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104TH CONGRESS

1ST SESSION H. R. 1955

To amend title I of the Employee Retirement Income Security Act of 1974

to provide for certain minimum requirements for group health plans

with respect to obstetrical benefits.

IN THE HOUSE OF REPRESENTATIVES

JUNE 29, 1995

Mr. DEFAZIO (for himself, Mr. MILLER of California, Mr. SANDERS, Mr.

WAXMAN, Mr. MCDERMOTT, Mr. DELLUMS, Mr. OWENS, Ms. NORTON,

Ms. PELOSI, Mr. STARK, Mr. FRAZER, Mr. BORSKI, Mr. SERRANO, Mr.

MATSUI, Mr. OBERSTAR, Mr. TORRICELLI, Mr. DURBIN, Mr. LIPINSKI,

Mr. EVANS, Mr. ABERCROMBIE, Ms. SLAUGHTER, Ms. WOOLSEY, and

Ms. FURSE) introduced the following bill; which was referred to the Committee on Economic and Educational Opportunities

A BILL

To amend title I of the Employee Retirement Income Security Act of 1974 to provide for certain minimum requirements for group health plans with respect to obstetrical

benefits.

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-Infant Health

5 Protection Act of 1995’’.
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1 SEC. 2. GROUP HEALTH PLAN REQUIREMENT.

2 Section 609 of the Employee Retirement Income Se3 curity Act of 1974 (29 U.S.C. 1169) is amended—

4 (1) by redesignating subsection (e) as sub5 section (f); and

6 (2) by inserting after subsection (d) the follow7 ing new subsection:

8 ‘‘(e) REQUIREMENTS RELATING TO OBSTETRICAL

9 BENEFITS.—

10 ‘‘(1) IN GENERAL.—A group health plan which

11 provides obstetrical benefits shall provide coverage

12 for at least—

13 ‘‘(A) 48 hours of inpatient care following a

14 vaginal delivery, and

15 ‘‘(B) 96 hours of inpatient care following

16 a delivery by caesarean section,

17 for the mother and her newborn child in a licensed

18 hospital.

19 ‘‘(2) EXCEPTION IF CERTAIN POST-DELIVERY

20 CARE IS PROVIDED.—

21 ‘‘(A) IN GENERAL.—Paragraph (1) shall

22 not apply if the plan provides coverage for post23 delivery care which satisfies subparagraph (B).

24 ‘‘(B) REQUIREMENTS.—In order to satisfy

25 this subparagraph, under the terms of the plan

26 providing for coverage for post-delivery care—
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1 ‘‘(i) Discharge of the mother and new2 born child may not be required unless they

3 meet the medical criteria for discharge as

4 enumerated in the Guidelines for Perinatal

5 Care, as last issued before January 1,

6 1996 (or such later date as may be pro7 vided in regulations of the Secretary), by

8 the American Academy of Pediatrics and

9 the American College of Obstetricians and

10 Gynecologists.

11 ‘‘(ii) Discharge of the newborn child

12 may not be required before opportunity for

13 appropriate screenings, including PKU,

14 has been provided. If the screening for

15 PKU is done prior to 24 hours after birth,

16 the plan must provide opportunity for a

17 second home visit for PKU screening with18 in two days after discharge.

19 ‘‘(iii) Discharge must not be before 24

20 hours of milk feeding.

21 ‘‘(iv) The mother and newborn child

22 must be allowed at least one overnight

23 stay.

24 ‘‘(v) Appropriate management of the

25 mother and newborn child must be estab-
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1 lished in advance of discharge, including

2 home visits by qualified health profes3 sionals, office visits, hospital stay, or any

4 combination thereof, including a home visit

5 with 24 hours after discharge.

6 ‘‘(vi) Discharge of the mother or new7 born child may not be required without a

8 link to a continuing care provider.’’.

9 SEC. 3. EFFECTIVE DATE.

10 The amendment made by section 2 shall apply with

11 respect to plan years beginning at least 6 months after

12 the date of the enactment of this Act.

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