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Sponsors: Senator Hawkins
Document Path: l:\council\bills\dka\3232dw05.doc
Companion/Similar bill(s): 4008
Introduced in the Senate on March 2, 2005
Currently residing in the Senate Committee on Banking and Insurance
Summary: Health insurance regulation and requirement for coverage, benefits or services for maternity or newborn care
HISTORY OF LEGISLATIVE ACTIONS
Date Body Action Description with journal page number ------------------------------------------------------------------------------- 3/2/2005 Senate Introduced and read first time SJ-4 3/2/2005 Senate Referred to Committee on Banking and Insurance SJ-4
View the latest legislative information at the LPITS web site
VERSIONS OF THIS BILL
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-137 SO AS TO PROVIDE FOR THE REGULATION OF AND REQUIREMENTS FOR HEALTH INSURANCE THAT PROVIDES COVERAGE, BENEFITS, OR SERVICES FOR MATERNITY OR NEWBORN CARE.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 71, Title 38 of the 1976 Code is amended by adding:
"Section 38-71-137. (A) A policy of health insurance that provides coverage for maternity care also must cover the services of certified nurse-midwives and midwives and the services of birth centers licensed pursuant to Chapter 89, Title 44, and supervised under the authority of the Department of Health and Environmental Control.
(B) An insurer issuing a health insurance policy that provides maternity and newborn coverage may not limit coverage for the length of a maternity and newborn stay in a hospital or for follow-up care outside of a hospital to any time period that is less than that determined to be medically necessary, in accordance with prevailing medical standards and consistent with guidelines for perinatal care of the American Academy of Pediatrics or the American College of Obstetricians and Gynecologists, by the treating obstetrical care provider or the pediatric care provider.
(C) This section does not affect any agreement between an insurer and a hospital or other health care provider with respect to reimbursement for health care services provided, rate negotiations with providers, or capitation of providers, and this section does not prohibit appropriate utilization review or case management by an insurer.
(D) A policy of health insurance that provides coverage, benefits, or services for maternity or newborn care must provide coverage for postdelivery care for a mother and her newborn infant. The postdelivery care must include a postpartum assessment and newborn assessment and may be provided at the hospital, at the attending physician's office, at an outpatient maternity center, or in the home by a qualified licensed health care professional trained in mother and baby care. The services must include physical assessment of the newborn and mother, and the performance of any medically necessary clinical tests and immunizations in keeping with prevailing medical standards.
(E) An insurer subject to subsection (A) shall communicate active case questions and concerns regarding postdelivery care directly to the treating physician or hospital in written form, in addition to other forms of communication. The insurers also shall use a process that includes a written protocol for utilization review and quality assurance.
(F) An insurer subject to subsection (A) may not:
(1) deny to a mother or her newborn infant eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the policy for the purpose of avoiding the requirements of this section;
(2) provide monetary payments or rebates to a mother to encourage the mother to accept less than the minimum protections available pursuant to this section;
(3) penalize or otherwise reduce or limit the reimbursement of an attending provider because the attending provider provided care to an individual participant or beneficiary in accordance with this section;
(4) provide incentives, monetary or otherwise, to an attending provider to induce the provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section; or
(5) subject to subsection (I), restrict benefits for any portion of a period within a hospital length of stay required pursuant to subsection (B) in a manner that is less favorable than the benefits provided for any preceding portion of that stay.
(G) This section does not require a mother who is a participant or beneficiary to:
(a) give birth in a hospital; or
(b) stay in the hospital for a fixed period of time following the birth of her infant.
(H) This section does not apply with respect to any health insurance coverage that does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn infant.
(I) This section does not prevent a policy from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn infant, except that coinsurance or other cost-sharing for any portion of a period within a hospital length of stay required pursuant to subsection (B) may not be greater than the coinsurance or cost-sharing for any preceding portion of that stay."
SECTION 2. This act takes effect upon approval by the Governor.
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