CERTIFICATION OF ENROLLMENT

 

             ENGROSSED SUBSTITUTE SENATE BILL 6120

 

 

                   Chapter 281, Laws of 1996

 

 

                        54th Legislature

                      1996 Regular Session

 

 

    HEALTH INSURANCE BENEFITS FOLLOWING THE BIRTH OF A CHILD

 

 

                    EFFECTIVE DATE:  6/6/96

Passed by the Senate March 4, 1996

  YEAS 46   NAYS 0

 

 

 

            JOEL PRITCHARD

President of the Senate

 

Passed by the House March 1, 1996

  YEAS 97   NAYS 0

             CERTIFICATE

 

I, Marty Brown, Secretary of the Senate of the State of Washington, do hereby certify that the attached is ENGROSSED SUBSTITUTE SENATE BILL 6120 as passed by the Senate and the House of Representatives on the dates hereon set forth.

 

 

 

             CLYDE BALLARD

Speaker of the

      House of Representatives

             MARTY BROWN

                            Secretary

 

 

Approved March 29, 1996 Place Style On Codes above, and Style Off Codes below.

                                FILED           

 

 

           March 29, 1996 - 5:04 p.m.

 

 

 

              MIKE LOWRY

Governor of the State of Washington

                   Secretary of State

                  State of Washington


          _______________________________________________

 

               ENGROSSED SUBSTITUTE SENATE BILL 6120

          _______________________________________________

 

                      AS AMENDED BY THE HOUSE

 

             Passed Legislature - 1996 Regular Session

 

State of Washington      54th Legislature     1996 Regular Session

 

By Senate Committee on Health & Long‑Term Care (originally sponsored by Senators Quigley, Fairley, Kohl, McAuliffe, Loveland, Drew, Smith, Thibaudeau, Sheldon, Spanel, Rinehart, Bauer, Franklin, Wojahn, Goings, Winsley, Pelz and Rasmussen)

 

Read first time 01/22/96.

 

Establishing health insurance benefits following the birth of a child.


    AN ACT Relating to health insurance benefits following the birth of a child; adding a new section to chapter 48.43 RCW; and creating new sections.

 

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

 

    NEW SECTION.  Sec. 1.  A new section is added to chapter 48.43 RCW to read as follows:

    (1) The legislature recognizes the role of health care providers as the appropriate authority to determine and establish the delivery of quality health care services to maternity patients and their newly born children.  It is the intent of the legislature to recognize patient preference and the clinical sovereignty of providers as they make determinations regarding services provided and the length of time individual patients may need to remain in a health care facility after giving birth.  It is not the intent of the legislature to diminish a carrier's ability to utilize managed care strategies but to ensure the clinical judgment of the provider is not undermined by restrictive carrier contracts or utilization review criteria that fail to recognize individual postpartum needs.

    (2) Unless otherwise specifically provided, the following definitions apply throughout this section:

    (a) "Attending provider" means a provider who:  Has clinical hospital privileges consistent with RCW 70.43.020; is included in a provider network of the carrier that is providing coverage; and is a physician licensed under chapter 18.57 or 18.71 RCW, a certified nurse midwife licensed under chapter 18.79 RCW, a midwife licensed under chapter 18.50 RCW, a physician's assistant licensed under chapter 18.57A or 18.71A RCW, or an advanced registered nurse practitioner licensed under chapter 18.79 RCW.

    (b) "Health carrier" or "carrier" means disability insurers regulated under chapter 48.20 or 48.21 RCW, health care services contractors regulated under chapter 48.44 RCW, health maintenance organizations regulated under chapter 48.46 RCW, plans operating under the health care authority under chapter 41.05 RCW, the state health insurance pool operating under chapter 48.41 RCW, and insuring entities regulated under this chapter.

     (3)(a) Every health carrier that provides coverage for maternity services must permit the attending provider, in consultation with the mother, to make decisions on the length of inpatient stay, rather than making such decisions through contracts or agreements between providers, hospitals, and insurers.  These decisions must be based on accepted medical practice.

    (b) Covered eligible services may not be denied for inpatient, postdelivery care to a mother and her newly born child after a vaginal delivery or a cesarean section delivery for such care as ordered by the attending provider in consultation with the mother.

    (c) At the time of discharge, determination of the type and location of follow-up care, including in-person care, must be made by the attending provider in consultation with the mother rather than by contract or agreement between the hospital and the insurer.  These decisions must be based on accepted medical practice.

    (d) Covered eligible services may not be denied for follow-up care as ordered by the attending provider in consultation with the mother.  Coverage for providers of follow‑up services must include, but need not be limited to, attending providers as defined in this section, home health agencies licensed under chapter 70.127 RCW, and registered nurses licensed under chapter 18.79 RCW.

    (e) Nothing in this section shall be construed to require attending providers to authorize care they believe to be medically unnecessary.

    (f) Coverage for the newly born child must be no less than the coverage of the child's mother for no less than three weeks, even if there are separate hospital admissions.

    (4) No carrier that provides coverage for maternity services may deselect, terminate the services of, require additional documentation from, require additional utilization review of, reduce payments to, or otherwise provide financial disincentives to any attending provider or health care facility solely as a result of the attending provider or health care facility ordering care consistent with the provisions of this section.  Nothing in this section shall be construed to prevent any insurer from reimbursing an attending provider or health care facility on a capitated, case rate, or other financial incentive basis.

    (5) Every carrier that provides coverage for maternity services must provide notice to policyholders regarding the coverage required under this section.  The notice must be in writing and must be transmitted at the earliest of 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 section.

    (6) This section is not intended to establish a standard of  medical care.

    (7) This section shall apply to coverage for maternity services under a contract issued or renewed by a health carrier after the effective date of this section and shall apply to plans operating under the health care authority under chapter 41.05 RCW beginning January 1, 1998.

 

    NEW SECTION.  Sec. 2.  Consistent with funds available for this purpose, the Washington health care policy board, created by chapter 43.73 RCW, shall conduct an analysis of the effects of this act, addressing:  The financial impact on health carriers in the public and private individual and group insurance markets; the impact on utilization of health care services; and, to the extent possible, the impact on the health status of mothers and their newly born children.  The board shall submit a final report to the appropriate committees of the legislature by December 15, 1998.

 

    NEW SECTION.  Sec. 3.  This act shall be known as "the Erin Act."


    Passed the Senate March 4, 1996.

    Passed the House March 1, 1996.

Approved by the Governor March 29, 1996.

    Filed in Office of Secretary of State March 29, 1996.