Newborns' and Mothers' Health Protection Act of 1996

Summary: Newborns' and Mothers' Health Protection Act of 1996 - Amends the Internal Revenue Code to impose a tax on an insurer, health maintenance organization (HMO), or group health plan sponsor that (if it provides any inpatient childbirth benefits for a mother or newborn) fails to provide:  (1) inpatient benefits for a minimum period after delivery; and (2) if the mother or newborn are discharged before the end of that period, certain post-delivery follow-up care.  Prohibits an insurer, HMO, or plan from using certain types of penalties or inducements regarding mothers or providers.  Declares that the provisions of this Act do not preempt provisions of State law that provide protections that are not less than the protections under this Act.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Newborns' and Mothers' Health 
Protection Act of 1996''.

SEC. 2. FINDING.

    Congress finds that--
            (1) the length of post-delivery inpatient care 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 infant, the ability and 
        confidence of the mother to care for her infant, the adequacy 
        of support systems at home, and the access of the mother and 
        infant 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. 3. NEWBORNS' AND MOTHERS' HEALTH PROTECTION.

    (a) In General.--The Internal Revenue Code of 1986 is amended by 
adding at the end the following:

         ``Subtitle K--Newborns' and Mothers' Health Protection

        ``CHAPTER 100--NEWBORNS' AND MOTHERS' HEALTH PROTECTION

``Sec. 9801. Imposition of tax for failure to meet newborns' and 
                            mothers' health protection requirements.
``Sec. 9802. Required coverage for minimum inpatient stay following 
                            birth.
``Sec. 9803. Definitions; general provisions.

``SEC. 9801. IMPOSITION OF TAX FOR FAILURE TO MEET NEWBORNS' AND 
              MOTHERS' HEALTH PROTECTION REQUIREMENTS.

    ``(a) Health Insurance Coverage.--
            ``(1) In general.--There is hereby imposed a tax on an 
        insurer or health maintenance organization that offers health 
        insurance coverage which the Secretary of Health and Human 
        Services certifies to the Secretary fails to meet an applicable 
        requirement specified in section 9802 at any time during a 
        calendar year.
            ``(2) Amount of tax.--The amount of tax imposed by 
        paragraph (1) shall be equal to 25 percent of the premiums 
        received under such coverage during the calendar year.
            ``(3) Premium.--For purposes of this subsection, the term 
        `premium' means the gross amount of premiums and other 
        consideration (including advance premiums, deposits, fees, and 
        assessments) arising from health insurance coverage issued by 
        an insurer or health maintenance organization, adjusted for any 
        return or additional premiums paid as a result of endorsements, 
        cancellations, audits, or retrospective rating.
            ``(4) Exemption if state regulation.--No tax shall be 
        imposed under paragraph (1) for a failure of an insurer or 
        organization to meet a requirement if the insurer or 
        organization is regulated by a State, unless the Secretary of 
        Health and Human Services has determined that such State has 
        not provided for enforcement of State laws which govern the 
        same matters as are governed by such requirement and which 
        assure substantial compliance by insurers or organizations with 
        such a requirement.
    ``(b) Group Health Plans.--
            ``(1) In general.--There is hereby imposed a tax on a plan 
        sponsor (as defined in section 3 of the Employee Retirement 
        Income Security Act of 1974) of a group health plan which the 
        Secretary of Labor certifies to the Secretary fails to meet an 
        applicable requirement of section 9802 at any time during a 
        calendar year.
            ``(2) Amount of tax.--The amount of tax imposed by 
        paragraph (1) shall be equal to 25 percent of the group health 
        plan coverage expenditures for such calendar year under such 
        plan.
            ``(3) Group health plan coverage expenditures.--For 
        purposes of this subsection, the group health plan coverage 
        expenditures of any self-insured group health plan for any 
        calendar year are the aggregate expenditures for such year for 
        health benefits provided under such plan to the extent that 
health benefits are provided other than through health insurance 
coverage.
    ``(c) Waiver.--If the Secretary of Health and Human Services finds, 
with respect to an insurer or health maintenance organization, or the 
Secretary of Labor finds, with respect to a group health plan, that a 
failure of such insurer, organization, or plan is due to reasonable 
cause and not to willful neglect and certifies such fact to the 
Secretary of the Treasury, the Secretary of the Treasury may waive part 
or all of the tax imposed by this section to the extent that the 
Secretary of Health and Human Services or the Secretary of Labor (as 
the case may be) finds that payment of such tax would be excessive 
relative to the failure involved.

``SEC. 9802. REQUIRED MINIMUM CHILDBIRTH BENEFITS.

    ``(a) Minimum Childbirth Benefits.--If an insurer or health 
maintenance organization provides health insurance coverage that 
includes any benefits for inpatient care for childbirth for a mother or 
newborn child or if a group health plan includes any such benefits, the 
insurer, organization, or plan shall meet the following requirements:
            ``(1) Minimum length of stay for inpatient care benefits.--
        The coverage or plan shall provide benefits for inpatient care 
        for childbirth for a minimum length of stay of 48 hours 
        following a vaginal delivery and a minimum length of stay of 96 
        hours following a caesarean section.
            ``(2) Coverage of post-delivery follow-up care.--If an 
        attending provider, in consultation with the mother, decides to 
        discharge a covered mother or newborn child from an inpatient 
        setting before the expiration of the minimum length of stay 
        period described in paragraph (1), the coverage or plan shall 
        include benefits for timely post-delivery care by a registered 
        nurse, physician, nurse practitioner, nurse midwife or 
        physician assistant experienced in maternal and child health in 
        the home, a provider's office, a hospital, a federally 
        qualified health center, a federally qualified rural health 
        clinic, a State health department maternity clinic, or another 
        setting (such as a birthing center or an intermediate care 
        facility) determined appropriate under regulations promulgated 
        by the Secretary of Health and Human Services.
            ``(3) Notice.--The insurer, organization, or plan shall 
        provide notice to each enrollee eligible for childbirth 
        benefits under this subsection regarding the requirements of 
        this section.
    (b) Prohibitions.--In implementing the requirements of subsection 
(a), an insurer, organization, or plan may not--
            ``(1) require or condition the provision of benefits under 
        subsection (a) on any authorization or approval of an attending 
        or other provider;
            ``(2) deny enrollment, renewal, or continued coverage to a 
        mother and her newborn child who are otherwise eligible to be 
        so covered based on compliance with this section;
            ``(3) provide monetary incentives to mothers to encourage 
        such mothers to request less than the minimum coverage required 
        under subsection (a);
            ``(4) provide incentives (monetary or otherwise) to an 
        attending provider to induce such provider to provide treatment 
        in a manner inconsistent with this section; or
            ``(5) penalize or otherwise reduce or limit the 
        reimbursement of an attending provider because such provider 
        provided treatment in accordance with this section.
    ``(c) Additional Terms and Conditions.--
            ``(1) Attending provider.--As used in this section, the 
        term `attending provider' means, with respect to a mother and 
        her newborn child, an obstetrician-gynecologist, pediatrician, 
        family physician, or other physician, or any other health care 
        provider (such as a nurse midwife or nurse practitioner), who, 
        acting in accordance with applicable State law, is primarily 
        responsible for the care of the mother and child.
            (2) Timely care defined.--As used in subsection (a)(2), the 
        term `timely post-delivery care' means health care that is 
        provided--
                    ``(A) following the discharge of a mother and her 
                newborn child from the inpatient setting following 
                childbirth; and
                    ``(B) in a manner that meets the health care needs 
                of the mother and her newborn child, that provides for 
                the appropriate monitoring of the conditions of the 
                mother and child, and that occurs within the 72-hour 
                period immediately following discharge.
            ``(3) Regulations regarding appropriate post-care delivery 
        settings.--The Secretary of Health and Human Services, with 
        respect to regulations promulgated under subsection (a)(2) 
        concerning appropriate post-delivery care settings--
                    ``(A) shall ensure that, to the extent practicable, 
                such regulations are consistent with State licensing 
                and practice laws,
                    ``(B) shall consider telemedicine and other 
                innovative means to provide follow-up care, and
                    ``(C) shall consider both urban and rural settings.
            ``(4) Rule of construction.--Nothing in this section shall 
        be construed to require that a mother--
                    ``(A) give birth in a hospital; or
                    ``(B) stay in the hospital for a fixed period of 
                time following the birth of her child.
            ``(5) Requirements.--The notice required under subsection 
        (a)(3) shall be in accordance with regulations promulgated by 
        the Secretary of Health and Human Services. Such regulations 
        shall provide that the notice shall be in writing, shall be 
        conspicuous and prominently positioned, and shall be required 
        to be provided as follows:
                    ``(A) Health insurance coverage.--By an insurer or 
                health maintenance organization--
                            ``(i) to enrollees described in subsection 
                        (a) who are enrolled on the effective date of 
                        this chapter within 120 days after such 
                        effective date and annually thereafter, and
                            ``(ii) to other enrollees at the time of 
                        enrollment and annually thereafter.
                    ``(B) Group health plans.--By a group health plan--
                            ``(i) to enrollees described in subsection 
                        (a) who are enrolled on the effective date of 
                        this chapter within 120 days after such 
                        effective date, and
                            ``(ii) for plan years beginning on or after 
                        such effective date, as part of its summary 
                        plan description.

``SEC. 9803. DEFINITIONS; GENERAL PROVISIONS.

    ``(a) Group Health Plan Defined.--For purposes of this chapter--
            ``(1) In general.--The term `group health plan' means an 
        employee welfare benefit plan (as defined in section 3(1) of 
        the Employee Retirement Income Security Act of 1974) to the 
        extent that the plan provides medical care directly or through 
        insurance, reimbursement, or otherwise, and includes a group 
        health plan within the meaning of section 5000(b)(1).
            ``(2) Exclusion of plans with limited coverage.--An 
        employee welfare benefit plan shall be treated as a group 
        health plan under this chapter only with respect to medical 
        care which is provided under the plan and which does not 
        consist of coverage excluded from the definition of health 
        insurance coverage under subsection (b)(1)(B).
            ``(3) Exclusion of church plans.--The requirements of this 
        chapter insofar as they apply to group health plans shall not 
        apply to church plans (as defined in section 3(33) of the 
        Employee Retirement Income Security Act of 1974).
            ``(4) Treatment of governmental plans.--If the plan sponsor 
        of a governmental plan (as such terms are defined in section 3 
        of the Employee Retirement Income Security Act of 1974) which 
        is a group health plan to which the provisions of this chapter 
        otherwise apply makes an election under this paragraph for any 
        specified period (in such form and manner as the Secretary of 
        Health and Human Services may by regulations prescribe), then 
        the requirements of this chapter insofar as they apply to group 
        health plans shall not apply to such governmental plans for 
        such period.
    ``(b) Definitions Relating to Health Insurance Coverage.--As used 
in this chapter--
            ``(1) Health insurance coverage.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), the term `health insurance coverage' 
                means benefits consisting of medical care (provided 
                directly, through insurance or reimbursement, or 
                otherwise) under any hospital or medical service policy 
                or certificate, hospital or medical service plan 
                contract, or health maintenance organization group 
                contract offered by an insurer or a health maintenance 
                organization.
                    ``(B) Exception.--Such term does not include 
                coverage under any separate policy, certificate, or 
                contract only for one or more of any of the following:
                            ``(i) Coverage only for accident, or 
                        disability income insurance, or any combination 
                        thereof.
                            ``(ii) Medicare supplemental health 
                        insurance (as defined under section 1882(g)(1) 
                        of the Social Security Act).
                            ``(iii) Coverage issued as a supplement to 
                        liability insurance.
                            ``(iv) Liability insurance, including 
                        general liability insurance and automobile 
                        liability insurance.
                            ``(v) Workers compensation or similar 
                        insurance.
                            ``(vi) Automobile medical payment 
                        insurance.
                            ``(vii) Coverage for a specified disease or 
                        illness.
                            ``(viii) Hospital or fixed indemnity 
                        insurance.
                            ``(ix) Short-term limited duration 
                        insurance.
                            ``(x) Credit-only, dental-only, or vision-
                        only insurance.
                            ``(xi) A health insurance policy providing 
                        benefits only for long-term care, nursing home 
                        care, home health care, community-based care, 
                        or any combination thereof.
            ``(2) Health maintenance organization.--The term `health 
        maintenance organization' means--
                    ``(A) a federally qualified health maintenance 
                organization (as defined in section 1301(a) of the 
                Public Health Service Act (42 U.S.C. 300e(a))),
                    ``(B) an organization recognized under State law as 
                a health maintenance organization, or
                    ``(C) a similar organization regulated under State 
                law for solvency in the same manner and to the same 
                extent as such a health maintenance organization,
        if the organization is subject to State law which regulates 
        insurance (within the meaning of section 514(b)(2) of the 
        Employee Retirement Income Security Act of 1974).
            ``(3) Insurer.--The term `insurer' means an insurance 
        company, insurance service, or insurance organization which is 
        licensed to engage in the business of insurance in a State and 
        which is subject to State law which regulates insurance (within 
        the meaning of section 514(b)(2)(A) of the Employee Retirement 
        Income Security Act of 1974).
    ``(c) Other Definitions.--As used in this chapter--
            ``(1) Medical care.--The term `medical care' means--
                    ``(A) amounts paid for, or items or services in the 
                form of, the diagnosis, cure, mitigation, treatment, or 
                prevention of disease, or amounts paid for, or items or 
                services provided for, the purpose of affecting any 
                structure or function of the body,
                    ``(B) amounts paid for, or services in the form of, 
                transportation primarily for and essential to medical 
                care referred to in subparagraph (A), and
                    ``(C) amounts paid for insurance covering medical 
                care referred to in subparagraphs (A) and (B).
            ``(2) State.--The term `State' includes the District of 
        Columbia, Puerto Rico, the Virgin Islands, Guam, American 
        Samoa, and the Northern Mariana Islands.
    ``(d) Nonpreemption.--
            ``(1) In general.--The provisions of this chapter shall not 
        preempt those provisions of State law that provide protections 
        that are not less than the protections provided under this 
        chapter, including any--
                    ``(A) requirement that health insurance coverage 
                provide for maternity and pediatric care that is in 
                accordance with guidelines established by the American 
                College of Obstetricians and Gynecologists and the 
                American Academy of Pediatrics, and
                    ``(B) leaving decisions regarding the appropriate 
                length of inpatient care for a mother and her newborn 
                child entirely to the attending provider in 
                consultation with the mother.
            ``(2) No override of erisa preemption.--Nothing in this 
        chapter shall be construed to affect or modify the provisions 
        of section 514 of the Employee Retirement Income Security Act 
        of 1974 (29 U.S.C. 1144).
    ``(e) Regulations.--Regulations promulgated by the Secretary to 
carry out this chapter shall be promulgated in consultation with the 
Secretary of Health and Human Services.''.
    (b) Effective Date.--The amendments made by this section shall 
apply--
            (1) to health insurance coverage for contract years 
        beginning on or after January 1, 1997; and
            (2) to group health plans as of the first day of the first 
        plan year beginning on or after January 1, 1997.
    (c) Clerical Amendment.--The table of contents for the Internal 
Revenue Code of 1986 is amended by adding after the item relating to 
subtitle J the following new item:

                              ``Subtitle K. Newborns' and Mothers' 
                                        Health Protection.''