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.