Senate Bill No. 29

(By Senator Minear)


[Introduced January 14, 1998;

referred to the Committee on Health and Human Resources; and then to the Committee on Finance.]


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- two, relating to health insurance; requiring coverage of in- patient 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-two, to read as follows:
§33-42-1. Short title.
This article shall be known and may be cited as the "Post-Delivery Care for Mothers and Newborns Act".
§33-42-2. 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 post-delivery in-patient 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 requirement that insurers cover minimum post- delivery in-patient 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.
§33-42-3. 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.
§33-42-4. Required benefits.
(a) Any insurer that offers maternity benefits shall provide coverage of a minimum of forty-eight hours of in-patient care for a mother and her newborn infant following a normal vaginal delivery and a minimum of ninety-six hours of in-patient care for a mother and her newborn infant following a cesarean delivery.
(b) Any decisions to shorten the length of in-patient 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 in-patient 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.
§33-42-5. 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.
§33-42-6. 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 in-patient 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.