One of the major issues we are facing in Title V populations is the increasingly earlier discharge of mothers and their newborns from hospitals, as early as less than 24 hours. But, even discharge at 25 hours is not necessarily safe for all infants. As of July 10, two states have laws regarding a minimum hospital stay for mothers and child following the birth of the child. These laws are requiring that the length of the mothers to stay in the hospital is a medical decision made according to the recommendations of ACOG and AAP in the Guidelines for Prenatal Care.
The Maryland law requires a 48 hour hospital stay, but an early discharge is permitted if medical stability is assured and the required newborn screening is done. Therefore, infants leaving prior to the obtaining of an adequate new born blood sample and/or 24 hours will receive a home visit. Insurers with networks are to "encourage and assist" the insured to select and contact a primary care provider prior to delivery. The law goes into effect October 1, 1995. Dr. Susan Panny, Director of the Office for Heredity Disorders at the Maryland Department of Health and Mental Hygiene was instrumental in the passage of this legislation. This was the first law of its kind in the nation. A similar law has been passed in New Jersey. Bills have been introduced in Massachusetts and Pennsylvania.
Nationally, the New Borns and Mothers' Health Protection Act of 1995 was introduced in both the House (H.R. 1948) and Senate (S.969) in late June. The bills have been referred on to committees. These proposals require health plans that provide maternity benefits for child birth, provide for a minimum of 48 hours of in-patient care following a vaginal delivery and a minimum of 96 hours on in-patient care following a caesarean section for a mother and her newly born child in a health care facility. A health care plan that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide coverage of in-patient care unless in-patient care is determined to be medically necessary by the attending physician or is requested by the mother.
A resource for states is the proceedings from the meeting "Early Hospital Discharge: Impact on New Born Screening" held March 31- April 1, 1995 in Washington, D.C. The proceedings include discussion of the problem, projections, methods to solve the problem and potential solutions. A draft statement on early discharge and its impact is included. The conference was sponsored by Council of Regional Networks for Genetic Services (Corn), Association of State and Territorial Public Health Laboratory Directors (ASTPHLD), Maternal and Child Health Bureau (MCHB), National Institutes of Health, Centers for Disease Control. Dr. Ken Pass is the contact for CORN on this meeting. Single copies of the proceedings can be obtained from the National Maternal and Child Health Clearinghouse, 8201 Greensboro Drive, Suite 600, McLean, Virginia 22102, Phone (703)-821-8955, ext. 254. Fax (703)821-2098.
It is vital that statewide programs offering population based services network with the private health care providers to assure that the needed services are reaching all the mothers and children in the state. Population based services, in addition to genetics programs, include early intervention, family support and preservation activities, breast-feeding promotion and services with education components such as nutrition, child safety, oral health, and child health management. This is an excellent opportunity for state health department programs to collectively examine the health care system together with providers in both the public and private sector.
