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S.B. 190
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VETOES
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(C) AN INTERNAL GRIEVANCE PROCESS ESTABLISHED BY A PRIVATE REVIEW
AGENT UNDER THIS SECTION MAY NOT CHARGE A FEE TO A PATIENT OR HEALTH
CARE PROVIDER FOR FILING A GRIEVANCE.
15-10B-09.
(a) In this section, "attending provider" means an obstetrician, pediatrician, or
other physician or certified nurse midwife or pediatric nurse practitioner attending
the mother or newborn child,
(b) Except as provided in subsections (c) and (d) of this section, the criteria
and standards used by a private review agent or health maintenance organization in
performing utilization review of hospital services related to maternity and newborn
care, including length of stay, shall be in accordance with the medical criteria outlined
in the most current version of the "Guidelines for Perinatal Care" prepared by the
American Academy of Pediatrics and the American College of Obstetricians and
Gynecologists.
(c) Subject to the provisions of subsection (d) of this section, a private review
agent or health maintenance organization performing utilization review of hospital
services related to maternity and newborn care shall authorize a minimum coverage
of:
(1) 48 hours of inpatient hospitalization care following an uncomplicated
vaginal delivery; and
(2) 96 hours of inpatient hospitalization care following an uncomplicated
cesarean section.
(d) (1) The private review agent or health maintenance organization may
authorize a shorter length of stay than that provided in subsection (c) of this section
if the mother, in consultation with her attending provider, decides that less time is
needed for recovery.
(2) For a mother and newborn child who have a hospital stay shorter in
length than that provided under subsection (c) of this section, the private review
agent or health maintenance organization performing utilization review shall
authorize:
(i) one home visit scheduled to occur within 24 hours after hospital
discharge; and
(ii) an additional home visit as may be prescribed by the attending
provider.
(3) For a mother and newborn child who remain in the hospital for at
least the period of time provided under subsection (c) of this section, the private
review agent or health maintenance organization performing utilization review shall
authorize a home visit as may be prescribed by the attending provider.
(4) A home visit under paragraph (2) or (3) of this subsection shall:
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- 3764 -
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