newborn

H.R.3666

PUBLIC LAW: 104-204, (became law 09/26/96)

SPONSOR: Rep Lewis, Jerry, (introduced 06/18/96)

TITLE VI--NEWBORNS' AND MOTHERS' HEALTH PROTECTION ACT OF 1996

SEC. 601. SHORT TITLE- This title may be cited as the `Newborns' and Mothers' Health

Protection Act of 1996'.

SEC. 602. FINDINGS- Congress finds that--

(1) the length of post-delivery hospital stay should be based on the unique characteristics of

each mother and her newborn child, taking into consideration the health of the mother, the

health and stability of the newborn, the ability and confidence of the mother and the father

to care for their newborn, the adequacy of support systems at home, and the access of the

mother and her newborn to appropriate follow-up health care; and

(2) the timing of the discharge of a mother and her newborn child from the hospital should

be made by the attending provider in consultation with the mother.

SEC. 603. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT

OF 1974- (a) IN GENERAL- Part 7 of subtitle B of title I of the Employee Retirement Income

Security Act of 1974 (added by section 101(a) of the Health Insurance Portability and Accountability

Act of 1996) is amended--

(1) by amending the heading of the part to read as follows:

`Part 7--Group Health Plan Requirements';

(2) by inserting after the part heading the following:

`Subpart A--Requirements Relating to Portability, Access, and

Renewability';

(3) by redesignating sections 704 through 707 as sections 731 through 734, respectively;

(4) by inserting before section 731 (as so redesignated) the following new heading:

`Subpart C--General Provisions';

and

(5) by inserting after section 703 the following new subpart:

`Subpart B--Other Requirements

`SEC. 711. STANDARDS RELATING TO BENEFITS FOR MOTHERS AND

NEWBORNS.

`(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY FOLLOWING BIRTH-

`(1) IN GENERAL- A group health plan, and a health insurance issuer offering group

health insurance coverage, may not--

`(A) except as provided in paragraph (2)--

`(i) restrict benefits for any hospital length of stay in connection with

childbirth for the mother or newborn child, following a normal vaginal

delivery, to less than 48 hours, or

`(ii) restrict benefits for any hospital length of stay in connection with

childbirth for the mother or newborn child, following a cesarean section,

to less than 96 hours; or

`(B) require that a provider obtain authorization from the plan or the issuer for

prescribing any length of stay required under subparagraph (A) (without regard to

paragraph (2)).

`(2) EXCEPTION- Paragraph (1)(A) shall not apply in connection with any group health

plan or health insurance issuer in any case in which the decision to discharge the mother or

her newborn child prior to the expiration of the minimum length of stay otherwise required

under paragraph (1)(A) is made by an attending provider in consultation with the mother.

`(b) PROHIBITIONS- A group health plan, and a health insurance issuer offering group health

insurance coverage in connection with a group health plan, may not--

`(1) deny to the mother or her newborn child eligibility, or continued eligibility, to enroll or

to renew coverage under the terms of the plan, solely for the purpose of avoiding the

requirements of this section;

`(2) provide monetary payments or rebates to mothers to encourage such mothers to accept

less than the minimum protections available under this section;

`(3) penalize or otherwise reduce or limit the reimbursement of an attending provider

because such provider provided care to an individual participant or beneficiary in

accordance with this section;

`(4) provide incentives (monetary or otherwise) to an attending provider to induce such

provider to provide care to an individual participant or beneficiary in a manner inconsistent

with this section; or

`(5) subject to subsection (c)(3), restrict benefits for any portion of a period within a

hospital length of stay required under subsection (a) in a manner which is less favorable

than the benefits provided for any preceding portion of such stay.

`(c) RULES OF CONSTRUCTION-

`(1) Nothing in this section shall be construed to require a mother who is a participant or

beneficiary--

`(A) to give birth in a hospital; or

`(B) to stay in the hospital for a fixed period of time following the birth of her

child.

`(2) This section shall not apply with respect to any group health plan, or any group health

insurance coverage offered by a health insurance issuer, which does not provide benefits

for hospital lengths of stay in connection with childbirth for a mother or her newborn child.

`(3) Nothing in this section shall be construed as preventing a group health plan or issuer

from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for

hospital lengths of stay in connection with childbirth for a mother or newborn child under

the plan (or under health insurance coverage offered in connection with a group health

plan), except that such coinsurance or other cost-sharing for any portion of a period within

a hospital length of stay required under subsection (a) may not be greater than such

coinsurance or cost-sharing for any preceding portion of such stay.

`(d) NOTICE UNDER GROUP HEALTH PLAN- The imposition of the requirements of this

section shall be treated as a material modification in the terms of the plan described in section

102(a)(1), for purposes of assuring notice of such requirements under the plan; except that the

summary description required to be provided under the last sentence of section 104(b)(1) with

respect to such modification shall be provided by not later than 60 days after the first day of the first

plan year in which such requirements apply.

`(e) LEVEL AND TYPE OF REIMBURSEMENTS- Nothing in this section shall be construed to

prevent a group health plan or a health insurance issuer offering group health insurance coverage

from negotiating the level and type of reimbursement with a provider for care provided in

accordance with this section.

`(f) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN CERTAIN

STATES-

`(1) IN GENERAL- The requirements of this section shall not apply with respect to health

insurance coverage if there is a State law (as defined in section 731(d)(1)) for a State that

regulates such coverage that is described in any of the following subparagraphs:

`(A) Such State law requires such coverage to provide for at least a 48-hour

hospital length of stay following a normal vaginal delivery and at least a 96-hour

hospital length of stay following a cesarean section.

`(B) Such State law requires such coverage to provide for maternity and pediatric

care in accordance with guidelines established by the American College of

Obstetricians and Gynecologists, the American Academy of Pediatrics, or other

established professional medical associations.

`(C) Such State law requires, in connection with such coverage for maternity care,

that the hospital length of stay for such care is left to the decision of (or required to

be made by) the attending provider in consultation with the mother.

`(2) CONSTRUCTION- Section 731(a)(1) shall not be construed as superseding a State

law described in paragraph (1).'.

(b) CONFORMING AMENDMENTS-

(1) Section 731(c) of such Act (as added by section 101 of the Health Insurance Portability

and Accountability Act of 1996 and redesignated by the preceding provisions of this

section) is amended by striking `Nothing' and inserting `Except as provided in section 711,

nothing'.

(2) Section 732(a) of such Act (as added by section 101 of the Health Insurance Portability

and Accountability Act of 1996 and redesignated by the preceding provisions of this

section) is amended by inserting `(other than section 711)' after `part'.

(3) Title I of such Act (as amended by section 101 of the Health Insurance Portability and

Accountability Act of 1996 and the preceding provisions of this section) is further

amended--

(A) in the last sentence of section 4(b), by striking `section 706(b)(2)', `section

706(b)(1)', and `section 706(a)(1)' and inserting `section 733(b)(2)', `section

733(b)(1)', and `section 733(a)(1)', respectively;

(B) in section 101(g), by striking `section 706(a)(2)' and inserting `section

733(a)(2)';

inserting `section 733(a)(1), and by striking `section 706(b)(2)' and inserting

`section 733(b)(2)';

(D) in section 104(b)(1), by striking `section 706(a)(1)' each place it appears and

inserting `section 733(a)(1)';

(E) in section 502(b)(3), by striking `section 706(a)(1)' and inserting `section

733(a)(1)';

(F) in section 506(c), by striking `section 706(a)(2)' and inserting `section

733(a)(2)';

(G) in section 514(b)(9), by striking `section 704' and inserting `section 731';

(H) in the last sentence of section 701(c)(1), by striking `section 706(c)' and

inserting `section 733(c)';

(I) in section 732(b), by striking `section 706(c)(1)' and inserting `section

733(c)(1)';

(J) in section 732(c)(1), by striking `section 706(c)(2)' and inserting `section

733(c)(2)';

(K) in section 732(c)(2), by striking `section 706(c)(3)' and inserting `section

733(c)(3)'; and

(L) in section 732(c)(3), by striking `section 706(c)(4)' and inserting `section

733(c)(4)'.

(4) The table of contents in section 1 of such Act is amended by striking the items relating to

part 7 and inserting the following:

`Part 7--Group Health Plan Requirements

`Subpart A--Requirements Relating to Portability, Access, and Renewability

`Sec. 701. Increased portability through limitation on preexisting condition exclusions.

`Sec. 702. Prohibiting discrimination against individual participants and beneficiaries based

on health status.

`Sec. 703. Guaranteed renewability in multiemployer plans and multiple employer welfare

arrangements.

`Subpart B--Other Requirements

`Sec. 711. Standards relating to benefits for mothers and newborns.

`Subpart C--General Provisions

`Sec. 731. Preemption; State flexibility; construction.

`Sec. 732. Special rules relating to group health plans.

`Sec. 733. Definitions.

`Sec. 734. Regulations.'.

health plans for plan years beginning on or after January 1, 1998.

SEC. 604. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE GROUP MARKET-

(a) IN GENERAL- Title XXVII of the Public Health Service Act (as added by

section 102 of the Health Insurance Portability and Accountability Act of 1996) is amended--

(1) by amending the title heading to read as follows:

`TITLE XXVII--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE';

(2) by redesignating subparts 2 and 3 of part A as subparts 3 and 4 of such part;

(3) by inserting after subpart 1 of part A the following new subpart:

`Subpart 2--Other Requirements

`SEC. 2704. STANDARDS RELATING TO BENEFITS FOR MOTHERS AND NEWBORNS.