Calendar No. 505

104TH CONGRESS

2D SESSION S. 969

[Report No. 104–326]

A BILL

To require that health plans provide coverage for a

purposes.following the birth of the child, and for otherminimum hospital stay for a mother and child

JULY 19, 1996

Reported with an amendment
II

Calendar No. 505

104TH CONGRESS

2D SESSION S. 969

[Report No. 104–326]

To require that health plans provide coverage for a minimum hospital stay

for a mother and child following the birth of the child, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 27 (legislative day, JUNE 19), 1995

Mr. BRADLEY (for himself, Mrs. KASSEBAUM, Mr. ROCKEFELLER, Mrs.

BOXER, Ms. MIKULSKI, Mrs. MURRAY, Mr. DEWINE, Mr. REID, Mr.

PELL, Mr. KENNEDY, Mr. SARBANES, Mr. SIMON, Mr. WELLSTONE, Mr.

KERREY, Ms. MOSELEY-BRAUN, Mr. BRYAN, Mr. FORD, Mr. LAUTENBERG, Mr. INOUYE, Mr. CAMPBELL, Mr. MCCONNELL, Mr. LEVIN, Mr.

GRASSLEY, Mr. HELMS, Mr. DOMENICI, Mr. KERRY, Ms. SNOWE, Mr.

SIMPSON, Mr. LEAHY, Mr. GLENN, Mr. STEVENS, Mr. ROBB, Mrs. FEINSTEIN, Mr. FRIST, Mr. BIDEN, Mr. GRAMS, Mr. D’AMATO, Mr. KOHL,

Mrs. HUTCHISON, Mr. GRAHAM, and Mr. WARNER) introduced the following bill; which was read twice and referred to the Committee on Labor

and Human Resources

JULY 19, 1996

Reported by Mrs. KASSEBAUM, with an amendment

[Strike out all after the enacting clause and insert the part printed in italic]

A BILL

To require that health plans provide coverage for a minimum

hospital stay for a mother and child following the birth

of the child, and for other purposes.
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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 ‘‘Newborns’ and Moth5 ers’ Health Protection Act of 1996’’.

6 SEC. 2. FINDING.

7 Congress finds that—

8 (1) the length of post-delivery inpatient care

9 should be based on the unique characteristics of

10 each mother and her newborn child, taking into con11 sideration the health of the mother, the health and

12 stability of the infant, the ability and confidence of

13 the mother to care for her infant, the adequacy of

14 support systems at home, and the access of the

15 mother and infant to appropriate follow-up health

16 care; and

17 (2) the timing of the discharge of a mother and

18 her newborn child from the hospital should be made

19 by the attending provider in consultation with the

20 mother.

21 SEC. 3. REQUIRED COVERAGE FOR MINIMUM HOSPITAL

22 STAY FOLLOWING BIRTH.

23 (a) IN GENERAL.—Except as provided in subsection

24 (b), a health plan or an employee health benefit plan that

25 provides maternity benefits, including benefits for child-
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1 birth, shall ensure that coverage is provided with respect

2 to a mother who is a participant, beneficiary, or policy3 holder under such plan and her newborn child for a mini4 mum of 48 hours of in-patient care following a normal

5 vaginal delivery, and a minimum of 96 hours of in-patient

6 care following a caesarean section, without requiring the

7 attending provider to obtain authorization from the health

8 plan or employee health benefit plan in order to keep a

9 mother and her newborn child in the inpatient setting for

10 such period of time.

11 (b) EXCEPTION.—Notwithstanding subsection (a), a

12 health plan or an employee health benefit plan shall not

13 be required to provide coverage for post-delivery in-patient

14 care for a mother who is a participant, beneficiary, or pol15 icyholder under such plan and her newborn child during

16 the period referred to in subsection (a) if—

17 (1) a decision to discharge the mother and her

18 newborn child prior to the expiration of such period

19 is made by the attending provider in consultation

20 with the mother; and

21 (2) the health plan or employee health benefit

22 plan provides coverage for post-delivery follow-up

23 care as described in section 4.
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1 SEC. 4. POST-DELIVERY FOLLOW-UP CARE.

2 (a) IN GENERAL.—In the case of a decision to dis3 charge a mother and her newborn child from the inpatient

4 setting prior to the expiration of 48 hours in the case of

5 a normal vaginal delivery or 96 hours in the case of a

6 caesarean section, the health plan or employee health ben7 efit plan shall provide coverage for timely post-delivery

8 care. Such health care shall be provided to a mother and

9 her newborn child by a registered nurse, physician, nurse

10 practitioner, nurse midwife or physician assistant experi11 enced in maternal and child health in—

12 (1) the home, a provider’s office, a hospital, a

13 federally qualified health center, a federally qualified

14 rural health clinic, or a State health department ma15 ternity clinic; or

16 (2) another setting determined appropriate

17 under regulations promulgated by the Secretary, in

18 consultation with the Secretary of Health and

19 Human Services, (including a birthing center or an

20 intermediate care facility);

21 except that such coverage shall ensure that the mother has

22 the option to be provided with such care in the home.

23 (b) TIMELY CARE.—As used in subsection (a), the

24 term ‘‘timely post-delivery care’’ means health care that

25 is provided—
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1 (1) following the discharge of a mother and her

2 newborn child from the inpatient setting; and

3 (2) in a manner that meets the health care

4 needs of the mother and her newborn child, that

5 provides for the appropriate monitoring of the condi6 tions of the mother and child, and that occurs within

7 the 24- to 72-hour period immediately following dis8 charge.

9 (c) CONSISTENCY WITH STATE LAW.—The Secretary

10 shall, with respect to regulations promulgated under sub11 section (a) concerning appropriate post-delivery care set12 tings, ensure that, to the extent practicable, such regula13 tions are consistent with State licensing and practice laws.

14 SEC. 5. PROHIBITIONS.

15 (a) TERMS AND CONDITIONS.—In implementing the

16 requirements of this Act, a health plan or an employee

17 health benefit plan may not—

18 (1) deny enrollment, renewal, or continued cov19 erage to a mother and her newborn child who are

20 participants, beneficiaries or policyholders based on

21 compliance with this Act;

22 (2) provide monetary incentives to mothers to

23 encourage such mothers to request less than the

24 minimum coverage required under this Act; or
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1 (3) provide incentives (monetary or otherwise)

2 to an attending provider to induce such provider to

3 provide treatment in a manner inconsistent with this

4 Act.

5 (b) PROVIDERS.—In implementing the requirements

6 of this section, a health plan or an employee health benefit

7 plan may not penalize or otherwise reduce or limit the re8 imbursement of an attending provider because such pro9 vider provided treatment in accordance with this Act.

10 (c) RULE OF CONSTRUCTION.—Nothing in this Act

11 shall be construed to require that a mother who is a par12 ticipant, beneficiary, or policyholder covered under this

13 Act—

14 (1) give birth in a hospital; or

15 (2) stay in the hospital for a fixed period of

16 time following the birth of her child.

17 SEC. 6. NOTICE.

18 (a) EMPLOYEE HEALTH BENEFIT PLAN.—An em19 ployee health benefit plan shall provide notice to each par20 ticipant regarding coverage required under this Act in ac21 cordance with regulations promulgated by the Secretary.

22 (b) HEALTH PLAN.—A health plan shall provide no23 tice to each policyholder regarding coverage required

24 under this Act.
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1 (c) REQUIREMENTS.—Notice required under this sec2 tion shall be in writing, prominently positioned in, and be

3 transmitted—

4 (1) in a mailing made within 120 days of the

5 date of enactment of this Act by such plan to the

6 participant or policyholder; and

7 (2) as part of the annual informational packet

8 sent to the participant or policyholder.

9 SEC. 7. APPLICABILITY.

10 (a) CONSTRUCTION.—

11 (1) IN GENERAL.—A requirement or standard

12 imposed under this Act on a health plan shall be

13 deemed to be a requirement or standard imposed on

14 the health plan issuer. Such requirements or stand15 ards shall be enforced by the State insurance com16 missioner for the State involved or the official or of17 ficials designated by the State to enforce the re18 quirements of this Act. In the case of a health plan

19 offered by a health plan issuer in connection with an

20 employee health benefit plan, the requirements or

21 standards imposed under this Act shall be enforced

22 with respect to the health plan issuer by the State

23 insurance commissioner for the State involved or the

24 official or officials designated by the State to enforce

25 the requirements of this Act.
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1 (2) LIMITATION.—Except as provided in section

2 8(c), the Secretary shall not enforce the require3 ments or standards of this Act as they relate to

4 health plan issuers or health plans. In no case shall

5 a State enforce the requirements or standards of

6 this Act as they relate to employee health benefit

7 plans.

8 (b) RULE OF CONSTRUCTION.—Nothing in this Act

9 shall be construed to affect or modify the provisions of

10 section 514 of the Employee Retirement Income Security

11 Act of 1974 (29 U.S.C. 1144).

12 SEC. 8. ENFORCEMENT.

13 (a) HEALTH PLAN ISSUERS.—Each State shall re14 quire that each health plan issued, sold, renewed, offered

15 for sale or operated in such State by a health plan issuer

16 meet the standards established under this Act. A State

17 shall submit such information as required by the Secretary

18 demonstrating effective implementation of the require19 ments of this Act.

20 (b) EMPLOYEE HEALTH BENEFIT PLANS.—With re21 spect to employee health benefit plans, the standards es22 tablished under this Act shall be enforced in the same

23 manner as provided for under sections 502, 504, 506, and

24 510 of the Employee Retirement Income Security Act of

25 1974 (29 U.S.C. 1132, 1134, 1136, and 1140). The civil
9

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1 penalties contained in paragraphs (1) and (2) of section

2 502(c) of such Act (29 U.S.C. 1132(c) (1) and (2)) shall

3 apply to any information required by the Secretary to be

4 disclosed and reported under this section.

5 (c) FAILURE TO ENFORCE.—In the case of the fail6 ure of a State to substantially enforce the standards and

7 requirements set forth in this Act with respect to health

8 plans, the Secretary, in consultation with the Secretary

9 of Health and Human Services, shall enforce the stand10 ards of this Act in such State. In the case of a State that

11 fails to substantially enforce the standards set forth in this

12 Act, each health plan issuer operating in such State shall

13 be subject to civil enforcement as provided for under sec14 tions 502, 504, 506, and 510 of the Employee Retirement

15 Income Security Act of 1974 (29 U.S.C. 1132, 1134,

16 1136, and 1140). The civil penalties contained in para17 graphs (1) and (2) of section 502(c) of such Act (29

18 U.S.C. 1132(c) (1) and (2)) shall apply to any information

19 required by the Secretary to be disclosed and reported

20 under this section.

21 (d) REGULATIONS.—The Secretary, in consultation

22 with the Secretary of Health and Human Services, may

23 promulgate such regulations as may be necessary or ap24 propriate to carry out this Act.
10

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1 SEC. 9. DEFINITIONS.

2 As used in this Act:

3 (1) ATTENDING PROVIDER.—The term ‘‘attend4 ing provider’’ shall include the obstetrician-gyne5 cologists, pediatrician, family physician, or other

6 physician attending the mother or newly born child.

7 Such term shall also include any other health care

8 provider who, in accordance with applicable State

9 law, may be primarily responsible for the care of a

10 mother and her newborn child (including nurse mid11 wives and nurse practitioners).

12 (2) BENEFICIARY.—The term ‘‘beneficiary’’ has

13 the meaning given such term under section 3(8) of

14 the Employee Retirement Income Security Act of

15 1974 (29 U.S.C. 1002(8)).

16 (3) EMPLOYEE HEALTH BENEFIT PLAN.—

17 (A) IN GENERAL.—The term ‘‘employee

18 health benefit plan’’ means any employee wel19 fare benefit plan, governmental plan, or church

20 plan (as defined under paragraphs (1), (32),

21 and (33) of section 3 of the Employee Retire22 ment Income Security Act of 1974 (29 U.S.C.

23 1002 (1), (32), and (33))) that provides or pays

24 for health benefits (such as provider and hos25 pital benefits) for participants and beneficiaries

26 whether—
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1 (i) directly;

2 (ii) through a health plan offered by

3 a health plan issuer as defined in para4 graph (4); or

5 (iii) otherwise.

6 (B) RULE OF CONSTRUCTION.—An em7 ployee health benefit plan shall not be con8 strued to be a health plan or a health plan is9 suer.

10 (C) ARRANGEMENTS NOT INCLUDED.—

11 Such term does not include the following, or

12 any combination thereof:

13 (i) Coverage only for accident, or dis14 ability income insurance, or any combina15 tion thereof.

16 (ii) Medicare supplemental health in17 surance (as defined under section

18 1882(g)(1) of the Social Security Act).

19 (iii) Coverage issued as a supplement

20 to liability insurance.

21 (iv) Liability insurance, including gen22 eral liability insurance and automobile li23 ability insurance.

24 (v) Workers compensation or similar

25 insurance.
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1 (vi) Automobile medical payment in2 surance.

3 (vii) Coverage for a specified disease

4 or illness.

5 (viii) Hospital or fixed indemnity in6 surance.

7 (ix) Short-term limited duration in8 surance.

9 (x) Credit-only, dental-only, or vision10 only insurance.

11 (xi) A health insurance policy provid12 ing benefits only for long-term care, nurs13 ing home care, home health care, commu14 nity-based care, or any combination there15 of.

16 (4) GROUP PURCHASER.—The term ‘‘group

17 purchaser’’ means any person (as defined under

18 paragraph (9) of section 3 of the Employee Retire19 ment Income Security Act of 1974 (29 U.S.C.

20 1002(9)) or entity that purchases or pays for health

21 benefits (such as provider or hospital benefits) on

22 behalf of participants or beneficiaries in connection

23 with an employee health benefit plan.

24 (5) HEALTH PLAN.—
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1 (A) IN GENERAL.—The term ‘‘health plan’’

2 means any group health plan or individual

3 health plan.

4 (B) GROUP HEALTH PLAN.—The term

5 ‘‘group health plan’’ means any contract, policy,

6 certificate or other arrangement offered by a

7 health plan issuer to a group purchaser that

8 provides or pays for health benefits (such as

9 provider and hospital benefits) in connection

10 with an employee health benefit plan.

11 (C) INDIVIDUAL HEALTH PLAN.—The term

12 ‘‘individual health plan’’ means any contract,

13 policy, certificate or other arrangement offered

14 to individuals by a health plan issuer that pro15 vides or pays for health benefits (such as pro16 vider and hospital benefits) and that is not a

17 group health plan.

18 (D) ARRANGEMENTS NOT INCLUDED.—

19 Such term does not include the following, or

20 any combination thereof:

21 (i) Coverage only for accident, or dis22 ability income insurance, or any combina23 tion thereof.
14

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1 (ii) Medicare supplemental health in2 surance (as defined under section

3 1882(g)(1) of the Social Security Act).

4 (iii) Coverage issued as a supplement

5 to liability insurance.

6 (iv) Liability insurance, including gen7 eral liability insurance and automobile li8 ability insurance.

9 (v) Workers compensation or similar

10 insurance.

11 (vi) Automobile medical payment in12 surance.

13 (vii) Coverage for a specified disease

14 or illness.

15 (viii) Hospital or fixed indemnity in16 surance.

17 (ix) Short-term limited duration in18 surance.

19 (x) Credit-only, dental-only, or vision20 only insurance.

21 (xi) A health insurance policy provid22 ing benefits only for long-term care, nurs23 ing home care, home health care, commu24 nity-based care, or any combination there25 of.
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1 (E) CERTAIN PLANS INCLUDED.—Such

2 term includes any plan or arrangement not de3 scribed in any clause of subparagraph (D)

4 which provides for benefit payments, on a peri5 odic basis, for—

6 (i) a specified disease or illness, or

7 (ii) a period of hospitalization,

8 without regard to the costs incurred or services

9 rendered during the period to which the pay10 ments relate.

11 (6) HEALTH PLAN ISSUER.—The term ‘‘health

12 plan issuer’’ means any entity that is licensed (prior

13 to or after the date of enactment of this Act) by a

14 State to offer a health plan.

15 (7) PARTICIPANT.—The term ‘‘participant’’ has

16 the meaning given such term under section 3(7) of

17 the Employee Retirement Income Security Act of

18 1974 (29 U.S.C. 1002(7)).

19 (8) SECRETARY.—The term ‘‘Secretary’’ unless

20 otherwise specified means the Secretary of Labor.

21 SEC. 10. PREEMPTION.

22 The provisions of this Act shall not preempt those

23 provisions of State law that require health plans to provide

24 a minimum of 48 hours of in-patient care in the case of

25 a normal vaginal delivery, and 96 hours of in-patient care
16

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1 in the case of a caesarean section, or that require health

2 plans to provide for maternity and pediatric care that is

3 in accordance with guidelines established by the American

4 College of Obstetricians and Gynecologists and the Amer5 ican Academy of Pediatrics, and to provide follow-up care

6 consistent with this Act.

7 SEC. 11. EFFECTIVE DATE.

8 Except as otherwise provided for in this Act, the pro9 visions of this Act shall apply as follows:

10 (1) With respect to health plans, such provi11 sions shall apply to plans offered, sold, issued, re12 newed, in effect, or operated on or after January 1,

13 1997.

14 (2) With respect to employee health benefit

15 plans, such provisions shall apply to such plans on

16 the first day of the first plan year beginning on or

17 after January 1, 1997.

18 SECTION 1. SHORT TITLE.

19 This Act may be cited as the ‘‘Newborns’ and Mothers’

20 Health Protection Act of 1996’’.

21 SEC. 2. FINDINGS.

22 Congress finds that—

23 (1) the length of post-delivery inpatient care

24 should be based on the unique characteristics of each

25 mother and her newborn child, taking into consider-
17

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1 ation the health of the mother, the health and stability

2 of the newborn, the ability and confidence of the

3 mother and father to care for the newborn, the ade4 quacy of support systems at home, and the access of

5 the mother and newborn to appropriate follow-up

6 health care; and

7 (2) the timing of the discharge of a mother and

8 her newborn child from the hospital should be made

9 by the attending provider in consultation with the

10 mother.

11 SEC. 3. REQUIRED COVERAGE FOR MINIMUM HOSPITAL

12 STAY FOLLOWING BIRTH.

13 (a) IN GENERAL.—Except as provided in subsection

14 (b), a health plan or an employee health benefit plan that

15 provides maternity benefits, including benefits for child16 birth, shall ensure that coverage is provided with respect

17 to a mother who is a participant, beneficiary, or policy18 holder under such plan and her newborn child for a mini19 mum of 48 hours of inpatient length of stay following a

20 normal vaginal delivery, and a minimum of 96 hours of

21 inpatient length of stay following a caesarean section, with22 out requiring the attending provider to obtain authoriza23 tion from the health plan or employee health benefit plan.

24 (b) EXCEPTION.—Notwithstanding subsection (a), a

25 health plan or an employee health benefit plan shall not
18

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1 be required to provide coverage for post-delivery inpatient

2 length of stay for a mother who is a participant, bene3 ficiary, or policyholder under such plan and her newborn

4 child for the period referred to in subsection (a) if—

5 (1) a decision to discharge the mother and her

6 newborn child prior to the expiration of such period

7 is made by the attending provider in consultation

8 with the mother; and

9 (2) the health plan or employee health benefit

10 plan provides coverage for post-delivery follow-up care

11 as described in section 4.

12 SEC. 4. POST-DELIVERY FOLLOW-UP CARE.

13 (a) IN GENERAL.—

14 (1) GENERAL RULE.—In the case of a decision to

15 discharge a mother and her newborn child from the

16 inpatient setting prior to the expiration of 48 hours

17 following a normal vaginal delivery or 96 hours fol18 lowing a caesarean section, the health plan or em19 ployee health benefit plan shall provide coverage for

20 timely post-delivery care. Such health care shall be

21 provided to a mother and her newborn child by a reg22 istered nurse, physician, nurse practitioner, nurse

23 midwife or physician assistant experienced in mater24 nal and child health in—
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1 (A) the home, a provider’s office, a hospital,

2 a birthing center, an intermediate care facility,

3 a federally qualified health center, a federally

4 qualified rural health clinic, or a State health

5 department maternity clinic; or

6 (B) another setting determined appropriate

7 under regulations promulgated by the Secretary,

8 in consultation with the Secretary of Health and

9 Human Services;

10 except that such coverage shall ensure that the mother

11 has the option to be provided with such care in the

12 home.

13 (2) CONSIDERATIONS BY SECRETARY.—In pro14 mulgating regulations under paragraph (1)(B), the

15 Secretary shall consider telemedicine and other inno16 vative means to provide follow-up care and shall con17 sider care in both urban and rural settings.

18 (b) TIMELY CARE.—As used in subsection (a), the term

19 ‘‘timely post-delivery care’’ means health care that is pro20 vided—

21 (1) following the discharge of a mother and her

22 newborn child from the inpatient setting; and

23 (2) in a manner that meets the health care needs

24 of the mother and her newborn child, that provides for

25 the appropriate monitoring of the conditions of the
20

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1 mother and child, and that occurs not later than the

2 72-hour period immediately following discharge.

3 (c) CONSISTENCY WITH STATE LAW.—The Secretary

4 shall, with respect to regulations promulgated under sub5 section (a) concerning appropriate post-delivery care set6 tings, ensure that, to the extent practicable, such regulations

7 are consistent with State licensing and practice laws.

8 SEC. 5. PROHIBITIONS.

9 In implementing the requirements of this Act, a health

10 plan or an employee health benefit plan may not—

11 (1) deny enrollment, renewal, or continued cov12 erage to a mother and her newborn child who are

13 participants, beneficiaries or policyholders based on

14 compliance with this Act;

15 (2) provide monetary payments or rebates to

16 mothers to encourage such mothers to request less than

17 the minimum coverage required under this Act;

18 (3) penalize or otherwise reduce or limit the re19 imbursement of an attending provider because such

20 provider provided treatment in accordance with this

21 Act; or

22 (4) provide incentives (monetary or otherwise) to

23 an attending provider to induce such provider to pro24 vide treatment to an individual policyholder, partici-
21

•S 969 RS

1 pant, or beneficiary in a manner inconsistent with

2 this Act.

3 SEC. 6. NOTICE.

4 (a) EMPLOYEE HEALTH BENEFIT PLAN.—An em5 ployee health benefit plan shall provide conspicuous notice

6 to each participant regarding coverage required under this

7 Act not later than 120 days after the date of enactment

8 of this Act, and as part of its summary plan description.

9 (b) HEALTH PLAN.—A health plan shall provide notice

10 to each policyholder regarding coverage required under this

11 Act. Such notice shall be in writing, prominently posi12 tioned, and be transmitted—

13 (1) in a mailing made within 120 days of the

14 date of enactment of this Act by such plan to the pol15 icyholder; and

16 (2) as part of the annual informational packet

17 sent to the policyholder.

18 SEC. 7. APPLICABILITY.

19 (a) CONSTRUCTION.—

20 (1) IN GENERAL.—A requirement or standard

21 imposed under this Act on a health plan shall be

22 deemed to be a requirement or standard imposed on

23 the health plan issuer. Such requirements or stand24 ards shall be enforced by the State insurance commis25 sioner for the State involved or the official or officials
22

•S 969 RS

1 designated by the State to enforce the requirements of

2 this Act. In the case of a health plan offered by a

3 health plan issuer in connection with an employee

4 health benefit plan, the requirements or standards im5 posed under this Act shall be enforced with respect to

6 the health plan issuer by the State insurance commis7 sioner for the State involved or the official or officials

8 designated by the State to enforce the requirements of

9 this Act.

10 (2) LIMITATION.—Except as provided in section

11 8(c), the Secretary shall not enforce the requirements

12 or standards of this Act as they relate to health plan

13 issuers or health plans. In no case shall a State en14 force the requirements or standards of this Act as they

15 relate to employee health benefit plans.

16 (b) RULE OF CONSTRUCTION.—Nothing in this Act

17 shall be construed to affect or modify the provisions of sec18 tion 514 of the Employee Retirement Income Security Act

19 of 1974 (29 U.S.C. 1144).

20 (c) RULE OF CONSTRUCTION.—Nothing in this Act

21 shall be construed to require that a mother who is a partici22 pant, beneficiary, or policyholder covered under this Act—

23 (1) give birth in a hospital; or

24 (2) stay in the hospital for a fixed period of time

25 following the birth of her child.
23

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1 SEC. 8. ENFORCEMENT.

2 (a) HEALTH PLAN ISSUERS.—Each State shall require

3 that each health plan issued, sold, renewed, offered for sale

4 or operated in such State by a health plan issuer meet the

5 standards established under this Act. A State shall submit

6 such information as required by the Secretary demonstrat7 ing effective implementation of the requirements of this Act.

8 (b) EMPLOYEE HEALTH BENEFIT PLANS.—With re9 spect to employee health benefit plans, the standards estab10 lished under this Act shall be enforced in the same manner

11 as provided for under sections 502, 504, 506, and 510 of

12 the Employee Retirement Income Security Act of 1974 (29

13 U.S.C. 1132, 1134, 1136, and 1140). The civil penalties

14 contained in paragraphs (1) and (2) of section 502(c) of

15 such Act (29 U.S.C. 1132(c)(1) and (2)) shall apply to any

16 information required by the Secretary to be disclosed and

17 reported under this section.

18 (c) FAILURE TO ENFORCE.—In the case of the failure

19 of a State to substantially enforce the standards and re20 quirements set forth in this Act with respect to health plans,

21 the Secretary, in consultation with the Secretary of Health

22 and Human Services, shall enforce the standards of this Act

23 in such State. In the case of a State that fails to substan24 tially enforce the standards set forth in this Act, each health

25 plan issuer operating in such State shall be subject to civil

26 enforcement as provided for under sections 502, 504, 506,
24

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1 and 510 of the Employee Retirement Income Security Act

2 of 1974 (29 U.S.C. 1132, 1134, 1136, and 1140). The civil

3 penalties contained in paragraphs (1) and (2) of section

4 502(c) of such Act (29 U.S.C. 1132(c)(1) and (2)) shall

5 apply to any information required by the Secretary to be

6 disclosed and reported under this section.

7 (d) REGULATIONS.—The Secretary, in consultation

8 with the Secretary of Health and Human Services, may

9 promulgate such regulations as may be necessary or appro10 priate to carry out this Act.

11 SEC. 9. DEFINITIONS.

12 As used in this Act:

13 (1) ATTENDING PROVIDER.—The term ‘‘attend14 ing provider’’ shall include—

15 (A) the obstetrician-gynecologists, pediatri16 cians, family physicians, and other physicians

17 primarily responsible for the care of a mother

18 and newborn; and

19 (B) the nurse midwives and nurse practi20 tioners primarily responsible for the care of a

21 mother and her newborn child in accordance

22 withg State licensure and certification laws.

23 (2) BENEFICIARY.—The term ‘‘beneficiary’’ has

24 the meaning given such term under section 3(8) of the
25

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1 Employee Retirement Income Security Act of 1974

2 (29 U.S.C. 1002(8)).

3 (3) EMPLOYEE HEALTH BENEFIT PLAN.—

4 (A) IN GENERAL.—The term ‘‘employee

5 health benefit plan’’ means any employee welfare

6 benefit plan, governmental plan, or church plan

7 (as defined under paragraphs (1), (32), and (33)

8 of section 3 of the Employee Retirement Income

9 Security Act of 1974 (29 U.S.C. 1002 (1), (32),

10 and (33))) that provides or pays for health bene11 fits (such as provider and hospital benefits) for

12 participants and beneficiaries whether—

13 (i) directly;

14 (ii) through a health plan offered by a

15 health plan issuer as defined in paragraph

16 (4); or

17 (iii) otherwise.

18 (B) RULE OF CONSTRUCTION.—An em19 ployee health benefit plan shall not be construed

20 to be a health plan or a health plan issuer.

21 (C) ARRANGEMENTS NOT INCLUDED.—Such

22 term does not include the following, or any com23 bination thereof:
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1 (i) Coverage only for accident, or dis2 ability income insurance, or any combina3 tion thereof.

4 (ii) Medicare supplemental health in5 surance (as defined under section

6 1882(g)(1) of the Social Security Act).

7 (iii) Coverage issued as a supplement

8 to liability insurance.

9 (iv) Liability insurance, including

10 general liability insurance and automobile

11 liability insurance.

12 (v) Workers compensation or similar

13 insurance.

14 (vi) Automobile medical payment in15 surance.

16 (vii) Coverage for a specified disease or

17 illness.

18 (viii) Hospital or fixed indemnity in19 surance.

20 (ix) Short-term limited duration insur21 ance.

22 (x) Credit-only, dental-only, or vision23 only insurance.

24 (xi) A health insurance policy provid25 ing benefits only for long-term care, nursing
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1 home care, home health care, community2 based care, or any combination thereof.

3 (4) GROUP PURCHASER.—The term ‘‘group pur4 chaser’’ means any person (as defined under para5 graph (9) of section 3 of the Employee Retirement In6 come Security Act of 1974 (29 U.S.C. 1002(9)) or en7 tity that purchases or pays for health benefits (such

8 as provider or hospital benefits) on behalf of partici9 pants or beneficiaries in connection with an employee

10 health benefit plan.

11 (5) HEALTH PLAN.—

12 (A) IN GENERAL.—The term ‘‘health plan’’

13 means any group health plan or individual

14 health plan.

15 (B) GROUP HEALTH PLAN.—The term

16 ‘‘group health plan’’ means any contract, policy,

17 certificate or other arrangement offered by a

18 health plan issuer to a group purchaser that pro19 vides or pays for health benefits (such as pro20 vider and hospital benefits) in connection with

21 an employee health benefit plan.

22 (C) INDIVIDUAL HEALTH PLAN.—The term

23 ‘‘individual health plan’’ means any contract,

24 policy, certificate or other arrangement offered to

25 individuals by a health plan issuer that provides
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1 or pays for health benefits (such as provider and

2 hospital benefits) and that is not a group health

3 plan.

4 (D) ARRANGEMENTS NOT INCLUDED.—Such

5 term does not include the following, or any com6 bination thereof:

7 (i) Coverage only for accident, or dis8 ability income insurance, or any combina9 tion thereof.

10 (ii) Medicare supplemental health in11 surance (as defined under section

12 1882(g)(1) of the Social Security Act).

13 (iii) Coverage issued as a supplement

14 to liability insurance.

15 (iv) Liability insurance, including

16 general liability insurance and automobile

17 liability insurance.

18 (v) Workers compensation or similar

19 insurance.

20 (vi) Automobile medical payment in21 surance.

22 (vii) Coverage for a specified disease or

23 illness.

24 (viii) Hospital or fixed indemnity in25 surance.
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1 (ix) Short-term limited duration insur2 ance.

3 (x) Credit-only, dental-only, or vision4 only insurance.

5 (xi) A health insurance policy provid6 ing benefits only for long-term care, nursing

7 home care, home health care, community8 based care, or any combination thereof.

9 (E) CERTAIN PLANS INCLUDED.—Such term

10 includes any plan or arrangement not described

11 in any clause of subparagraph (D) which pro12 vides for benefit payments, on a periodic basis,

13 for—

14 (i) a specified disease or illness, or

15 (ii) a period of hospitalization,

16 without regard to the costs incurred or services

17 rendered during the period to which the pay18 ments relate.

19 (6) HEALTH PLAN ISSUER.—The term ‘‘health

20 plan issuer’’ means any entity that is licensed (prior

21 to or after the date of enactment of this Act) by a

22 State to offer a health plan.

23 (7) PARTICIPANT.—The term ‘‘participant’’ has

24 the meaning given such term under section 3(7) of the
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1 Employee Retirement Income Security Act of 1974

2 (29 U.S.C. 1002(7)).

3 (8) SECRETARY.—The term ‘‘Secretary’’ unless

4 otherwise specified means the Secretary of Labor.

5 SEC. 10. PREEMPTION.

6 (a) IN GENERAL.—The provisions of sections 3, 5, and

7 6 relating to inpatient care shall not preempt a State law

8 or regulation—

9 (1) that provides greater protections to patients

10 or policyholders than those required in this Act;

11 (2) that requires health plans to provide coverage

12 for at least 48 hours of inpatient length of stay fol13 lowing a normal vaginal delivery, and at least 96

14 hours of inpatient length of stay following a caesar15 ean section;

16 (3) that requires health plans to provide coverage

17 for maternity and pediatric care in accordance with

18 guidelines established by the American College of Ob19 stetricians and Gynecologists, the American Academy

20 of Pediatrics, or other established professional medical

21 associations; or

22 (4) that leaves decisions regarding appropriate

23 length of stay entirely to the attending provider, in

24 consultation with the mother.
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1 (b) FOLLOW-UP CARE.—The provisions of section 4 re2 lating to follow-up care shall not preempt those provisions

3 of State law or regulation that provide greater protection

4 to patients or policyholders than those required under this

5 Act or that provide mothers and newborns with an option

6 of timely post delivery follow-up care (as defined in section

7 4(b)) in the home.

8 (c) EMPLOYEE HEALTH BENEFIT PLANS.—Nothing in

9 this section affects the application of this Act to employee

10 health benefit plans, as defined in section 9(3).

11 SEC. 11. REPORTS TO CONGRESS CONCERNING CHILD12 BIRTH.

13 (a) FINDINGS.—Congress finds that—

14 (1) childbirth is one part of a continuum of ex15 perience that includes prepregnancy, pregnancy and

16 prenatal care, labor and delivery, the immediate

17 postpartum period, and a longer period of adjustment

18 for the newborn, the mother, and the family;

19 (2) health care practices across this continuum

20 are changing in response to health care financing and

21 delivery system changes, science and clinical research,

22 and patient preferences; and

23 (3) there is a need to—
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1 (A) examine the issues and consequences as2 sociated with the length of hospital stays follow3 ing childbirth;

4 (B) examine the follow-up practices for

5 mothers and newborns used in conjunction with

6 shorter hospital stays;

7 (C) identify appropriate health care prac8 tices and procedures with regard to the hospital

9 discharge of newborns and mothers;

10 (D) examine the extent to which such care

11 is affected by family and environmental factors;

12 and

13 (E) examine the content of care during hos14 pital stays following childbirth.

15 (b) ADVISORY PANEL.—

16 (1) IN GENERAL.—Not later than 90 days after

17 the date of enactment of this Act, the Secretary of

18 Health and Human Services shall establish an advi19 sory panel (hereafter referred to in this section as the

20 ‘‘advisory panel’’) to—

21 (A) guide and review methods, procedures,

22 and data collection necessary to conduct the

23 study described in subsection (c) that is intended

24 to enhance the quality, safety, and effectiveness
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1 of health care services provided to mothers and

2 newborns;

3 (B) develop a consensus among the members

4 of the advisory panel regarding the appropriate5 ness of the specific requirements of this Act; and

6 (C) prepare and submit to the Secretary of

7 Health and Human Services, as part of the re8 port of the Secretary submitted under subsection

9 (d), a report summarizing the consensus devel10 oped under subparagraph (B) if any, including

11 the reasons for not reaching such a consensus.

12 (2) PARTICIPATION.—

13 (A) DEPARTMENT REPRESENTATIVES.—The

14 Secretary of Health and Human Services shall

15 ensure that representatives from within the De16 partment of Health and Human Services that

17 have expertise in the area of maternal and child

18 health or in outcomes research are appointed to

19 the advisory panel established under paragraph

20 (1).

21 (B) REPRESENTATIVES OF PUBLIC AND PRI22 VATE SECTOR ENTITIES.—

23 (i) IN GENERAL.—The Secretary of

24 Health and Human Services shall ensure

25 that members of the advisory panel include
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1 representatives of public and private sector

2 entities having knowledge or experience in

3 one or more of the following areas:

4 (I) Patient care.

5 (II) Patient education.

6 (III) Quality assurance.

7 (IV) Outcomes research.

8 (V) Consumer issues.

9 (ii) REQUIREMENT.—The panel shall

10 include representatives from each of the fol11 lowing categories:

12 (I) Health care practitioners.

13 (II) Health plans.

14 (III) Hospitals.

15 (IV) Employers.

16 (V) States.

17 (VI) Consumers.

18 (c) STUDIES.—

19 (1) IN GENERAL.—The Secretary of Health and

20 Human Services shall conduct a study of—

21 (A) the factors affecting the continuum of

22 care with respect to maternal and child health

23 care, including outcomes following childbirth;

24 (B) the factors determining the length of

25 hospital stay following childbirth;
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1 (C) the diversity of negative or positive out2 comes affecting mothers, infants, and families;

3 (D) the manner in which post natal care

4 has changed over time and the manner in which

5 that care has adapted or related to changes in

6 the length of hospital stay, taking into account—

7 (i) the types of post natal care avail8 able and the extent to which such care is

9 accessed; and

10 (ii) the challenges associated with pro11 viding post natal care to all populations,

12 including vulnerable populations, and solu13 tions for overcoming these challenges; and

14 (E) the financial incentives that may—

15 (i) impact the health of newborns and

16 mothers; and

17 (ii) influence the clinical decisionmak18 ing of health care providers.

19 (2) RESOURCES.—The Secretary of Health and

20 Human Services shall provide to the advisory panel

21 the resources necessary to carry out the duties of the

22 advisory panel.

23 (d) REPORTS.—

24 (1) IN GENERAL.—The Secretary of Health and

25 Human Services shall prepare and submit to the
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1 Committee on Labor and Human Resources of the

2 Senate and the Committee on Commerce of the House

3 of Representatives a report that contains—

4 (A) a summary of the study conducted

5 under subsection (c);

6 (B) a summary of the best practices used in

7 the public and private sectors for the care of

8 newborns and mothers;

9 (C) recommendations for improvements in

10 prenatal care, post natal care, delivery and fol11 low-up care, and whether the implementation of

12 such improvements should be accomplished by

13 the private health care sector, Federal or State

14 governments, or any combination thereof; and

15 (D) limitations on the databases in exist16 ence on the date of enactment of this Act.

17 (2) SUBMISSION OF REPORTS.—The Secretary of

18 Health and Human Services shall prepare and sub19 mit to the Committees referred to in paragraph (1)—

20 (A) an initial report concerning the study

21 conducted under subsection (c) and the report re22 quired under subsection (d), not later than 18

23 months after the date of enactment of this Act;
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1 (B) an interim report concerning such

2 study and report not later than 3 years after the

3 date of enactment of this Act; and

4 (C) a final report concerning such study

5 and report not later than 5 years after the date

6 of enactment of this Act.

7 (e) TERMINATION OF PANEL.—The advisory panel

8 shall terminate on the date that occurs 60 days after the

9 date on which the last report is submitted under this sec10 tion.

11 SEC. 12. EFFECTIVE DATE.

12 Except as otherwise provided for in this Act, the provi13 sions of this Act shall apply as follows:

14 (1) With respect to health plans, such provisions

15 shall apply to such plans on the first day of the con16 tract year beginning on or after January 1, 1997.

17 (2) With respect to employee health benefit plans,

18 such provisions shall apply to such plans on the first

19 day of the first plan year beginning on or after Janu20 ary 1, 1997.