SENATE HEALTH COMMITTEE

STATEMENT TO

SENATE, No. 1361

with committee amendments

STATE OF NEW JERSEY

DATED: NOVEMBER 7, 1996

      The Senate Health Committee reports favorably and with committee amendments Senate Bill No. 1361.

      As amended by committee, 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.

      The committee amended the bill to add the provision 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 be in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996" become operative. This amendment conforms the provisions of this bill with those of Senate Bill No. 1360 of 1996 (Inverso/Matheussen), which amends P.L.1995, c.138, requiring insurers to provide the 48-hour or 96-hour inpatient care benefits.