A Massachusetts law mandating minimum hospital stays for new mothers includes a provision protecting providers from shouldering the financial consequences of state-imposed lengths of stay.
The new law, which takes effect Feb. 19, also calls for regulations governing conditions under which a recovering mother and her newborn can be discharged from the hospital earlier than the 48-hour minimum for a normal birth or 96 hours for a Caesarean section.
A committee of hospital, physician and other healthcare interests met last week to take up the regulations, which by law must be "consistent with the most current guidelines established by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics."
Massachusetts is the fourth state to enact a law aimed at curbing HMOs' attempts to limit hospital stays to fewer than 24 hours, and sometimes as little as eight hours. Nearly 20 other states are considering similar legislation in reaction to public outcry about so-called "drive-through deliveries" (Aug. 7, 1995, p. 44).
The other states that have enacted laws are Maryland, New Jersey and North Carolina. The Massachusetts law is the first to address the fallout over healthcare contract provisions governing utilization and reimbursement.
The state has a 40% HMO penetration characterized by negotiated rates for procedures. Reimbursements typically are based on a shorter negotiated length of stay than the state law now requires in most instances, a spokeswoman for the Massachusetts Hospital Association said.
Those rates will have to be renegotiated at some point, but in the meantime, the MHA successfully lobbied for a provision that said HMOs and insurers can't "terminate the services, de-select, reduce capitation payment or otherwise penalize an attending physician or other healthcare provider" for care consistent with state law.
The law does not affect self-insured employers, which are exempt from state laws under the federal Employee Retirement Income Security Act and conceivably could pass the extra costs on to providers, the MHA spokeswoman said. But the association expects large employers to work with providers on the cost consequences of the law, she said.
Other consequences include risk of losing state licensure for violations of the care guidelines. Those guidelines allow for exceptions to the minimum stays when agreed to by a physician and patient but only if other provisions are made for follow-up care, such as home visits, parent education and performance of clinical tests.
The MHA called for clear guidelines by the state Department of Public Health, through the advisory committee, to avoid putting provider licenses at risk, the spokeswoman said.