I

104TH CONGRESS

2D SESSION H. R. 3101

To require health plans to provide coverage for a minimum period of time

for a mother and child following the birth of the child.

IN THE HOUSE OF REPRESENTATIVES

MARCH 14, 1996

Mr. TOWNS introduced the following bill; which was referred to the Committee

on Commerce

A BILL

To require health plans to provide coverage for a minimum

period of time for a mother and child following the

birth of the child.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Mother and Child Pro5 tection Act of 1996’’.

6 SEC. 2. REQUIRED COVERAGE FOLLOWING CHILDBIRTH.

7 (a) COVERAGE FOR INPATIENT CARE.—An entity

8 that offers a health plan that provides maternity benefits,

9 including benefits for childbirth, shall ensure that, in the

10 case of delivery in a hospital or other inpatient setting,
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1 coverage is provided for a mother and her newly born child

2 for a minimum of 48 hours of inpatient care following a

3 vaginal delivery and a minimum of 120 hours of inpatient

4 care following a caesarean section. A health plan shall pro5 vide coverage for additional inpatient care following a de6 livery if a licensed health care practitioner who is directly

7 involved in the inpatient care determines that it is medi8 cally necessary for the mother or newly born child.

9 (b) LIMITED COVERAGE FOR OUTPATIENT CARE.—

10 An entity that offers a health plan that provides maternity

11 benefits, including benefits for childbirth, shall ensure

12 that, in a case in which a mother who delivers a child in

13 a hospital or other inpatient setting elects to leave the in14 patient setting before the expiration of 48 hours in the

15 case of a vaginal delivery or 120 hours in the case of a

16 caesarean section, coverage is provided for the mother and

17 her newly born child for one home service visit within 24

18 hours after the discharge.

19 (c) COVERAGE FOR OTHER MATERNITY BENE20 FITS.—An entity that offers a health plan that provides

21 maternity benefits shall ensure that coverage is provided

22 for parental education, including training in breast or bot23 tle feeding, and performance of any maternal or newborn

24 clinical assessments.
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1 (d) PROHIBITION.—The Secretary of Health and

2 Human Services shall promulgate regulations to ensure

3 that an entity that offers a health plan does not penalize

4 a licensed health care practitioner for administering care

5 consistent with this section.

6 (e) NOTICE.—An entity that offers a health plan

7 shall provide notice to each enrollee under such plan re8 garding the coverage required by this section. Such notice

9 shall be in writing and prominently positioned in any lit10 erature or correspondence made available or distributed

11 by the health plan and shall be transmitted in the next

12 mailing of general information made by the plan to the

13 enrollee as part of the yearly informational packet sent

14 to the enrollee.

15 (f) REGULATIONS.—The Secretary of Health and

16 Human Services, in consultation with the National Asso17 ciation of Insurance Commissioners, shall promulgate reg18 ulations to carry out this section. Such regulations shall

19 include standards for home visits.

20 SEC. 3. ENFORCEMENT.

21 (a) FAILURE TO PROVIDE COVERAGE OR NOTICE.—

22 Any entity that offers a health plan that violates the provi23 sions of this Act shall be subject to a civil money penalty

24 in an amount determined by the Secretary of Health and

25 Human Services.
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1 (b) PROCESS.—The provisions of section 1128A of

2 the Social Security Act (42 U.S.C. 1320a–7a) (other than

3 subsections (a) and (b)) shall apply to civil money pen4 alties under this section in the same manner as they apply

5 to a penalty or proceeding under section 1128A(a) of such

6 Act.

7 SEC. 4. DEFINITIONS.

8 For purposes of this Act:

9 (1) HEALTH PLAN.—The term ‘‘health plan’’

10 means a plan that provides health insurance cov11 erage.

12 (2) HEALTH INSURANCE COVERAGE.—The term

13 ‘‘health insurance coverage’’ means any hospital or

14 medical service policy or certificate, hospital or medi15 cal service plan contract, or health maintenance or16 ganization contract offered by an insurer.

17 (3) LICENSED HEALTH CARE PRACTITIONER.—

18 The term ‘‘licensed health care practitioner’’ has the

19 meaning given such term in section 431(6) of the

20 Health Care Quality Improvement Act of 1986

21 (Public Law 99–660; 42 U.S.C. 11151(6)).
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1 SEC. 5. EFFECTIVE DATE.

2 The provisions of section 2 shall apply to all health

3 plans offered, sold, issued, or renewed after the date of

4 the enactment of this Act.

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