By Wilson H.B. No. 60
75R1022 PB-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to minimum coverage under certain health benefit plans for
1-3 inpatient stays 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 HOSPITAL STAY FOLLOWING
1-8 BIRTH OF CHILD
1-9 Sec. 1. SHORT TITLE. This article may be cited as the Lee
1-10 Alexandria Hanley Act.
1-11 Sec. 2. DEFINITIONS. In this article:
1-12 (1) "Attending physician" means an obstetrician,
1-13 pediatrician, or other physician who attends a woman who has given
1-14 birth or who attends the newborn child.
1-15 (2) "Health plan" means a plan that provides benefits
1-16 for medical or surgical expenses incurred as a result of an
1-17 accident or sickness that is offered by any insurance company,
1-18 group hospital service corporation, or health maintenance
1-19 organization, that delivers or issues for delivery an individual,
1-20 group, blanket, or franchise insurance policy or insurance
1-21 agreement, a group hospital service contract, or an evidence of
1-22 coverage. The term does not include:
1-23 (A) a plan that provides coverage:
1-24 (i) only for accidental death or
2-1 dismemberment;
2-2 (ii) for wages or payments in lieu of
2-3 wages for any period during which an employee is absent from work
2-4 because of sickness or injury; or
2-5 (iii) as a supplement to liability
2-6 insurance;
2-7 (B) a Medicare supplemental policy as defined by
2-8 Section 1882(g)(1), Social Security Act (42 U.S.C. Sec. 1395ss);
2-9 (C) workers' compensation insurance coverage;
2-10 (D) medical payment insurance issued as part of
2-11 a motor vehicle insurance policy; or
2-12 (E) a long-term care policy, including a nursing
2-13 home fixed indemnity policy, unless the commissioner determines
2-14 that the policy provides benefit coverage so comprehensive that the
2-15 policy should be treated as a health plan.
2-16 Sec. 3. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY
2-17 FOLLOWING BIRTH; EXCEPTION. (a) A health plan that provides
2-18 maternity benefits, including benefits for childbirth, must include
2-19 coverage for inpatient care for a mother and her newly born child
2-20 in a health care facility for a minimum of:
2-21 (1) 48 hours following a vaginal delivery; and
2-22 (2) 96 hours following a delivery by caesarean
2-23 section.
2-24 (b) Notwithstanding Subsection (a) of this section, a health
2-25 plan that provides coverage for in-home postdelivery care to a
2-26 mother and her newly born child is not required to provide the
2-27 minimum coverage of inpatient care required under Subsection (a) of
3-1 this section unless that inpatient care is determined to be
3-2 medically necessary by the attending physician or is requested by
3-3 the mother.
3-4 Sec. 4. PROHIBITION. A health plan may not modify the terms
3-5 and conditions of coverage because an enrollee in the plan requests
3-6 less than the minimum coverage required under Section 3(a) of this
3-7 article.
3-8 Sec. 5. NOTICE. (a) Each health plan shall provide written
3-9 notice to each enrollee under the plan regarding the coverage
3-10 required by this article. The health plan shall provide the notice
3-11 in accordance with rules adopted by the commissioner.
3-12 (b) The notice required under this section must be
3-13 prominently positioned in any literature or correspondence made
3-14 available or distributed by the health plan.
3-15 SECTION 2. The notice required under Section 5(a), Article
3-16 21.53D, Insurance Code, as added by this Act, must be transmitted
3-17 to each enrollee in an affected health plan not later than the
3-18 earlier of:
3-19 (1) the date of the first mailing scheduled to be made
3-20 by the plan to the enrollee after January 1, 1998;
3-21 (2) the date that the first yearly informational
3-22 packet is scheduled to be sent to the enrollee after January 1,
3-23 1998; or
3-24 (3) February 1, 1998.
3-25 SECTION 3. This Act takes effect September 1, 1997, and
3-26 applies only to an insurance policy or evidence of coverage that is
3-27 delivered, issued for delivery, or renewed on or after January 1,
4-1 1998. A policy or evidence of coverage that is delivered, issued
4-2 for delivery, or renewed before January 1, 1998, is governed by the
4-3 law as it existed immediately before the effective date of this
4-4 Act, and that law is continued in effect for that purpose.
4-5 SECTION 4. The importance of this legislation and the
4-6 crowded condition of the calendars in both houses create an
4-7 emergency and an imperative public necessity that the
4-8 constitutional rule requiring bills to be read on three several
4-9 days in each house be suspended, and this rule is hereby suspended.