MISSISSIPPI LEGISLATURE

1997 Regular Session

To: Public Health and Welfare

By: Senator(s) Gunn

AN ACT TO REQUIRE INSURANCE COVERAGE FOR A MINIMUM AMOUNT OF POST-DELIVERY CARE FOR MOTHERS AND NEWBORNS; TO PROHIBIT CERTAIN PENALIZING ACTIONS AGAINST ATTENDING PROVIDERS WHO ORDER CARE CONSISTENT WITH THE PROVISIONS OF THIS ACT; TO REQUIRE INSURANCE COVERAGE FOR A MINIMUM AMOUNT OF POST-SURGICAL CARE FOR WOMEN WHO HAVE HAD MASTECTOMIES; TO PROHIBIT CERTAIN PENALIZING ACTIONS AGAINST ATTENDING PROVIDERS WHO ORDER CARE CONSISTENT WITH THE PROVISIONS OF THIS ACT; AND FOR RELATED PURPOSES. 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. This act shall be known and may be cited as the "Post-Delivery Care for Mothers, Newborns and Post-Mastectomy Care Act."

SECTION 2. The Legislature hereby finds and declares that:

(a) Whereas the timing of hospital discharge of the mother and infant after birth was, until recently, a mutual decision between the physician and the mother, many insurers are now refusing payment for a hospital stay that extends beyond twenty-four (24) hours after an uncomplicated vaginal delivery and forty-eight (48) hours after a Caesarean delivery.

(b) There are insufficient scientific data to support the safety of such early releases from the hospital following delivery, particularly as it relates to the detection of many problems which if undiagnosed may pose life-threatening and costly complications, and may require a longer period of observation by skilled personnel.

(c) Guidelines developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend as a minimum that mothers and infants meet certain medical criteria and conditions prior to discharge, and it is unlikely that these criteria and conditions can be met in less than forty-eight (48) hours following a normal vaginal delivery and ninety-six (96) hours following a Caesarean delivery.

(d) The length of post-delivery inpatient stay should be based on the unique characteristics of each mother and her infant, taking into consideration the health of the mother, the health and stability of the baby, the ability and confidence of the mother to care for her baby, the adequacy of support systems at home, and access to appropriate follow-up care.

(e) Requiring insurers to cover minimum post-delivery inpatient stays will allow identification of early problems with the newborn, prevent disability through appropriate use of metabolic screening, and help ensure that the family is able and prepared to care for the baby at home.

SECTION 3. The following words shall have the meanings ascribed herein unless the context clearly indicates otherwise:

(a) "Attending provider" means (i) pediatricians and other physicians attending the newborn and two (2) obstetricians, other physicians and certified nurse midwives attending the mother.

(b) "Insurer" means any entity that provides maternity benefits on a risk basis including, but not limited to, group and individual insurers, health maintenance organizations and preferred provider organizations, and any program funded under Title XIX of the Social Security Act or any other publicly funded program.

SECTION 4. (1) Any insurer that offers maternity benefits shall provide coverage of a minimum of forty-eight (48) hours of inpatient care for a mother and her newborn infant following a normal vaginal delivery and a minimum of ninety-six (96) hours of inpatient care for a mother and her newborn infant following a Caesarean delivery.

(2) Any decision to shorten the length of inpatient stay to less than that provided under subsection (1) shall be made by the attending providers after conferring with the mother.

(3) If a mother and newborn are discharged pursuant to subsection (2) prior to the inpatient length of stay provided under subsection (1), coverage shall be provided for a follow-up visit within forty-eight (48) hours of discharge. Services provided shall include, but not be limited to, physical assessment of the newborn, parent education, assistance and training in breast or bottle feeding, assessment of the home support system, and the performance of any medically necessary and appropriate clinical tests. Such services shall be consistent with protocols and guidelines developed by national pediatric, obstetric and nursing professional organizations for these services.

SECTION 5. No insurer may deselect, terminate the services of, require additional documentation from, require additional utilization review, reduce payments, or otherwise provide financial disincentives to any attending provider who orders care consistent with the provisions of this act.

SECTION 6. Every insurer shall provide notice to policyholders regarding the coverage required under this act. The notice shall be in writing and shall be transmitted at the earliest of either the next mailing to the policyholder, the yearly summary of benefits sent to the policyholder, or January 1 of the year following the effective date of this act.

SECTION 7. The Legislature hereby finds and declares that:

(a) Some insurers are cutting costs by making mastectomies, the surgical amputation of a woman's breast, an outpatient procedure.

(b) Women, even those sixty-five (65) and over, are discharged from the hospital hours after surgery, and husbands and other family members are expected to monitor bleeding and empty drainage bags hanging from the wound.

(c) More than three thousand (3,000) elderly women endured mastectomies as outpatients last year alone.

(d) Advocates for outpatient mastectomies cite cost savings. A mastectomy with a customary three-night hospital stay costs over Six Thousand Dollars ($6,000.00), while an outpatient procedure saves about seventy-five percent (75%) of that; but it doesn't save a woman from the danger of hemorrhaging the first night or from out-of-control pain or from psychological trauma.

SECTION 8. The following words shall have the meanings ascribed herein unless the context clearly indicates otherwise:

(a) "Attending provider" means the licensed physician attending the woman.

(b) "Insurer" means any entity that provides health benefits on a risk basis including, but not limited to, group and individual insurers, health maintenance organizations and preferred provider organizations, and any program funded under Title XIX of the Social Security Act or any other publicly funded program.

(c) "Mastectomy" means the surgical amputation of a woman's breast by a licensed physician.

SECTION 9. (1) Any insurer that offers health benefits shall provide coverage of a minimum of forty-eight (48) hours of inpatient care for a woman following a normal mastectomy.

(2) Any decision to shorten the length of inpatient stay to less than that provided under subsection (1) shall be made by the attending providers after conferring with the patient.

(3) If a woman is discharged pursuant to subsection (2) prior to the inpatient length of stay provided under subsection (1), coverage shall be provided for a follow-up visit within forty-eight (48) hours of discharge. Services provided shall be consistent with protocols and guidelines developed by national professional organizations for these services.

SECTION 10. No insurer may deselect, terminate the services of, require additional documentation from, require additional utilization review, reduce payments, or otherwise provide financial disincentives to any attending provider who orders care consistent with the provisions of this act.

SECTION 11. Every insurer shall provide notice to policyholders regarding the coverage required under this act. The notice shall be in writing and shall be transmitted at the earliest of either the next mailing to the policyholder, the yearly summary of benefits sent to the policyholder, or January 1 of the year following the effective date of this act.

SECTION 12. This act shall take effect and be in force from and after July 1, 1997.