40 Pa. Stat. § 1583

Current through Pa Acts 2024-35, 2024-56
Section 1583 - Post partum coverage standards
(a) General rule.--Every health insurance policy that provides maternity benefits and is delivered, issued, executed or renewed in this Commonwealth on or after the effective date of this act shall provide coverage for a minimum of 48 hours of inpatient care following normal vaginal delivery and 96 hours of inpatient care following Caesarean delivery.
(b) Other lengths of stay.--In addition to the coverage in subsection (a), a health insurance policy may also provide for a shorter length of stay, but only if the treating or attending physician determines that the mother and newborn meet medical criteria for safe discharge contained within guidelines developed by or in cooperation with treating physicians which recognize treatment standards, including those of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, that determine appropriate length of stay based upon, but not limited to, the following: the evaluation of the antepartum, intrapartum and post partum course of the mother and infant; the gestational stage, birth weight and clinical condition of the infant; the demonstrated ability of the mother to care for the infant postdischarge; and the availability of the postdischarge follow-up care to verify the condition of the infant and mother within 48 hours after discharge.
(c) Home health care visits.--The health insurance policy shall provide coverage for at least one home health care visit within 48 hours after discharge when discharge occurs prior to the times set forth in subsection (a). Such visits shall be made by a licensed health care provider whose scope of practice includes post partum care. Home health care visits shall include parent education, assistance and training in breast and bottle feeding, infant screening and clinical tests and the performance of any necessary maternal and neonatal physical assessments. At the mother's sole discretion, any visits may occur at the facility of the provider. The health insurance policy shall not include any copayment, coinsurance or deductible amount for any post partum home health care visits.

40 P.S. § 1583

1996, July 2, P.L. 514, No. 85, § 3, effective in 60 days.