BILL ANALYSIS
AB 38
Page 1
Date of Hearing: April 8, 1997
ASSEMBLY COMMITTEE ON INSURANCE
Liz Figueroa, Chair
AB 38 (Figueroa) - As Amended: April 7, 1997
Urgency statute. 2/3 vote required.
SUBJECT : Maternity benefits.
SUMMARY : Requires health plans and insurers to provide coverage
for a minimum of 48 hours of inpatient care for a mother and child
following a vaginal delivery and 96 hours following a caesarean
section. Specifically, this bill :
1) Enacts the "Newborns' and Mothers' Health Act of 1997";
2) Prohibits health care service plan contracts and disability
insurance policies from restricting benefits for inpatient
hospital care to less than 48 hours following a normal vaginal
delivery and less than 96 hours following a caesarean section;
3) Permits an exception to the above requirement if the discharge
decision is made by the treating physician in consultation
with the mother, and the plan covers a postdischarge follow-up
visit for the mother and newborn within 48 hours of discharge,
when prescribed by the treating physician. At the mother's
discretion, the visit may occur at home or at the plan
facility;
4) Prohibits contracts and policies from reducing or limiting
reimbursement to the attending provider for providing care to
an individual enrollee in accordance with coverage
requirements, and prohibits monetary or other incentives to
induce the provider to provide care in a manner inconsistent
with coverage requirements;
5) Prohibits contracts and policies from denying a mother or her
newborn eligibility to enroll or renew coverage solely to
avoid coverage requirements and prohibits payments or rebates
to a mother to encourage her to accept less than the minimum
coverage requirements;
6) Prohibits contracts and policies from restricting inpatient
benefits for the second day of hospital care in a manner less
favorable than those provided during the preceding portion of
the hospital stay;
7) Prohibits contracts and policies from requiring the treating
physician to obtain prior plan authorization for the services
covered by this bill;
8) Requires plans and insurers to provide specified notices to
enrollees regarding the coverage specified in this bill; and
AB 38
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9) States legislative findings that the length of a postdelivery
hospital stay should be based on the unique characteristics of
each mother and her newborn child and that the timing of
hospital discharge should be made by the treating physician in
consultation with the mother.
AB 38
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EXISTING LAW :
1) Provides for the regulation of health care service plans by the
Department of Corporations and the regulation of disability
insurers by the Department of Insurance.
2) Requires plans and insurers that provide maternity coverage to
include coverage for involuntary complications of pregnancy, as
specified.
3) Prohibits contracts between providers and either health plans
or insurers from containing incentive plans that induce the
provider to deny, reduce, limit, or delay medically necessary
and appropriate treatments.
FISCAL EFFECT : Undetermined.
COMMENTS :
1) Purpose of the bill : According to the author, AB 38 addresses
a growing trend in managed care to discharge mothers and
newborns from the hospital as early as eight hours after
childbirth. There is often no at-home follow-up care for the
mother and child. The author believes that early release can
be detrimental to good health care for mother and baby. Some
common problems, such as jaundice or dehydration, can take one
or two days to develop and might not be noticed by hospital
staff during the first eight to twelve hours after childbirth.
The author is also concerned that early discharge may place
newborns at greater risk for malnutrition or dehydration. Many
mothers are exhausted after childbirth; proper follow-up
resources, such as instructions for breast-feeding, may not be
available with early discharge.
2) Background : AB 38 is similar to legislation proposed by the
same author last year, AB 1841. AB 1841 passed out of both
houses of the Legislature but died in the Assembly pending
concurrence in Senate Amendments.
AB 38 is almost identical to federal legislation enacted last
year governing health coverage for postpartum hospital stays.
Among the major differences between this bill and the new
federal law is the requirement that this bill take effect
immediately, whereas the federal law becomes operative on
January 1, 1998. In addition, if the mother and newborn are
released before 48 hours, this bill provides coverage for a
follow-up visit when prescribed by the treating physician, a
benefit not guaranteed by federal law.
3) Support : This bill is supported by a broad range of
organizations, including the California Association of HMOs,
Health Access, Planned Parenthood Affiliates of California, and
the California Healthcare Association. Supporters note that
this bill would conform California law to the recently enacted
AB 38
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federal standard. They also argue that the follow-up visit is
important so that physicians who may feel it is appropriate to
discharge a woman from the hospital before 48 hours have the
assurance that there will be follow-up care in the first few
days after childbirth. This would also be more cost effective
than staying in the hospital for the full two days.
AB 38
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4) Opposition : The California Manufacturers Association is
opposed to the bill because of the added cost of the
postdischarge visit.
SUPPORT :Author (Sponsor)
Alameda County Commission on the Status of Women
American Association of Physicians of Indian Origin
American Association of Retired Persons
American Association of University Women
American Society of Plastic and Reconstructive Surgeons
Berkeley Addiction Treatment Services, Inc.
Berkeley Gray Panthers
Blue Cross of California
Board of Supervisors, County of Sacramento
Board of Supervisors of the City and County of San
Francisco
Butte County Health Coalition
California Advocates for Nursing Home Reform
California Association of HMOs, Inc.
California Catholic Conference
California Church Impact
California Coalition of United Cerebral Palsy Associations
California Commission on Aging
California Federation of Business and Professional Women
California Federation of Teachers
California Healthcare Association
California Legislative Council for Older Americans
California Neighbor to Neighbor
California Nurses Association
California School Employees Association
California Teachers Association
California WIC Association
California Women Lawyers
Commission on the Status of Women
Committee for Recognition of Nursing Achievement
Committee for Reproductive Rights
Congress of California Seniors
Consumer Attorneys of California
County of Santa Cruz Health Services Agency
Gray Panthers of San Francisco
Health Access California
International League of Peace and Freedom
Latino Coalition for a Healthy California
Los Angeles United Cerebral Palsy
Marin Democratic Club
Marin Women's Commission
Monterey County Commission on the Status of Women
National Association of Social Workers
National Council of Senior Citizens-LA Chapter
National Lawyers Guild
National Women's Political Caucus of California, Inc.
Neighbor to Neighbor-LA Chapter
North Country Clinic
Older Women's League of California
Planned Parenthood Affiliates of California
Planning for Elders in the Central City
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Registered Nurses Professional Association
Resources for Independent Living, Inc.
San Fernando Gray Panthers
San Francisco AIDS Foundation
San Luis Obispo County Commission on the Status of Women
Screen Actors Guild
SEIU 535 (American Federation of Nurses, Social Service
Workers Union)
Senior Action Network
Senior Medi-Benefits
Service Employees International Union
The American College of Obstetricians and Gynecologists
The American Federation of State, County and Municipal
Employees
The Fourth Trimester, Inc.
United Nurses Association of California
Vote Health Coalition
women for:
Women's Commission County of Santa Cruz
several individuals
OPPOSITION : California Manufacturers Association
Analysis prepared by : Elizabeth Fenton / ains / (916) 445-9160