CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Minimum Post-partum Hospital Stay Coverage

Governs minimum hospital length-of-stay coverage after childbirth for mothers and newborns for Blue Cross & Blue Shield of Rhode Island members, in accordance with Rhode Island law. Affects providers and members covered by BCBSRI commercial and Medicare Advantage plans where noted.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMinimum Post-partum Hospital Stay Coverage

Policy CodePolicy N/A

Change TypeAnnual review — no material changes

Effective DateJan 3, 2020

Next Review DateN/A

Key ActionAttending health care provider must document any decision to shorten the minimum coverage in consultation with the mother consistent with ACOG/AAP guidelines.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

48 hrsminimum coverage after vaginal delivery

96 hrsminimum coverage after Cesarean section

BCBSRI membersApplies to

May opt outSelf-funded plans

Coverage Criteria

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Minimum Post-partum Hospital Stay Coverage

Covered when ALL of the following are met:

Statutory minimum stay: Health plan provides at least 48 hours hospital coverage after vaginal delivery and 96 hours after Cesarean section for mother and newborn.48 hours for vaginal; 96 hours for Cesarean

Per Rhode Island RIGL 27-20-17.1; mirrors the federal Newborns' and Mothers' Health Protection Act.

Early discharge decision: Decision to shorten these minimum coverages is made by the attending health care provider in consultation with the mother and must follow ACOG/AAP perinatal care guidelines.N/A

If early discharge is chosen, post-discharge care should include home visits, parent education, feeding support, and necessary clinical tests as appropriate.

Self-funded (ERISA) employer groups may choose not to follow Rhode Island's state mandate for minimum post-partum hospital stays. Benefit coverage for pregnancy and nursery services can therefore vary by group and by contract. Verify the member's specific coverage by reviewing the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement before assuming state-mandated benefits apply.

Provider Actions and Responsibilities

Prior Authorization

Prior Authorization Not Applicable

Prior authorization is not applicable for covered post-partum lengths of stay under this policy. Verify member contract and benefits for any variations by group or plan (self-funded groups may not follow state mandates).

Verify member's Benefit Booklet or Evidence of Coverage for applicable Pregnancy and Nursery Services benefits.
Self-funded groups may not be subject to the Rhode Island mandate — confirm plan design.

Note

Post-discharge Care Expectations

If the attending health care provider and mother elect an early discharge (less than 48 hours after vaginal delivery or less than 96 hours after Cesarean), post-discharge care must be arranged. This should include home visits, parent education, breastfeeding (or bottle feeding) assistance and training, and any necessary clinical tests or other appropriate services consistent with applicable guidelines.

Home visits for clinical assessment and support.
Parent education and instruction on newborn care.
Breastfeeding support and assistance, or bottle-feeding training as appropriate.
Arrangement and performance of any necessary clinical tests or other appropriate services.

Documentation Required

Decision and Documentation for Early Discharge

The attending health care provider must make the decision to shorten the minimum covered hospital stay in consultation with the mother and in accordance with standards/guidelines for perinatal care (e.g., ACOG and AAP). The decision and relevant clinical rationale should be documented in the medical record per documentation standards.

Document the joint decision-making discussion with the mother and the clinical justification for early discharge.
Reference applicable perinatal care guidelines (ACOG/AAP) when determining appropriateness of early discharge.
Ensure documentation supports any ordered post-discharge services.

Denial Risk

Appeal Rights on Denial

Subscribers may appeal denials of benefits related to post-partum length of stay in accordance with the department of health regulations and the plan's appeal procedures.

Follow the plan's standard appeal process and timelines as outlined in the Evidence of Coverage or Subscriber Agreement.
Inform the subscriber of their right to appeal denials related to this mandate.

Background

Rhode Island law requires that health plans provide a minimum hospital stay following childbirth: at least 48 hours after a vaginal delivery and at least 96 hours after a Cesarean delivery for the mother and newborn, unless the attending health care provider, in consultation with the mother, decides on an earlier discharge. If early discharge occurs, post-discharge care should follow ACOG/AAP perinatal guidance and may include home visits, parent education, breastfeeding support, and any necessary clinical testing.

Definitions

Attending health care provider — definition

Included provider typesAttending obstetrician, pediatrician, family practitioner, general practitioner, or certified nurse midwife.

Role in discharge decisionsAttending health care provider must make the decision to shorten the minimum postpartum stay in consultation with the mother per ACOG/AAP guidelines.

ScopeApplies to the provider attending the mother and the newly born child for purposes of post-partum hospital stay decisions.

Protections for providersPlans may not penalize an attending physician or other health care provider who orders care consistent with this section.

OpenPayer

Minimum Post-partum Hospital Stay Coverage

Coverage Criteria

Coding

Provider Actions and Responsibilities

Background

Definitions