ASSEMBLY, No. 2593
STATE OF NEW JERSEY
INTRODUCED DECEMBER 16, 1996
By Assemblyman KRAMER and Assemblywoman WRIGHT
An Act concerning maternity benefits in the State Health Benefits Program and supplementing P.L.1961, c.49 (C.52:14-17.25 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides obstetrical benefits shall provide coverage for a minimum of 48 hours of inpatient care following a vaginal delivery and a minimum of 96 hours of inpatient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). The contract shall also provide that upon receipt of notification that the woman will be or has been admitted to an inpatient facility, the carrier shall preauthorize inpatient care for the woman and her newly born child for the 48-hour or 96-hour period, as applicable. The preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996," become operative.
b. Notwithstanding the provisions of subsection a. of this section, a contract that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of inpatient care unless such inpatient care is determined to be medically necessary by the attending physician or is requested by the mother; except that, the requirement in subsection a. of this section to preauthorize inpatient care for the full 48-hour or 96-hour period, as applicable, also shall apply to this subsection. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.
c. The commission shall provide notice to employees regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health and Senior Services pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the employee; (2) the yearly informational packet sent to the employee; or (3) January 1, 1997. The commission shall also ensure that the carrier under contract with the commission, upon receipt of information that a covered person is pregnant, shall promptly notify that person of the coverage required by this section.
2. This act shall take effect immediately.
STATEMENT
This bill requires the State Health Benefits Commission to provide the same maternity benefits to persons covered under the State Health Benefits Program as is required for other insurers and health maintenance organizations under P.L.1995, c.138.
The bill requires that coverage be provided for a minimum of 48 hours of inpatient care following a vaginal delivery and a minimum of 96 hours of inpatient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). The bill also provides that upon receipt of notification that the woman will be or has been admitted to an inpatient facility, the carrier shall preauthorize inpatient care for the woman and her newly born child for the 48-hour or 96-hour period, as applicable. This preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996" become operative.
The bill further provides that a contract that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of inpatient care unless such inpatient care is determined to be medically necessary by the attending physician or is requested by the mother. Attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.
Finally, the bill requires the commission to notify employees regarding this coverage in any literature or correspondence sent to the employee and requires that the information shall be transmitted at the earliest of: (1) the next mailing to the employee; (2) the yearly informational packet sent to the employee; or (3) January 1, 1997. The commission shall also ensure that when the carrier receives information that a covered person is pregnant, the carrier shall promptly notify that person of the maternity benefits required by this bill.
Requires State Health Benefits Program to provide certain maternity benefits.