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September 12, 2007

Public Act 95-445: Birth Centers

II. BIRTH CENTERS DEFINED. Ten birth centers have been authorized under the Alternative Health Care Delivery Act. A birth center is a designated site that is away from the mother’s usual place of residence and in which births are planned to occur following a normal, uncomplicated, and low-risk pregnancy. A birth center shall be exclusively dedicated to serving the childbirth-related needs of women and their newborns; shall have no more than 10 beds; shall offer prenatal care and community education services and coordinate these services with other health care services available in the community.

III. REQUIREMENTS FOR BIRTH CENTERS. Effective January 1, 2008, the following requirements shall apply to an entity seeking to establish a birth center:

A. Location and Ownership. The Act authorizes (a) four birth centers in the area comprising Cook, DuPage, Kane, Lake, McHenry and Will counties (b) three birth centers in municipalities with a population of 50,000 or more not located in the area described in paragraph (a) above and (c) three birth centers in rural areas.

In each of the three categories above, one birth center shall be owned or operated by a hospital and one shall be owned or operated by a federally qualified health center (FQHC). The first three birth centers authorized shall be located in or predominantly serve the residents of a health professional shortage area as determined by the U. S. Department of Health and Human Services. There shall be no more than two birth centers authorized to operate in any single health planning area for obstetric services as determined under the Illinois Health Facilities Planning Act. If a birth center is located outside of a health professional shortage area, (1) the birth center shall be located in a health planning area with a demonstrated need for OB service beds, as determined by the Health Facilities Planning Board or (2) there must be a reduction in the existing number of OB service beds so that the establishment of the birth center does not result in an increase in the total number of obstetrical service beds in the health planning area.

In addition, a birth center not operated under a hospital license shall be located within a ground travel time distance from the general acute care hospital with which the birth center maintains a contractual relationship, including a transfer agreement, that allows for an emergency caesarian delivery to be started within 30 minutes of the decision that a caesarian delivery is necessary. The location of a birth center operated under a hospital license shall also allow for a "decision to incision" time of 30 minutes from the hospital.

B. Medicare and Medicaid. A birth center shall be certified to participate in the Medicare and Medicaid programs.

C. Licensure. A birth center shall not be separately licensed if it is part of a hospital or a freestanding facility that is physically distinct from a hospital, but is operated under a license issued to a hospital under the Hospital Licensing Act. A separate birth center license is required if the birth center is operated as (1) part of an FQHC or (2) a facility other than any of those described above whose costs are reimbursable under Medicaid.

1. Medical Director. A birth center must have a medical director who is (1) a physician certified or eligible for certification by the American College of Obstetricians and Gynecologists or the American Board of Osteopathic Obstetricians and Gynecologists or (2) a physician who has hospital obstetrical privileges. The medical director or his or her physician designee shall be available on the premises or within a close proximity of the birth center, as defined by rule. The medical director in consultation with the Director of Nursing and Midwifery Services shall coordinate the clinical staff and overall provision of patient care, including the development and approval of policies defining the criteria to determine which pregnancies are accepted as normal, uncomplicated, and low-risk, and the anesthesia (no general anesthesia) services available at the center.

2. Midwives. If a birth center employs certified nurse midwives, a certified nurse midwife shall be the Director of Nursing and Midwifery Services who is responsible for the development of policies and procedures for services as provided by Department rules.

3. Attendance During Labor and Delivery. An obstetrician, family practitioner, or certified nurse midwife shall attend each woman in labor from the time of admission through birth and throughout the immediate postpartum period. Attendance may be delegated only to another physician or certified nurse midwife. A second staff person shall also be present at each birth who is licensed or certified in Illinois in a health-related field and under the supervision of the physician or certified nurse midwife in attendance, has specialized training in labor and delivery techniques and care of newborns, and receives planned and ongoing training as needed.

E. Limitations.

1. No general anesthesia may be administered and no surgery may be performed.
2. The maximum length of stay in a birth center shall be consistent with existing State laws allowing a 48-hour stay or appropriate post-delivery care, if discharged earlier.
3. A birth center may not discriminate against any patient requiring treatment because of the source of payment for services, including Medicare and Medicaid recipients.

F. Rules and Accreditation. In adopting rules for birth centers, the Department of Public Health (Department) shall consider the American Association of Birth Centers’ Standards for Freestanding Birth Centers; the American Academy of Pediatrics/American College of Obstetricians and Gynecologists Guidelines for Perinatal Care; and the Regionalized Perinatal Health Care Code. The Department’s rules shall stipulate the eligibility criteria for birth center admission. The rules shall provide for a time period within which each birth center not part of a hospital must become accredited by either the Commission for the Accreditation of Freestanding Birth Centers or the Joint Commission.

G. Reporting. The Department shall by rule require each birth center to report information which the Department shall make publicly available on birth center ownership; payment sources; utilization; admissions and discharges; complications; transfers; unusual incidents; deaths; patient status data where patients are followed for 14 days after discharge from the birth center to determine incidence of complication or infection; and other publicly reported data required under the Illinois Consumer Guide.

H. Letter of Agreement with a Hospital. A birth center shall participate in the Illinois Perinatal System, and at a minimum must establish a letter of agreement with a hospital designated under the Perinatal System.

IV. REQUIREMENTS FOR HOSPITALS. A hospital that operates or has a letter of agreement with a birth center shall include the birth center under its maternity service plan and shall include the birth center in the hospital’s letter of agreement with its regional perinatal center.

The full text of P.A. 95-445 can be accessed at the Illinois General Assembly web site (click here).

Under the Act, the Department of Public Health must adopt rules within nine months to implement the birth center provisions of the Alternative Health Care Delivery Act. IHA will inform you when rules are published. In the meantime, if you have any questions, please contact Barb Haller at bhaller@ihastaff.org or 630.276.5474.