By McCall H.B. No. 44
75R199 MWV-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to minimum coverage under certain health plans for care
1-3 following the birth of a child.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.53D to read as follows:
1-7 Art. 21.53D. COVERAGE FOR MINIMUM IN-PATIENT STAY IN HEALTH
1-8 CARE FACILITY FOLLOWING BIRTH OF CHILD
1-9 Sec. 1. DEFINITIONS. In this article:
1-10 (1) "Attending physician" means an obstetrician,
1-11 pediatrician, or other physician who attends a woman who has given
1-12 birth or who attends the newborn child.
1-13 (2) "Health plan" means a plan that provides benefits
1-14 for medical or surgical expenses incurred as a result of a health
1-15 condition, accident, or sickness and that is offered by any
1-16 insurance company, group hospital service corporation, or health
1-17 maintenance organization that delivers or issues for delivery an
1-18 individual, group, blanket, or franchise insurance policy or
1-19 insurance agreement, a group hospital service contract, or an
1-20 evidence of coverage. The term does not include:
1-21 (A) a plan that provides coverage:
1-22 (i) only for accidental death or
1-23 dismemberment;
1-24 (ii) for wages or payments in lieu of
2-1 wages for a period during which an employee is absent from work
2-2 because of sickness or injury; or
2-3 (iii) as a supplement to liability
2-4 insurance;
2-5 (B) a medicare supplemental policy as defined by
2-6 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
2-7 (C) worker's compensation insurance coverage;
2-8 (D) medical payment insurance issued as part of
2-9 a motor vehicle insurance policy; or
2-10 (E) a long-term care policy, including a nursing
2-11 home fixed indemnity policy, unless the commissioner determines
2-12 that the policy provides benefit coverage so comprehensive that the
2-13 policy meets the definition of a health plan.
2-14 Sec. 2. REQUIRED COVERAGE FOR MINIMUM IN-PATIENT STAY
2-15 FOLLOWING BIRTH. A health plan that provides maternity benefits,
2-16 including benefits for childbirth, must include coverage for
2-17 in-patient care for a mother and her newborn child in a health care
2-18 facility for a minimum of:
2-19 (1) 48 hours following a vaginal delivery; and
2-20 (2) 96 hours following a delivery by caesarean
2-21 section.
2-22 Sec. 3. REQUIRED COVERAGE FOR MINIMUM IN-HOME POSTDELIVERY
2-23 CARE. (a) Notwithstanding Section 2 of this article, a health
2-24 plan that provides coverage for in-home postdelivery care to a
2-25 mother and her newborn child is not required to provide the minimum
2-26 hours of coverage of in-patient care required under Section 2 of
2-27 this article unless that in-patient care is determined to be
3-1 medically necessary by an attending physician or is requested by
3-2 the mother.
3-3 (b) A health plan that provides coverage for in-home
3-4 postdelivery care to a mother and her newborn child shall provide
3-5 services by a registered nurse who has at least three years
3-6 experience in community maternal and child health nursing. The
3-7 registered nurse shall provide the services in accordance with
3-8 accepted maternal and neonatal physical assessments. The services
3-9 must include:
3-10 (1) parent education;
3-11 (2) assistance and training in breast or bottle
3-12 feeding;
3-13 (3) performance of necessary or appropriate clinical
3-14 tests;
3-15 (4) a home visit conducted within 24 hours after the
3-16 discharge of the mother and her newborn child;
3-17 (5) a home visit conducted within 25 to 48 hours after
3-18 the discharge of the mother and her newborn child; and
3-19 (6) a home visit conducted within 96 to 120 hours
3-20 after the discharge of the mother and her newborn child.
3-21 (c) The commissioner by rule shall define "medically
3-22 necessary" for purposes of Subsection (a) of this section.
3-23 Sec. 4. PROHIBITIONS. (a) A health plan may not modify the
3-24 terms and conditions of coverage based on the determination by a
3-25 person enrolled in the health plan to request less than the minimum
3-26 coverage required under Section 2 or 3 of this article.
3-27 (b) A health benefit plan may not offer to the mother of a
4-1 newborn child a financial incentive or other compensation the
4-2 receipt of which is contingent on the waiver by the mother of the
4-3 minimum coverage required under Section 2 or 3 of this article.
4-4 (c) A health plan may not impose any type of penalty on an
4-5 attending physician who recommends health care facility in-patient
4-6 care that exceeds the minimum care required by Section 2 of this
4-7 article for a mother and her newborn child.
4-8 Sec. 5. NOTICE. (a) Each health plan shall provide written
4-9 notice to each enrollee under the plan regarding the coverage
4-10 required by this article. The health plan shall provide the notice
4-11 in accordance with rules adopted by the commissioner.
4-12 (b) The notice required under this section must be
4-13 prominently positioned in any literature or correspondence made
4-14 available or distributed by the health plan.
4-15 Sec. 6. RULES. The commissioner may adopt rules to
4-16 administer this article.
4-17 SECTION 2. The notice required under Section 5(a), Article
4-18 21.53D, Insurance Code, as added by this Act, must be transmitted
4-19 to each person enrolled in a health plan subject to that article
4-20 not later than the earlier of:
4-21 (1) the date of the next mailing scheduled to be made
4-22 by the plan to the enrollee after January 1, 1998;
4-23 (2) the next yearly informational packet scheduled to
4-24 be sent to the enrollee after January 1, 1998; or
4-25 (3) February 1, 1998.
4-26 SECTION 3. This Act takes effect September 1, 1997, and
4-27 applies only to an insurance policy or evidence of coverage that is
5-1 delivered, issued for delivery, or renewed on or after January 1,
5-2 1998. A policy or evidence of coverage that is delivered, issued
5-3 for delivery, or renewed before January 1, 1998, is governed by the
5-4 law as it existed immediately before the effective date of this
5-5 Act, and that law is continued in effect for that purpose.
5-6 SECTION 4. The importance of this legislation and the
5-7 crowded condition of the calendars in both houses create an
5-8 emergency and an imperative public necessity that the
5-9 constitutional rule requiring bills to be read on three several
5-10 days in each house be suspended, and this rule is hereby suspended.