I
104TH CONGRESS
1ST SESSION
H. R. 1970
To require that health plans provide coverage for minimum period of time
for a mother and child following the birth of the child.
IN THE HOUSE OF REPRESENTATIVES
JUNE 29, 1995
Mr. TORRICELLI (for himself, Mr. NADLER, Mr. SANDERS, Mr. DEFAZIO, and
Mr. PALLONE) introduced the following bill; which was referred to the
Committee on Commerce
A BILL
To require that health plans provide coverage for minimum
period of time for a mother and child following the
birth of the child.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Mothers’ and Infants’
Good Health Act of 1995’’.
SEC. 2. REQUIRED COVERAGE FOR CHILD BIRTH.
(a) IN GENERAL.—A health plan that provides ma-
ternity benefits that include benefits for child birth shall
ensure that—
(1) in the case of delivery in a hospital or other
inpatient setting, coverage is provided for a mini-
mum of 48 hours of inpatient care following a vagi-
nal delivery and a minimum of 96 hours of inpatient
care following a caesarean section for a mother and
her newly born child in a health care facility; and
(2) in the case of delivery in the home or other
outpatient setting, coverage for appropriate home
health care in the setting is provided for a minimum
of 48 hours following delivery.
(b) TERMS OF COVERAGE.—A health plan fails to
provide coverage required under subsection (a) if the plan
imposes cost-sharing with respect to care described in such
subsection which varies depending on the length of stay
within the minimum period required under such sub-
section.
(c) PROHIBITION.—In implementing the require-
ments of this section, a health plan may not modify the
terms and conditions of coverage based on the determina-
tion by an enrollee to request less than the minimum cov-
erage required under subsection (a).
(d) NOTICE.—A health plan shall provide notice to
each enrollee under such plan regarding the coverage re-
quired by this section in accordance with regulations pro-
mulgated by the Secretary of Health and Human Services,
in consultation with the National Association of Insurance
Commissioners. Such notice shall be in writing and promi-
nently positioned in any literature or correspondence made
available or distributed by the health plan and shall be
transmitted—
(1) in the next mailing of general information
made by the plan to the enrollee,
(2) as part of the yearly informational packet
sent to the enrollee, or
(3) not later than January 1, 1996,
whichever is earliest.
(e) ENFORCEMENT.—
(1) FAILURE
TO
PROVIDE
COVERAGE.—Any
health plan that violates the provisions of this sec-
tion (other than subsection (d)) shall be subject to
a civil money penalty in an amount determined by
the Secretary of Health and Human Services.
(2) FAILURE TO PROVIDE NOTICE.—Any health
plan that violates the provisions of subsection (d)
shall be subject to a civil money penalty in an
amount determined by the Secretary of Health and
Human Services.
(3) PROCESS.—The provisions of section 1128A
of the Social Security Act (other than subsections
(a) and (b)) shall apply to civil money penalties