IN THE MATTER OF:
NEWBORNS' AND MOTHERS'
HEALTH PROTECTION
REGULATION 2000-2                                                                                                              CAUSE NO. 00-4012
 

This cause came on for hearing to consider the adoption of Mississippi Department of Insurance Proposed Regulation No. 2000-2, entitled "Newborns And Mothers' Health Protection", and the Commissioner of Insurance ("Commissioner"), having provided interested parties with the opportunity to submit written comments, and having held a public hearing and heard the comments of all interested parties and the evidence produced by such parties, finds as follows, to-wit:
 

That on or about June 6, 2000, the Commissioner, or his duly appointed representative, pursuant to the provisions of Miss. Code Ann. § 25-43-7(l) (Rev. 1999), filed with the Secretary of State of the State of Mississippi notice that said Commissioner, or his duly appointed representative, would hold a public hearing on Tuesday, July 11, 2000, at 9:30 a.m., in the Offices of the Commissioner, 18th Floor, Walter Sillers State Office Building, 550 High Street, Jackson, Hinds County, Mississippi, to afford all interested persons the opportunity to submit testimony and evidence and to give opinions, make comments, suggestions or objections concerning proposed Regulation 2000-2.
 

That the Commissioner, or his duly appointed representative, pursuant to the provisions of Miss. Code Ann. § 25-43-7(l) (Rev. 1999), mailed, postage prepaid, copies of an Administrative Procedures Filing Notice and Notice of Hearing to all persons who had made a timely request of the Mississippi Department of Insurance for advance notice of said Department's rule-making proceedings.
 

That pursuant to said Notice of Hearing, a public hearing was held before the Commissioner, or his duly appointed representative, on Tuesday, July 11, 2000, at 9:3 0 a.m., in the offices of the Commissioner, 18th Floor, Walter Sillers State Office Building, Jackson, Hinds County, Mississippi, in which all interested parties were given an opportunity to present their views, opinions, suggestions, comments or objections relative to proposed Regulation 2000-2.
 

That the Commissioner, after having considered all relevant evidence, is of the opinion that it would be in the public interest to adopt Mississippi Department of Insurance Regulation 2000-2, entitled "Newborns' and Mothers' Health Protection".

IT IS, THEREFORE, ORDERED that Mississippi Department of Insurance Regulation No. 2000-2, a copy of which is attached hereto as Exhibit "A", and made a part hereof as if copied herein in words, lines and figures, should be and same is hereby adopted, to be effective thirty days from and after its filing with the Office of the Secretary of State of the State of Mississippi.

IT IS FURTHER ORDERED that any interested person or party who feels they will be adversely affected by this Order shall have ten (10) days from the date of this Order in which such adversely affected person or party may file with the Commissioner a written statement outlining how such person or party will be adversely affected and their reasons for review of this Order.

SO ORDERED this the day of July, 2000.

GEORGE DALE
COMMISSIONER OF INSURANCE
___________________________
 

Table of Contents

Section 1. Authority
Section 2. Purpose and Intent
Section 3. Definition of Health Insurance Issuer
Section 4. Benefit Requirements for Minimum Hospital Stay
Section 5. Prohibited Practices
Section 6. Exceptions
Section 7. Notice
Section 8. Effective Date

Section 1. Authority

This Regulation is promulgated pursuant to the authority vested in the Commissioner of Insurance under Miss. Code Ann. §§ 83-1-43 and 83-5-1 (Rev. 1999), and is promulgated in accordance with Mississippi Insurance Department Regulation No. 88-101, said Regulation being the Rules of Practice and Procedure Before the Mississippi Insurance Department.

Section 2. Purpose and Intent

In order to fully comply with the Health Insurance Portability and Accountability Act of 1996, as Amended, including information issued by the Health Care Financing Administration to the Mississippi Department of Insurance regarding the enforcement thereof, this Regulation is promulgated to prevent health insurance issuers in the group or individual market that cover hospitalization in connection with childbirth for mothers and/or their newborns from restricting coverage to less than forty-eight (48) hours following a vaginal delivery and ninety-six (96) hours following a Cesarean section.

Section 3. Definition of Health Insurance Issuer

As used in this Regulation, the term "health insurance issuer" shall mean any insurance company, hospital or medical service plan or any entity defined in Miss. Code Ann. § 83-41-303(n) (Rev. 1999), which offers group or individual health insurance coverage in the State of Mississippi.

Section 4. Benefit Requirements for Minimum Hospital Stay

A. A health insurance issuer shall not, except as provided in subsection B. of this Section:

(1) Restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child following a normal vaginal delivery to less than forty-eight (48) hours; or

(2) Restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child following a Cesarean section to less than ninety-six (96) hours; or

(3) Require that a provider obtain authorization from the health insurance issuer for prescribing any length of stay required in this Section 4.

Section 5. Prohibited Practices

A health insurance issuer offering group or individual health insurance coverage shall not:

(a) Deny to the mother or her newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the policy solely for the purpose of avoiding the requirements of this Regulation;

(b) Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum protections available under this Regulation;

(c) Penalize or otherwise reduce or limit the reimbursement of an attending provider because such provider provided care to an insured or enrollee in accordance with this Regulation;

(d) Provide incentives, monetary or otherwise, to an attending provider to induce such provider to provide care to an insured or enrollee in a manner inconsistent with this Regulation; or

(e) Subject to subsection C. of Section 6. of this Regulation, restrict benefits for any portion of a period within a hospital length of stay required under subsections (1) and (2) of Section 4. of this Regulation in a manner which is less favorable than the benefits provided for any preceding portion of such stay.

A. Nothing in this Regulation shall be construed to require a mother who is an insured or enrollee:

(1) To give birth in a hospital; or

(2) To stay in the hospital for a fixed period of time following the birth of her child.

C. Nothing in this Regulation shall be construed as preventing a health insurance issuer from imposing deductibles, coinsurance or other cost-sharing in relation to benefits for hospital lengths of stay in connection with childbirth for a mother or newborn child under group or individual health insurance coverage, except that such coinsurance or other cost-sharing for any portion of a period within a hospital length of stay required under subsections (1) and (2) of Section 4. of this Regulation may not be greater than such coinsurance or cost-sharing for any preceding portion of such stay.

D. Nothing in this Regulation shall be construed to prevent a health insurance issuer offering group or individual health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this Regulation.

Section 7. Notice

A health insurance issuer providing group or individual health insurance coverage shall provide notice to the named insured in the case of an individual policy, and to each certificate holder in the case of a group policy, regarding the coverage required by this Regulation. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the health insurance issuer and shall be transmitted to the named insured or certificate holder not later than October 1, 2000. The notice prescribed by this Section 7. shall be filed with and approved by the Commissioner of Insurance before distribution by the health insurance issuer.

Section 8. Effective Date

The effective date of this Regulation shall be thirty (30) days from and after its adoption and filing with the Secretary of State of the State of Mississippi.

GEORGE DALE
COMMISSIONER OF INSURANCE