RS H.B. 102 75(R)BILL ANALYSIS INSURANCE H.B. 102 By: Gray 4-18-97 Committee Report (Substituted) BACKGROUND Close to 4 million babies are born annually in the United States making childbirth the most common cause of hospitalization. In 1970 the average length of hospital stay was four days after normal vaginal delivery and eight days for a caesarean section. By 1992 it had become common practice to release mothers and babies from the hospital 24 hours after a normal vaginal delivery and 76 hours after a caesarean section. Some health maintenance organizations (HMO's) limit hospital stays to 8 and 12 hours after childbirth. This trend to shorten hospital stays is a push by insurers to save money. According to the Centers for Disease Control and Prevention about 14 percent of women and 11 percent of newborns experience complications after their release from the hospital. PURPOSE This bill would require health benefit plans to provide minimum inpatient stay and post delivery care for the mother and infant. RULEMAKING AUTHORITY It is the opinion of the committee that additional rulemaking authority is granted to the Commissioner of Insurance in SECTION 1 of the bill, (Section 5, Section 7, and Section 8, Article 21.53F, Chapter 21E, Insurance Code). SECTION BY SECTION ANALYSIS Section 1. Amends Chapter 21E, Insurance Code, by adding Article 21.53F, as follows: Article 21.53F. COVERAGE FOR MINIMUM INPATIENT STAY IN HEALTH CARE FACILITY AND POST DELIVERY CARE FOLLOWING THE BIRTH OF A CHILD Sec. 1. SHORT TITLE: "Lee Alexandria Hanley Act." Sec. 2. DEFINITIONS. Defines "attending physician," "enrollee," and "health benefit plan." Sec. 3. SCOPE OF ARTICLE. (a) Outlines the types of health benefit plans this article does and does not apply to. Sec. 4. REQUIRED COVERAGE FOR MINIMUM INPATIENT STAY FOLLOWING BIRTH; EXCEPTION. (a) A plan that provides maternity benefits must include coverage for inpatient care for mother and newborn for 48 hours following an uncomplicated vaginal deliver, and 96 hours following an uncomplicated caesarean section. (b) Health plan that provides for in-home post delivery care for mother and newborn is not required to provide minimum number of hours unless determined medically necessary by doctor or requested by mother. (c) Determination of an uncomplicated delivery shall be made by the attending physician. (d) This article does not require a mother who is eligible for coverage under this plan to give birth in a hospital or other health care facility, or require the mother to remain under inpatient care in a hospital or health care facility for a fixed amount of time. Sec. 5. POST DELIVERY CARE (a) If mother and newborn are discharged before minimum hours of care are reached then care shall be provided at mother's home, health care provider's office, health care facility, or other location considered appropriate by rules of commissioner. (b) Mother must have option of in home care. (c) "Post delivery care" shall mean postpartum health care services according to accepted maternal and neonatal physical assessments. Sec. 6. PROHIBITIONS (a) A health benefit plan may not modify the terms and conditions of coverage based on determination of enrollee to request less than minimum amount of coverage under section 4(a) of this article, offer compensation in return for waiving the minimum amount of coverage possible, refuse to accept physicians recommendation for care after consultation with patient, reduce payment or reimbursement for care below customary rate, or penalize a physician for recommending in home care for patient. Sec. 7. NOTICE. Written notice shall be provided to each enrollee in accordance with rules adopted by commissioner Sec. 8. RULES. The commissioner shall adopt rules as necessary to enforce article. SECTION 2. Effective Date: September 1, 1997. Article shall apply only to plan that is delivered, issued for delivery or renewed on or after January 1, 1998. SECTION 3. Emergency Clause. COMPARISON OF SUBSTITUTE TO ORIGINAL BILL SECTION 1. Changes article to be added from article 21.53D to 21.53F. Adds short title as new section 1. In Section 1, substitute adds definition of "enrollee" and changes definition of "health benefit plan" to new Section 3, "Scope of Article." Renumbers other sections accordingly. Section 4 specifies that minimum stay requirements apply to an "uncomplicated" delivery, vaginal or caesarean. Adds subsection (c) to clarify who determines "uncomplicated." Adds subsection (d) to provide that it is not necessary to give birth in a hospital or health care facility. Changes subsection (5) to say a health benefit plan "must" provide coverage for timely postdelivery care instead of "shall" in previous version. Section 6 is changed to specify "American College of Obstetricians and Gynecologists," and "the American Academy of Pediatrics" as organizations which may recommend minimum standards. Adds "in accordance with rules adopted by the commissioner" to the notice requirement in Section 7. Renumbers section in which rulemaking authority is granted to the Commissioner to Section 8. SECTION 2. Eliminates requirement that the notice be transmitted to enrollees by a specified date. Changes to effective date of article. SECTION 3. New section for emergency clause.