101 20758 SPS 70445 b
shall update such list on a quarterly basis, except that the
acquisition costs of all prescription drugs shall be updated no
less frequently than every 30 days as required by Section
5-5.12.
Notwithstanding any other law to the contrary, the Illinois
Department shall, within 365 days after July 22, 2013 (the
effective date of Public Act 98-104), establish procedures to
permit skilled care facilities licensed under the Nursing Home
Care Act to submit monthly billing claims for reimbursement
purposes. Following development of these procedures, the
Department shall, by July 1, 2016, test the viability of the
new system and implement any necessary operational or
structural changes to its information technology platforms in
order to allow for the direct acceptance and payment of nursing
home claims.
Notwithstanding any other law to the contrary, the Illinois
Department shall, within 365 days after August 15, 2014 (the
effective date of Public Act 98-963), establish procedures to
permit ID/DD facilities licensed under the ID/DD Community Care
Act and MC/DD facilities licensed under the MC/DD Act to submit
monthly billing claims for reimbursement purposes. Following
development of these procedures, the Department shall have an
additional 365 days to test the viability of the new system and
to ensure that any necessary operational or structural changes
to its information technology platforms are implemented.
The Illinois Department shall require all dispensers of

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medical services, other than an individual practitioner or
group of practitioners, desiring to participate in the Medical
Assistance program established under this Article to disclose
all financial, beneficial, ownership, equity, surety or other
interests in any and all firms, corporations, partnerships,
associations, business enterprises, joint ventures, agencies,
institutions or other legal entities providing any form of
health care services in this State under this Article.
The Illinois Department may require that all dispensers of
medical services desiring to participate in the medical
assistance program established under this Article disclose,
under such terms and conditions as the Illinois Department may
by rule establish, all inquiries from clients and attorneys
regarding medical bills paid by the Illinois Department, which
inquiries could indicate potential existence of claims or liens
for the Illinois Department.
Enrollment of a vendor shall be subject to a provisional
period and shall be conditional for one year. During the period
of conditional enrollment, the Department may terminate the
vendor's eligibility to participate in, or may disenroll the
vendor from, the medical assistance program without cause.
Unless otherwise specified, such termination of eligibility or
disenrollment is not subject to the Department's hearing
process. However, a disenrolled vendor may reapply without
penalty.
The Department has the discretion to limit the conditional

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enrollment period for vendors based upon category of risk of
the vendor.
Prior to enrollment and during the conditional enrollment
period in the medical assistance program, all vendors shall be
subject to enhanced oversight, screening, and review based on
the risk of fraud, waste, and abuse that is posed by the
category of risk of the vendor. The Illinois Department shall
establish the procedures for oversight, screening, and review,
which may include, but need not be limited to: criminal and
financial background checks; fingerprinting; license,
certification, and authorization verifications; unscheduled or
unannounced site visits; database checks; prepayment audit
reviews; audits; payment caps; payment suspensions; and other
screening as required by federal or State law.
The Department shall define or specify the following: (i)
by provider notice, the "category of risk of the vendor" for
each type of vendor, which shall take into account the level of
screening applicable to a particular category of vendor under
federal law and regulations; (ii) by rule or provider notice,
the maximum length of the conditional enrollment period for
each category of risk of the vendor; and (iii) by rule, the
hearing rights, if any, afforded to a vendor in each category
of risk of the vendor that is terminated or disenrolled during
the conditional enrollment period.
To be eligible for payment consideration, a vendor's
payment claim or bill, either as an initial claim or as a

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resubmitted claim following prior rejection, must be received
by the Illinois Department, or its fiscal intermediary, no
later than 180 days after the latest date on the claim on which
medical goods or services were provided, with the following
exceptions:
(1) In the case of a provider whose enrollment is in
process by the Illinois Department, the 180-day period
shall not begin until the date on the written notice from
the Illinois Department that the provider enrollment is
complete.
(2) In the case of errors attributable to the Illinois
Department or any of its claims processing intermediaries
which result in an inability to receive, process, or
adjudicate a claim, the 180-day period shall not begin
until the provider has been notified of the error.
(3) In the case of a provider for whom the Illinois
Department initiates the monthly billing process.
(4) In the case of a provider operated by a unit of
local government with a population exceeding 3,000,000
when local government funds finance federal participation
for claims payments.
For claims for services rendered during a period for which
a recipient received retroactive eligibility, claims must be
filed within 180 days after the Department determines the
applicant is eligible. For claims for which the Illinois
Department is not the primary payer, claims must be submitted

SB3851 - 65 - LRB101 20758 SPS 70445 b
to the Illinois Department within 180 days after the final
adjudication by the primary payer.
In the case of long term care facilities, within 45
calendar days of receipt by the facility of required
prescreening information, new admissions with associated
admission documents shall be submitted through the Medical
Electronic Data Interchange (MEDI) or the Recipient
Eligibility Verification (REV) System or shall be submitted
directly to the Department of Human Services using required
admission forms. Effective September 1, 2014, admission
documents, including all prescreening information, must be
submitted through MEDI or REV. Confirmation numbers assigned to
an accepted transaction shall be retained by a facility to
verify timely submittal. Once an admission transaction has been
completed, all resubmitted claims following prior rejection
are subject to receipt no later than 180 days after the
admission transaction has been completed.
Claims that are not submitted and received in compliance
with the foregoing requirements shall not be eligible for
payment under the medical assistance program, and the State
shall have no liability for payment of those claims.
To the extent consistent with applicable information and
privacy, security, and disclosure laws, State and federal
agencies and departments shall provide the Illinois Department
access to confidential and other information and data necessary
to perform eligibility and payment verifications and other

SB3851 - 66 - LRB101 20758 SPS 70445 b
Illinois Department functions. This includes, but is not
limited to: information pertaining to licensure;
certification; earnings; immigration status; citizenship; wage
reporting; unearned and earned income; pension income;
employment; supplemental security income; social security
numbers; National Provider Identifier (NPI) numbers; the
National Practitioner Data Bank (NPDB); program and agency
exclusions; taxpayer identification numbers; tax delinquency;
corporate information; and death records.
The Illinois Department shall enter into agreements with
State agencies and departments, and is authorized to enter into
agreements with federal agencies and departments, under which
such agencies and departments shall share data necessary for
medical assistance program integrity functions and oversight.
The Illinois Department shall develop, in cooperation with
other State departments and agencies, and in compliance with
applicable federal laws and regulations, appropriate and
effective methods to share such data. At a minimum, and to the
extent necessary to provide data sharing, the Illinois
Department shall enter into agreements with State agencies and
departments, and is authorized to enter into agreements with
federal agencies and departments, including, but not limited
to: the Secretary of State; the Department of Revenue; the
Department of Public Health; the Department of Human Services;
and the Department of Financial and Professional Regulation.
Beginning in fiscal year 2013, the Illinois Department

SB3851 - 67 - LRB101 20758 SPS 70445 b
shall set forth a request for information to identify the
benefits of a pre-payment, post-adjudication, and post-edit
claims system with the goals of streamlining claims processing
and provider reimbursement, reducing the number of pending or
rejected claims, and helping to ensure a more transparent
adjudication process through the utilization of: (i) provider
data verification and provider screening technology; and (ii)
clinical code editing; and (iii) pre-pay, pre- or
post-adjudicated predictive modeling with an integrated case
management system with link analysis. Such a request for
information shall not be considered as a request for proposal
or as an obligation on the part of the Illinois Department to
take any action or acquire any products or services.
The Illinois Department shall establish policies,
procedures, standards and criteria by rule for the acquisition,
repair and replacement of orthotic and prosthetic devices and
durable medical equipment. Such rules shall provide, but not be
limited to, the following services: (1) immediate repair or
replacement of such devices by recipients; and (2) rental,
lease, purchase or lease-purchase of durable medical equipment
in a cost-effective manner, taking into consideration the
recipient's medical prognosis, the extent of the recipient's
needs, and the requirements and costs for maintaining such
equipment. Subject to prior approval, such rules shall enable a
recipient to temporarily acquire and use alternative or
substitute devices or equipment pending repairs or

SB3851 - 68 - LRB101 20758 SPS 70445 b
replacements of any device or equipment previously authorized
for such recipient by the Department. Notwithstanding any
provision of Section 5-5f to the contrary, the Department may,
by rule, exempt certain replacement wheelchair parts from prior
approval and, for wheelchairs, wheelchair parts, wheelchair
accessories, and related seating and positioning items,
determine the wholesale price by methods other than actual
acquisition costs.
The Department shall require, by rule, all providers of
durable medical equipment to be accredited by an accreditation
organization approved by the federal Centers for Medicare and
Medicaid Services and recognized by the Department in order to
bill the Department for providing durable medical equipment to
recipients. No later than 15 months after the effective date of
the rule adopted pursuant to this paragraph, all providers must
meet the accreditation requirement.
In order to promote environmental responsibility, meet the
needs of recipients and enrollees, and achieve significant cost
savings, the Department, or a managed care organization under
contract with the Department, may provide recipients or managed
care enrollees who have a prescription or Certificate of
Medical Necessity access to refurbished durable medical
equipment under this Section (excluding prosthetic and
orthotic devices as defined in the Orthotics, Prosthetics, and
Pedorthics Practice Act and complex rehabilitation technology
products and associated services) through the State's

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assistive technology program's reutilization program, using
staff with the Assistive Technology Professional (ATP)
Certification if the refurbished durable medical equipment:
(i) is available; (ii) is less expensive, including shipping
costs, than new durable medical equipment of the same type;
(iii) is able to withstand at least 3 years of use; (iv) is
cleaned, disinfected, sterilized, and safe in accordance with
federal Food and Drug Administration regulations and guidance
governing the reprocessing of medical devices in health care
settings; and (v) equally meets the needs of the recipient or
enrollee. The reutilization program shall confirm that the
recipient or enrollee is not already in receipt of same or
similar equipment from another service provider, and that the
refurbished durable medical equipment equally meets the needs
of the recipient or enrollee. Nothing in this paragraph shall
be construed to limit recipient or enrollee choice to obtain
new durable medical equipment or place any additional prior
authorization conditions on enrollees of managed care
organizations.
The Department shall execute, relative to the nursing home
prescreening project, written inter-agency agreements with the
Department of Human Services and the Department on Aging, to
effect the following: (i) intake procedures and common
eligibility criteria for those persons who are receiving
non-institutional services; and (ii) the establishment and
development of non-institutional services in areas of the State

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where they are not currently available or are undeveloped; and
(iii) notwithstanding any other provision of law, subject to
federal approval, on and after July 1, 2012, an increase in the
determination of need (DON) scores from 29 to 37 for applicants
for institutional and home and community-based long term care;
if and only if federal approval is not granted, the Department
may, in conjunction with other affected agencies, implement
utilization controls or changes in benefit packages to
effectuate a similar savings amount for this population; and
(iv) no later than July 1, 2013, minimum level of care
eligibility criteria for institutional and home and
community-based long term care; and (v) no later than October
1, 2013, establish procedures to permit long term care
providers access to eligibility scores for individuals with an
admission date who are seeking or receiving services from the
long term care provider. In order to select the minimum level
of care eligibility criteria, the Governor shall establish a
workgroup that includes affected agency representatives and
stakeholders representing the institutional and home and
community-based long term care interests. This Section shall
not restrict the Department from implementing lower level of
care eligibility criteria for community-based services in
circumstances where federal approval has been granted.
The Illinois Department shall develop and operate, in
cooperation with other State Departments and agencies and in
compliance with applicable federal laws and regulations,

SB3851 - 71 - LRB101 20758 SPS 70445 b
appropriate and effective systems of health care evaluation and
programs for monitoring of utilization of health care services
and facilities, as it affects persons eligible for medical
assistance under this Code.
The Illinois Department shall report annually to the
General Assembly, no later than the second Friday in April of
1979 and each year thereafter, in regard to:
(a) actual statistics and trends in utilization of
medical services by public aid recipients;
(b) actual statistics and trends in the provision of
the various medical services by medical vendors;
(c) current rate structures and proposed changes in
those rate structures for the various medical vendors; and
(d) efforts at utilization review and control by the
Illinois Department.
The period covered by each report shall be the 3 years
ending on the June 30 prior to the report. The report shall
include suggested legislation for consideration by the General
Assembly. The requirement for reporting to the General Assembly
shall be satisfied by filing copies of the report as required
by Section 3.1 of the General Assembly Organization Act, and
filing such additional copies with the State Government Report
Distribution Center for the General Assembly as is required
under paragraph (t) of Section 7 of the State Library Act.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance

SB3851 - 72 - LRB101 20758 SPS 70445 b
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
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.
Because kidney transplantation can be an appropriate,
cost-effective alternative to renal dialysis when medically
necessary and notwithstanding the provisions of Section 1-11 of
this Code, beginning October 1, 2014, the Department shall
cover kidney transplantation for noncitizens with end-stage
renal disease who are not eligible for comprehensive medical
benefits, who meet the residency requirements of Section 5-3 of
this Code, and who would otherwise meet the financial
requirements of the appropriate class of eligible persons under
Section 5-2 of this Code. To qualify for coverage of kidney
transplantation, such person must be receiving emergency renal
dialysis services covered by the Department. Providers under
this Section shall be prior approved and certified by the
Department to perform kidney transplantation and the services
under this Section shall be limited to services associated with
kidney transplantation.
Notwithstanding any other provision of this Code to the

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contrary, on or after July 1, 2015, all FDA approved forms of
medication assisted treatment prescribed for the treatment of
alcohol dependence or treatment of opioid dependence shall be
covered under both fee for service and managed care medical
assistance programs for persons who are otherwise eligible for
medical assistance under this Article and shall not be subject
to any (1) utilization control, other than those established
under the American Society of Addiction Medicine patient
placement criteria, (2) prior authorization mandate, or (3)
lifetime restriction limit mandate.
On or after July 1, 2015, opioid antagonists prescribed for
the treatment of an opioid overdose, including the medication
product, administration devices, and any pharmacy fees related
to the dispensing and administration of the opioid antagonist,
shall be covered under the medical assistance program for
persons who are otherwise eligible for medical assistance under
this Article. As used in this Section, "opioid antagonist"
means a drug that binds to opioid receptors and blocks or
inhibits the effect of opioids acting on those receptors,
including, but not limited to, naloxone hydrochloride or any
other similarly acting drug approved by the U.S. Food and Drug
Administration.
Upon federal approval, the Department shall provide
coverage and reimbursement for all drugs that are approved for
marketing by the federal Food and Drug Administration and that
are recommended by the federal Public Health Service or the

SB3851 - 74 - LRB101 20758 SPS 70445 b
United States Centers for Disease Control and Prevention for
pre-exposure prophylaxis and related pre-exposure prophylaxis
services, including, but not limited to, HIV and sexually
transmitted infection screening, treatment for sexually
transmitted infections, medical monitoring, assorted labs, and
counseling to reduce the likelihood of HIV infection among
individuals who are not infected with HIV but who are at high
risk of HIV infection.
A federally qualified health center, as defined in Section
1905(l)(2)(B) of the federal Social Security Act, shall be
reimbursed by the Department in accordance with the federally
qualified health center's encounter rate for services provided
to medical assistance recipients that are performed by a dental
hygienist, as defined under the Illinois Dental Practice Act,
working under the general supervision of a dentist and employed
by a federally qualified health center.
(Source: P.A. 100-201, eff. 8-18-17; 100-395, eff. 1-1-18;
100-449, eff. 1-1-18; 100-538, eff. 1-1-18; 100-587, eff.
6-4-18; 100-759, eff. 1-1-19; 100-863, eff. 8-14-18; 100-974,
eff. 8-19-18; 100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19;
100-1148, eff. 12-10-18; 101-209, eff. 8-5-19; 101-580, eff.
1-1-20; revised 9-18-19.)