Bill Text: NJ A4935 | 2018-2019 | Regular Session | Introduced
Bill Title: Prohibits health benefits coverage for certain non-medically indicated early elective deliveries under Medicaid program, SHBP, and SEHBP.
Spectrum: Partisan Bill (Democrat 12-0)
Status: (Introduced - Dead) 2019-03-25 - Substituted by S3378 (2R) [A4935 Detail]
Download: New_Jersey-2018-A4935-Introduced.html
Sponsored by:
Assemblywoman ANGELA V. MCKNIGHT
District 31 (Hudson)
Assemblyman RAJ MUKHERJI
District 33 (Hudson)
SYNOPSIS
Prohibits health benefits coverage for certain non-medically indicated early elective deliveries under Medicaid program, SHBP, and SEHBP.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health benefits coverage for non-medically indicated early elective deliveries and supplementing various parts of statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. The Legislature finds and declares:
a. Data strongly demonstrates that early elective deliveries--scheduled cesarean sections or medical inductions performed prior to 39 weeks of gestation without medical necessity--carry risks to both babies and mothers;
b. During the last few weeks of pregnancy, critical fetal development is still occurring;
c. As such, studies have shown that non-medically indicated early elective deliveries provide for higher incidences of neonatal intensive care unit admissions, pneumonia, and longer hospital stays for infants than if delivery was prolonged;
d. Additionally, an unsuccessful induction will result in a cesarean section, which can lead to infections, bleeding, and anesthesia complications for mothers;
e. The American College of Obstetricians and Gynecologists (ACOG) has advised against these deliveries for over 30 years;
f. According to the ACOG, medical indications for early delivery are not absolute but should take into account maternal and fetal conditions, gestational age, cervical status, and other factors;
g. Factors such as maternal request, availability of effective pain management, provider convenience, or facility scheduling should not be considered when determining whether to induce labor early or to perform a cesarean delivery;
h. While the early elective delivery rate in New Jersey has generally declined in recent years, approximately three to four percent of all births in the State are the result of a scheduled cesarean section or medical induction performed prior to 39 weeks of gestation without medical necessity; and
i. It is, therefore, in the public interest for the Legislature to prohibit coverage of such medical interventions which are not necessary by clinical standards within the Medicaid Program, State Health Benefits Program, and School Employees' Health Benefits Program as a means to improve medical outcomes for mothers and babies.
2. a. No provider shall be approved for reimbursement by the Division of Medical Assistance and Health Services in the Department of Human Services under Medicaid for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation.
b. As used in this section:
"Medicaid" means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.)
"Non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists.
3. a. Notwithstanding the provisions of any other law or regulation to the contrary, any contract between a carrier and the Division of Medical Assistance and Health Services in the Department of Human Services that provides benefits to persons who are eligible for Medicaid under P.L.1968, c.413 (C.30:4D-1 et seq.) shall not provide coverage for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation.
b. As used in this section, "non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists.
4. a. Notwithstanding any other law or regulation to the contrary, the State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall not provide coverage for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation.
b. As used in this section, "non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists.
5. a. Notwithstanding any other law or regulation to the contrary, the School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall not provide coverage for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation.
b. As used in this section, "non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists.
6. This act shall take effect on the first day of the fourth month next following enactment.
STATEMENT
This bill prohibits the health benefits coverage of certain non-medically indicated early elective deliveries under the Medicaid Program, the State Health Benefits Program (SHBP), and the School Employees' Health Benefits Program (SEHBP). Specifically, this bill prohibits health benefits contracts which are issued or purchased pursuant to the SHBP, SEHBP, and the Medicaid Program, as well as services purchased under the fee-for-service delivery system within the Medicaid Program, from providing health benefits coverage or reimbursing a provider for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation.
As used in the bill, "non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists (ACOG).
The ACOG has long discouraged non-medically indicated deliveries before 39 weeks of gestation. Data strongly suggest that early elective deliveries carry risks for both babies and mothers. Early deliveries increase the chance the baby will be admitted to the neonatal intensive care unit, resulting in longer stays and higher costs. Risks are also higher for pneumonia as a baby's lungs continue to develop into the last week of gestation. Additionally, an unsuccessfully induced labor will result in a cesarean section, which carries its own additional risks for the mother - such as infections, bleeding, and anesthesia complications - and high costs.
According to the ACOG, medical indications for early delivery are not absolute but should take into account maternal and fetal conditions, gestational age, cervical status, and other factors. Factors such as maternal request, availability of effective pain management, provider convenience, or facility scheduling should not be considered when determining whether to induce labor early or to perform a cesarean delivery.
The sponsor's intent is that this bill will improve medical outcomes for mothers and babies within the Medicaid Program, SHBP, and SEHBP by discouraging medical interventions that are not necessary by clinical standards.
