Senate Bill No. 104
(By Senators Minear, Walker, Sprouse, Snyder, Boley, White,
Jackson, Ross, Sharpe, Wooton, Plymale, Anderson, Love, Craigo
and Kimble)
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[Introduced February 21, 1997; referred to the Committee
on Health and Human Resources; and then to the Committee on
Finance.]
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A BILL to amend chapter thirty-three of the code of West
Virginia, one thousand nine hundred thirty-one, as amended,
by adding thereto a new article, designated article forty- one, relating to health insurance; requiring coverage of
inpatient care for mothers and newly born infants for
specified time periods following childbirth; requiring
coverage for follow-up visit when attending provider and
mother elect early discharge; insurer prohibited from
penalizing attending provider who orders care consistent
with this act; insurer required to provide notice to
policyholders of coverage mandated under this act; legislative findings and purpose; and definition of terms.
Be it enacted by the Legislature of West Virginia:
That chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended by
adding thereto a new article, designated article forty-one, to
read as follows:
ARTICLE 41.POSTDELIVERY CARE FOR MOTHERS AND NEWBORNS ACT.
§33-41-1. Short title.
This article shall be known and may be cited as the "Post-
Delivery Care for Mothers and Newborns Act."
§33-41-2. Legislative findings and purpose.
(a) The Legislature hereby finds and declares that:
(1) Whereas the timing of hospital discharge of the mother and
infant after birth was, until recently, a mutual decision between
the physician and the mother, many insurers are now refusing
payment for a hospital stay that extends beyond twenty-four
hours after an uncomplicated vaginal delivery and forty-eight
hours after a cesarean delivery;
(2) There are insufficient scientific data to support the
safety of early releases from the hospital following delivery,
particularly as it relates to the detection of many problems,
which if undiagnosed may pose life-threatening and costly
complications, and may require a longer period of observation by
skilled personnel;
(3) Guidelines developed by the American Academy of Pediatrics
and the American College of Obstetricians and Gynecologists recommend as a minimum that mothers and infants meet certain
medical criteria and conditions prior to discharge, and it is
unlikely that these criteria and conditions can be met in less
than forty-eight hours following a normal vaginal delivery and
ninety-six hours following a cesarean delivery;
(4) The length of postdelivery inpatient stay should be based
on the unique characteristics of each mother and her infant,
taking into consideration the health of the mother, the health
and stability of the baby, the ability and confidence of the
mother to care for her baby, the adequacy of support systems at
home, and access to appropriate follow-up care; and
(5) The requirment that insurers cover minimum postdelivery
inpatient stays will allow identification of early problems with
the newborn, prevent disability through appropriate use of
metabolic screening, and help ensure that the family is able and
prepared to care for the baby at home.
§33-41-3. Definitions.
(a) "Attending provider" means: (1) Pediatricians and other
physicians attending the newborn; and (2) obstetricians, other
physicians, and certified nurse midwives attending the mother.
(b) "Insurer" means any entity that provides maternity
benefits on a risk basis including, but not limited to, group and
individual insurers, health maintenance organizations and preferred provider organizations, and any program funded under
Title XIX of the Social Security Act or any other publicly funded
program.
§33-41-4. Required benefits.
(a) Any insurer that offers maternity benefits shall provide
coverage of a minimum of forty-eight hours of inpatient care for
a mother and her newborn infant following a normal vaginal
delivery and a minimum of ninety-six hours of inpatient care for
a mother and her newborn infant following a cesarean delivery.
(b) Any decisions to shorten the length of inpatient stay to
less than that provided under subsection (a) of this section may
only be made by the attending providers after conferring with the
mother.
(c) If a mother and newborn are discharge pursuant to
subsection (b) of this section prior to the inpatient length of
stay provided under subsection (a) of this section, coverage
shall be provided for a follow-up within forty-eight hours of
discharge. Services provided shall include, but not be limited
to, physical assessment of the newborn, parent education
assistance and training in breast or bottle feeding, assessment
of the home support system, and the performance of any medically
necessary and appropriate clinical tests. Services shall be
consistent with protocols and guidelines developed by national pediatric, obstetric and nursing professional organizations for
these services.
§33-41-5. Physician penalties prohibited.
No insurer may deselect, terminate the services of, require
additional documentation from, require additional utilization
review, reduce payments, or otherwise provide financial
disincentives to any attending provider who orders care
consistent with the provisions of this article.
§33-41-6. Insurer notification.
Every insurer shall provide notice to policyholders regarding
the coverage required under this article. The notice shall be in
writing and shall be transmitted at the earliest of either the
next mailing to the policyholder, the yearly summary of benefits
sent to the policyholder, or the first day of January of the year
following the effective date of this article.
NOTE: The purpose of this bill is to require insurers to
provide coverage for inpatient care for a mother and her newly
born infant for a minimum of 48 hours after a normal vaginal
delivery and a minimum of 96 hours after a cesarean delivery.
This article is new; therefore, strike-throughs and
underscoring have been omitted.