New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 2 - MOTHERS AND NEWLY BORN CHILDREN HEALTH SECURITY › Section 13.10.2.9 - MINIMUM HEALTHCARE PROTECTION ACT POLICIES AND BENEFIT PLANS

Current through Register Vol. 35, No. 13, July 16, 2024
A. All healthcare
				policies or healthcare benefit plans offered under the authority of the Minimum
				Healthcare Protection Act delivered or issued for delivery in this state and
				which provide maternity coverage shall also provide coverage for a minimum of
				48 hours of inpatient care following a vaginal delivery and a minimum of 96
				hours of inpatient care following a caesarian section for a mother and her
				newly born child in a health facility unless earlier discharge is made in
				accordance with the medical criteria outlined in the most current version of
				the "Guidelines for Perinatal Care" prepared by the American academy of
				pediatrics and the American college of obstetricians and gynecologists,
				including, but not limited to, the criterion that family members or other
				support person(s) should be available to the mother for the first few days
				following discharge. In addition, a decision for early discharge should be
				individualized and should be a mutual decision between the mother and the
				attending physician. Inpatient care in excess of a minimum of 48 hours
				following a vaginal delivery and a minimum of 96 hours following a caesarian
				section for a mother and her newly born child in a health facility shall be
				covered if determined to be medically necessary by the attending
				physician.
B. Notwithstanding the
				provisions of subsection 9.1 of this section [now Subsection A of 13.10.2.9
				NMAC], an approved healthcare policy or healthcare benefit plan offered under
				the authority of the Minimum Healthcare Protection Act delivered or issued for
				delivery in this state that provides coverage for postpartum care to a mother
				and her newly born child in the home shall not be required to provide for
				coverage for a minimum of 48 hours of inpatient care following a vaginal
				delivery and a minimum of 96 hours of inpatient care following a caesarian
				section, unless such inpatient care is determined to be medically necessary by
				the attending physician, or early discharge is inconsistent with the most
				current version of the "Guidelines for Perinatal Care" prepared by the American
				academy of pediatrics and the American college of obstetricians and
				gynecologists, or this rule.
C.
				Postpartum care in the home shall be made in accordance with accepted maternal
				and neonatal physician assessments, by a person with appropriate licensure,
				training and experience to provide postpartum care. Services provided by such
				person shall include, but not be limited to, parent education, assistance and
				training in breast and bottle feeding, and the performance of any necessary and
				appropriate clinical tests.
D.
				Postpartum care in the home shall consist of a minimum of three home visits,
				unless one or two home visits are determined to be sufficient by the attending
				physician or person with appropriate licensure, training and experience to
				provide postpartum care, and the mother. The home visits shall be conducted
				within the time period ordered by the attending physician or person with
				appropriate licensure, training and experience to provide postpartum
				care.
E. Each insurer providing
				coverage under the authority of the Minimum Healthcare Protection Act through a
				healthcare policy or healthcare benefit plan which provides maternity coverage
				in this state shall mail a written description of the coverage required under
				this rule, in a form approved by the superintendent, to the expectant mother
				covered by the insurer and to her attending physician, upon receipt by the
				insurer of notification of the diagnosis of pregnancy of the expectant
				mother.
F. In addition to the
				notification provided in subsection 9.5 [now Subsection E of 13.10.2.9 NMAC],
				each insurer providing coverage under the authority of the Minimum Healthcare
				Protection Act through a healthcare policy or healthcare benefit plan which
				provides maternity coverage in this state shall mail a written statement, in a
				form approved by the superintendent, to the expectant mother covered by the
				insurer, notifying the expectant mother of her right to complain to the
				superintendent if there is concern that the mother or her newly born child has
				not received the coverage required by this rule. In the event of a complaint,
				the insurer will have the burden of proof to demonstrate that the coverage
				provided was in compliance with this rule.