These documents are not legal documents but are placed here for reference purposes only. For a legal copy please contact the department.

Maternity Stays Guideline

Bulletin
Friday, May 2, 1997
Insurance Bulletin #114

MATERNITY STAYS GUIDELINE

Maternity Coverage Regulation #89-1 applies to all policies of health insurance issued to Vermonters, and generally provides that maternity coverage be a part of all health insurance policies on a non-discriminatory basis. Such coverage is also subject to Bulletin #96, issued on September 27, 1989.

Concerns have been raised by consumers, providers, and legislators that Vermont health insurers may be using utilization review criteria in determining whether to approve or deny health services to their insureds that may require the discharge of new mothers and their newborns from health care facilities shortly after birth, and that the use of such criteria may jeopardize the health of the mothers as well as the newborns if applied against the advice of the health care provider treating the mother. The Legislature has asked the Department to prepare “[g]uidelines for postpartum care” that “shall allow health care providers to determine the appropriate length of postpartum hospital stay based on relevant factors including the complexity of the delivery, whether the delivery was vaginal or caesarian, the clinical condition of the infant and the mother, their social situation and available community support services.” P.A. No. 180 (1996 Vt., Adj. Sess.), Sec. 40(a)(2).

The Department has contracted with the Vermont Program for Quality in Health Care, Inc., which issued a set of recommendations for a maternity stays guideline on January 2, 1997. The Commissioner has adopted the recommendations in full, and accordingly expects all health insurers offering maternity coverage in Vermont shall use the attached Maternity Stays Guideline, which are incorporated herein by reference, in deciding when to authorize or deny requested health care services relating to postpartum care.

Please contact Steve Kappel at (802) 828-2900 if you have any questions.