Senate Bill No. 29
(By Senator Minear)
[Introduced January 14, 1998;
referred to the Committee on Health and Human Resources; and
then to the Committee on Finance.]
A BILL to amend chapter thirty-three of the code of West
Virginia, one thousand nine hundred thirty-one, as amended,
by adding thereto a new article, designated article forty- two, relating to health insurance; requiring coverage of in- patient care for mothers and newly born infants for
specified time periods following childbirth; requiring
coverage for follow-up visit when attending provider and
mother elect early discharge; insurer prohibited from
penalizing attending provider who orders care consistent
with this act; insurer required to provide notice to
policyholders of coverage mandated under this act;
legislative findings and purpose; and definition of terms.
Be it enacted by the Legislature of West Virginia:
That chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by
adding thereto a new article, designated article forty-two, to
read as follows:
ARTICLE 42. POST-DELIVERY CARE FOR MOTHERS AND NEWBORNS ACT.
§33-42-1. Short title.
This article shall be known and may be cited as the
"Post-Delivery Care for Mothers and Newborns Act".
§33-42-2. Legislative findings and purpose.
(a) The Legislature hereby finds and declares that:
(1) 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 hours after an uncomplicated vaginal delivery and
forty-eight hours after a cesarean delivery;
(2) There are insufficient scientific data to support the
safety of 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
(3) 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 hours following a normal vaginal
delivery and ninety-six hours following a cesarean delivery;
(4) The length of post-delivery in-patient 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; and
(5) The requirement that insurers cover minimum post- delivery in-patient 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.
(a) "Attending provider" means: (1) Pediatricians and other
physicians attending the newborn; and (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
§33-42-4. Required benefits.
(a) Any insurer that offers maternity benefits shall provide
coverage of a minimum of forty-eight hours of in-patient care for
a mother and her newborn infant following a normal vaginal
delivery and a minimum of ninety-six hours of in-patient care for
a mother and her newborn infant following a cesarean delivery.
(b) Any decisions to shorten the length of in-patient stay
to less than that provided under subsection (a) of this section
may only be made by the attending providers after conferring with
(c) If a mother and newborn are discharge pursuant to
subsection (b) of this section prior to the in-patient length of
stay provided under subsection (a) of this section, coverage
shall be provided for a follow-up within forty-eight 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. Services shall be
consistent with protocols and guidelines developed by national
pediatric, obstetric and nursing professional organizations for
§33-42-5. Physician penalties prohibited.
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 article.
§33-42-6. Insurer notification.
Every insurer shall provide notice to policyholders
regarding the coverage required under this article. 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 the first day of January
of the year following the effective date of this article.
NOTE: The purpose of this bill is to require insurers to
provide coverage for in-patient care for a mother and her newly
born infant for a minimum of 48 hours after a normal vaginal
delivery and a minimum of 96 hours after a cesarean delivery.
This article is new; therefore, strike-throughs and
underscoring have been omitted.