Georgia House of Representatives - 1995/1996 Sessions

HB 1189 - Postdelivery Care for Mothers and Newborns Act; enact

Page Numbers - 1/ 2/ 3/ 4

Code Sections - 33-24-58

1. Burkhalter  41st       2. Henson  65th            3. Ashe  46th
4. Towery  30th           5. Heard  89th


House Comm: Ins        /                Senate Comm:            /                                   
House Vote: Yeas       Nays             Senate Vote: Yeas     Nays                                  
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               House          Action         Senate                                                 
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              1/9/96   Read 1st Time                                                                
              1/10/96  Read 2nd Time                                                                
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Code Sections amended:                                                                              


HB 1189                                          LC 11 8793/1






                        A BILL TO BE ENTITLED
                               AN ACT


  1- 1  To amend Chapter 24 of Title 33 of the Official Code of
  1- 2  Georgia Annotated, relating to insurance generally, so as to
  1- 3  require certain policies which provide maternity benefits to
  1- 4  provide a minimum time period of inpatient care for a mother
  1- 5  and her newborn infant following delivery of the infant; to
  1- 6  provide for a short title and legislative findings; to
  1- 7  provide for definitions; to provide for exceptions and
  1- 8  conditions thereof; to prohibit retaliatory actions; to
  1- 9  provide for coverage notification; to provide for rules and
  1-10  regulations; to repeal conflicting laws; and for other
  1-11  purposes.

  1-12       BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

                         SECTION 1.

  1-13  Chapter 24 of Title 33 of the Official Code of Georgia
  1-14  Annotated, relating to insurance generally, is amended by
  1-15  adding at the end of Article 1 a new Code section to read as
  1-16  follows:

  1-17    "33-24-58. (Index)

  1-18    (a) This Code section shall be known and may be cited as
  1-19    the 'Postdelivery Care for Mothers and Newborns Act.'

  1-20    (b) The General Assembly finds and declares that:

  1-21      (1) Whereas the timing of hospital discharge of the
  1-22      mother and infant after birth was, until recently, a
  1-23      mutual decision between the physician and the mother,
  1-24      many insurers are now refusing payment for a hospital
  1-25      stay that extends beyond 24 hours after an uncomplicated
  1-26      vaginal delivery and 48 hours after a cesarean delivery;

  1-27      (2) There are insufficient scientific data to support
  1-28      the safety of such early releases from the hospital
  1-29      following delivery, particularly as it relates to the
  1-30      detection of many problems which, if undiagnosed, may
  1-31      pose life-threatening and costly complications and may



                                 -1- (Index)

                                                LC 11 8793/1

  2- 1      require a longer period of observation by skilled
  2- 2      personnel;

  2- 3      (3) Guidelines developed by the American Academy of
  2- 4      Pediatrics and the American College of Obstetricians and
  2- 5      Gynecologists recommend as a minimum that mothers and
  2- 6      infants meet certain medical criteria and conditions
  2- 7      prior to discharge and it is unlikely that these
  2- 8      criteria and conditions can be met in less than 48 hours
  2- 9      following a normal vaginal delivery and 96 hours
  2-10      following a cesarean delivery;

  2-11      (4) The length of postdelivery inpatient stay should be
  2-12      based on the unique characteristics of each mother and
  2-13      her infant, taking into consideration the health of the
  2-14      mother, the health and stability of the baby, the
  2-15      ability and confidence of the mother to care for her
  2-16      baby, the adequacy of support systems at home, and
  2-17      access to appropriate follow-up care; and

  2-18      (5) Requiring insurers to cover minimum postdelivery
  2-19      inpatient stays will allow identification of early
  2-20      problems with the newborn, prevent disability through
  2-21      appropriate use of metabolic screening, and help ensure
  2-22      that the family is able and prepared to care for the
  2-23      baby at home.

  2-24    (c) As used in this Code section, the term:

  2-25      (1) 'Attending provider' means:

  2-26        (A) Pediatricians and other physicians attending the
  2-27        newborn; and

  2-28        (B) Obstetricians, other physicians, and certified
  2-29        nurse midwives attending the mother.

  2-30      (2) 'Health benefit policy' means any individual or
  2-31      group plan, policy, or contract for health care services
  2-32      issued, delivered, issued for delivery, or renewed in
  2-33      the state by a health care corporation, health
  2-34      maintenance organization, preferred provider
  2-35      organization, accident and sickness insurer, fraternal
  2-36      benefit society, nonprofit hospital service corporation,
  2-37      nonprofit medical service corporation, publicly funded
  2-38      program, or similar entity.

  2-39      (3) 'Insurer' means an accident and sickness insurer,
  2-40      fraternal benefit society, nonprofit hospital service
  2-41      corporation, nonprofit medical service corporation,



                                 -2- (Index)

                                                LC 11 8793/1

  3- 1      health care corporation, health maintenance
  3- 2      organization, preferred provider organization, any
  3- 3      program funded under Title XIX of the Social Security
  3- 4      Act, or any other publicly funded program or similar
  3- 5      entity authorized to issue contracts under this title.

  3- 6      (d)(1) Every health benefit policy by whatever name
  3- 7      called which is issued, delivered, issued for delivery,
  3- 8      renewed, or entered into by an insurer on or after July
  3- 9      1, 1996, and which provides maternity benefits on a risk
  3-10      basis shall provide coverage of a minimum of 48 hours of
  3-11      postpartum inpatient care for a mother and her newborn
  3-12      infant following a normal vaginal delivery and a minimum
  3-13      of 96 hours of postpartum inpatient care for a mother
  3-14      and her newborn infant following a cesarean delivery.

  3-15      (2) Any decision to shorten the length of inpatient stay
  3-16      to less than that provided under paragraph (1) of this
  3-17      subsection shall be made by the attending providers
  3-18      after conferring with the mother.

  3-19      (3) If a mother and newborn are discharged pursuant to
  3-20      paragraph (2) of this subsection prior to the postpartum
  3-21      inpatient length of stay provided under paragraph (1) of
  3-22      this subsection, coverage shall be provided for up to
  3-23      two follow-up visits, with the first such visit within
  3-24      48 hours of discharge.  The visit or visits may be
  3-25      either office or home visits.  Such visits shall be
  3-26      conducted by a physician or by a registered professional
  3-27      nurse with experience in maternal and child health
  3-28      nursing.  Services provided shall include, but not be
  3-29      limited to, physical assessment of the newborn, parent
  3-30      education, assistance and training in breast or bottle
  3-31      feeding, assessment of the home support system, and the
  3-32      performance of any medically necessary and appropriate
  3-33      clinical tests.  Such services shall be consistent with
  3-34      protocols and guidelines developed by national
  3-35      pediatric, obstetric, and nursing professional
  3-36      organizations for these services.

  3-37    (e) No insurer may deselect, terminate the services of,
  3-38    require additional documentation from, require additional
  3-39    utilization review, reduce payments, or otherwise provide
  3-40    financial disincentives to any attending provider who
  3-41    orders care consistent with the provisions of this Code
  3-42    section.




                                 -3- (Index)

                                                LC 11 8793/1

  4- 1    (f) Every insurer shall provide notice to policyholders
  4- 2    regarding the coverage required under this Code section.
  4- 3    The notice shall be in writing and shall be transmitted at
  4- 4    the earliest of either the next mailing to the
  4- 5    policyholder, the yearly summary of benefits sent to the
  4- 6    policyholder, or January 1, 1997.

  4- 7    (g) The Commissioner shall adopt rules and regulations
  4- 8    necessary to implement the provisions of this Code
  4- 9    section."

                         SECTION 2.

  4-10  All laws and parts of laws in conflict with this Act are
  4-11  repealed.



































                                 -4- (Index)