(a) As used in this Code section, the term: (1) "Attending provider" means: (A) Pediatricians and other physicians attending the newborn;
and (B) Obstetricians, other physicians, and certified nurse
midwives attending the mother. (2) "Health benefit policy" means any individual or group plan,
policy, or contract for health care services issued, delivered,
issued for delivery, or renewed in this state, including those
contracts executed by the State of Georgia on behalf of indigents
and on behalf of state employees under Article 1 of Chapter 18 of
Title 45, by a health care corporation, health maintenance
organization, preferred provider organization, accident and
sickness insurer, fraternal benefit society, hospital service
corporation, medical service corporation, or other insurer or
similar entity. (3) "Insurer" means an accident and sickness insurer, fraternal
benefit society, hospital service corporation, medical service
corporation, health care corporation, health maintenance
organization, or any similar entity authorized to issue contracts
under this title and also means any state program funded under
Title XIX of the federal Social Security Act, 42 U.S.C.A. Section
1396 et seq., and any other publicly funded state health care
program. (b) Every health benefit policy that provides maternity benefits
that is delivered, issued, executed, or renewed in this state or
approved for issuance or renewal in this state by the Commissioner
on or after July 1, 1996, shall provide coverage for a minimum of 48
hours of inpatient care following a normal 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 licensed health care
facility. (c) Any decision to shorten the length of stay to less than that
provided under subsection (b) of this Code section shall be made by
the attending physician, the obstetrician, pediatrician, or
certified nurse midwife after conferring with the mother. (d) If a mother and newborn are discharged pursuant to subsection
(c) of this Code section prior to the postpartum inpatient length of
stay provided under subsection (b) of this Code section, coverage
shall be provided for up to two follow-up visits, provided that the
first such visit shall occur within 48 hours of discharge. Such
visits shall be conducted by a physician, a physician's assistant,
or a registered professional nurse with experience and training in
maternal and child health nursing. After conferring with the
mother, the health care provider shall determine whether the initial
visit will be conducted at home or at the office. Thereafter, he or
she shall confer with the mother and determine whether a second
visit is appropriate and where it shall be conducted. Services
provided shall include, but not be limited to, physical assessment
of the newborn, parent education, assistance and training in breast
or bottle feeding, assessment of the home support system, and the
performance of any medically necessary and appropriate clinical
tests. Such services shall be consistent with protocols and
guidelines developed by national pediatric, obstetric, and nursing
professional organizations for these services. (e) The Commissioner shall adopt rules and regulations necessary to
implement the provisions of this Code section. (f) Every insurer shall provide notice to policyholders regarding
the coverage required by this Code section and any rules and
regulations promulgated by the Commissioner relating to this Code
section. The notice shall be in writing and prominently positioned
in any of the following literature: (1) The next mailing to the policyholder; (2) The yearly informational packets sent to the policyholder; or (3) Other literature mailed before January 1, 1997. (g) No insurer covered under this Code section shall deselect,
terminate the services of, require additional utilization review,
reduce capitation payment, or otherwise penalize an attending
physician or other health care provider who orders care consistent
with the provisions of this Code section. For purposes of this
subsection, health care provider shall be defined to include the
attending physician, certified nurse midwife, and hospital. |