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guarantees to carry out section 306 of the National Housing
Act, as amended (12 U.S.C. 1721(g)), shall not exceed
$20,000,000,000.
Ω117æTITLE VI—NEWBORNS’ AND
MOTHERS’ HEALTH PROTEC-
TION ACT OF 1996
SEC. 601. SHORT TITLE.
This title may be cited as the ‘‘Newborns’ and Mothers’
Health Protection Act of 1996’’.
SEC. 602. FINDINGS.
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 consider-
ation the health of the mother, the health and stability
of the newborn, the ability and confidence of the
mother and father to care for the newborn, the ade-
quacy of support systems at home, and the access of
the mother and newborn 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.
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SEC. 603. REQUIRED COVERAGE FOR MINIMUM HOSPITAL
STAY FOLLOWING BIRTH.
(a) IN GENERAL.—Except as provided in subsection
(b), a health plan or an employee health benefit plan that
provides maternity benefits, including benefits for child-
birth, shall ensure that coverage is provided with respect
to a mother who is a participant, beneficiary, or policy-
holder under such plan and her newborn child for a mini-
mum of 48 hours of inpatient length of stay following a
normal vaginal delivery, and a minimum of 96 hours of
inpatient length of stay following a caesarean section, with-
out requiring the attending provider to obtain authoriza-
tion from the health plan or employee health benefit plan.
(b) EXCEPTION.—Notwithstanding subsection (a), a
health plan or an employee health benefit plan shall not
be required to provide coverage for post-delivery inpatient
length of stay for a mother who is a participant, bene-
ficiary, or policyholder under such plan and her newborn
child for the period referred to in subsection (a) if—
(1) a decision to discharge the mother and her
newborn child prior to the expiration of such period
is made by the attending provider in consultation
with the mother; and
(2) the health plan or employee health benefit
plan provides coverage for post-delivery follow-up care
as described in section 604.
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SEC. 604. POST-DELIVERY FOLLOW-UP CARE.
(a) IN GENERAL.—
(1) GENERAL RULE.—In the case of a decision to
discharge a mother and her newborn child from the
inpatient setting prior to the expiration of 48 hours
following a normal vaginal delivery or 96 hours fol-
lowing a caesarean section, the health plan or em-
ployee health benefit plan shall provide coverage for
timely post-delivery care. Such health care shall be
provided to a mother and her newborn child by a reg-
istered nurse, physician, nurse practitioner, nurse
midwife or physician assistant experienced in mater-
nal and child health in—
(A) the home, a provider’s office, a hospital,
a birthing center, an intermediate care facility,
a federally qualified health center, a federally
qualified rural health clinic, or a State health
department maternity clinic; or
(B) another setting determined appropriate
under regulations promulgated by the Secretary,
in consultation with the Secretary of Health and
Human Services.
The attending provider in consultation with the
mother shall decide the most appropriate location for
follow-up care.
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(2) CONSIDERATIONS BY SECRETARY.—In pro-
mulgating regulations under paragraph (1)(B), the
Secretary shall consider telemedicine and other inno-
vative means to provide follow-up care and shall con-
sider care in both urban and rural settings.
(b) TIMELY CARE.—As used in subsection (a), the term
‘‘timely post-delivery care’’ means health care that is pro-
vided—
(1) following the discharge of a mother and her
newborn child from the inpatient setting; and
(2) 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 not later than the
72-hour period immediately following discharge.
(c) CONSISTENCY WITH STATE LAW.—The Secretary
shall, with respect to regulations promulgated under sub-
section (a) concerning appropriate post-delivery care set-
tings, ensure that, to the extent practicable, such regulations
are consistent with State licensing and practice laws.
SEC. 605. PROHIBITIONS.
In implementing the requirements of this title, a health
plan or an employee health benefit plan may not—
(1) deny enrollment, renewal, or continued cov-
erage to a mother and her newborn child who are
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participants, beneficiaries or policyholders based on
compliance with this title;
(2) provide monetary payments or rebates to
mothers to encourage such mothers to request less than
the minimum coverage required under this title;
(3) penalize or otherwise reduce or limit the re-
imbursement of an attending provider because such
provider provided treatment to an individual patient
in accordance with this title; or
(4) provide incentives (monetary or otherwise) to
an attending provider to induce such provider to pro-
vide treatment to an individual policyholder, partici-
pant, or beneficiary in a manner inconsistent with
this title.
SEC. 606. NOTICE.
(a) EMPLOYEE HEALTH BENEFIT PLAN.—An em-
ployee health benefit plan shall provide conspicuous notice
to each participant regarding coverage required under this
Act not later than 120 days after the date of enactment
of this title, and as part of its summary plan description.
(b) HEALTH PLAN.—A health plan shall provide notice
to each policyholder regarding coverage required under this
title. Such notice shall be in writing, prominently posi-
tioned, and be transmitted—
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(1) in a mailing made within 120 days of the
date of enactment of this title by such plan to the pol-
icyholder; and
(2) as part of the annual informational packet
sent to the policyholder.
SEC. 607. APPLICABILITY.
(a) CONSTRUCTION.—
(1) IN GENERAL.—A requirement or standard
imposed under this title on a health plan shall be
deemed to be a requirement or standard imposed on
the health plan issuer. Such requirements or stand-
ards shall be enforced by the State insurance commis-
sioner for the State involved or the official or officials
designated by the State to enforce the requirements of
this title. In the case of a health plan offered by a
health plan issuer in connection with an employee
health benefit plan, the requirements or standards im-
posed under this title shall be enforced with respect to
the health plan issuer by the State insurance commis-
sioner for the State involved or the official or officials
designated by the State to enforce the requirements of
this title.
(2) LIMITATION.—Except as provided in section
608(c), the Secretary shall not enforce the require-
ments or standards of this title as they relate to
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health plan issuers or health plans. In no case shall
a State enforce the requirements or standards of this
title as they relate to employee health benefit plans.
(b) ERISA.—Nothing in this title shall be construed
to affect or modify the provisions of section 514 of the Em-
ployee Retirement Income Security Act of 1974 (29 U.S.C.
1144).
(c) EFFECT ON MOTHER.—Nothing in this title shall
be construed to require that a mother who is a participant,
beneficiary, or policyholder covered under this title—
(1) give birth in a hospital; or
(2) stay in the hospital for a fixed period of time
following the birth of her child.
(d) LEVEL AND TYPE OF REIMBURSEMENTS.—Nothing
in this title shall be construed to prevent a health plan or
an employee health benefit plan from negotiating the level
and type of reimbursement with an attending provider for
care provided in accordance with this title.
SEC. 608. ENFORCEMENT.
(a) HEALTH PLAN ISSUERS.—Each State shall require
that each health plan issued, sold, renewed, offered for sale
or operated in such State by a health plan issuer meet the
standards established under this title. A State shall submit
such information as required by the Secretary demonstrat-
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ing effective implementation of the requirements of this
title.
(b) EMPLOYEE HEALTH BENEFIT PLANS.—With re-
spect to employee health benefit plans, the standards estab-
lished under this title shall be enforced in the same manner
as provided for under sections 502, 504, 506, and 510 of
the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1132, 1134, 1136, and 1140). The civil penalties
contained in paragraphs (1) and (2) of section 502(c) of
such Act (29 U.S.C. 1132(c)(1) and (2)) shall apply to any
information required by the Secretary to be disclosed and
reported under this section.
(c) FAILURE TO ENFORCE.—In the case of the failure
of a State to substantially enforce the standards and re-
quirements set forth in this title with respect to health
plans, the Secretary, in consultation with the Secretary of
Health and Human Services, shall enforce the standards
of this title in such State. In the case of a State that fails
to substantially enforce the standards set forth in this title,
each health plan issuer operating in such State shall be sub-
ject to civil enforcement as provided for under sections 502,
504, 506, and 510 of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1132, 1134, 1136, and 1140).
The civil penalties contained in paragraphs (1) and (2) of
section 502(c) of such Act (29 U.S.C. 1132(c)(1) and (2))
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shall apply to any information required by the Secretary
to be disclosed and reported under this section.
(d) REGULATIONS.—The Secretary, in consultation
with the Secretary of Health and Human Services, may
promulgate such regulations as may be necessary or appro-
priate to carry out this title.
SEC. 609. DEFINITIONS.
As used in this title:
(1) ATTENDING PROVIDER.—The term ‘‘attend-
ing provider’’ shall include—
(A) the obstetrician-gynecologists, pediatri-
cians, family physicians, and other physicians
primarily responsible for the care of a mother
and newborn; and
(B) the nurse midwives and nurse practi-
tioners primarily responsible for the care of a
mother and her newborn child in accordance
with State licensure and certification laws.
(2) BENEFICIARY.—The term ‘‘beneficiary’’ has
the meaning given such term under section 3(8) of the
Employee Retirement Income Security Act of 1974
(29 U.S.C. 1002(8)).
(3) EMPLOYEE HEALTH BENEFIT PLAN.—
(A) IN
GENERAL.—The term ‘‘employee
health benefit plan’’ means any employee welfare
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benefit plan, governmental plan, or church plan
(as defined under paragraphs (1), (32), and (33)
of section 3 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1002 (1), (32),
and (33))) that provides or pays for health bene-
fits (such as provider and hospital benefits) for
participants and beneficiaries whether—
(i) directly;
(ii) through a health plan offered by a
health plan issuer as defined in paragraph
(4); or
(iii) otherwise.
(B) RULE
OF
CONSTRUCTION.—An em-
ployee health benefit plan shall not be construed
to be a health plan or a health plan issuer.
(C) ARRANGEMENTS NOT INCLUDED.—Such
term does not include the following, or any com-
bination thereof:
(i) Coverage only for accident, or dis-
ability income insurance, or any combina-
tion thereof.
(ii) Medicare supplemental health in-
surance 
(as 
defined 
under 
section
1882(g)(1) of the Social Security Act).
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(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 in-
surance.
(vii) Coverage for a specified disease or
illness.
(viii) Hospital or fixed indemnity in-
surance.
(ix) Short-term limited duration insur-
ance.
(x) Credit-only, dental-only, or vision-
only insurance.
(xi) A health insurance policy provid-
ing benefits only for long-term care, nursing
home care, home health care, community-
based care, or any combination thereof.
(4) GROUP PURCHASER.—The term ‘‘group pur-
chaser’’ means any person (as defined under para-
graph (9) of section 3 of the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1002(9)) or en-
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tity that purchases or pays for health benefits (such
as provider or hospital benefits) on behalf of partici-
pants or beneficiaries in connection with an employee
health benefit plan.
(5) HEALTH PLAN.—
(A) IN GENERAL.—The term ‘‘health plan’’
means any group health plan or individual
health plan.
(B) GROUP
HEALTH
PLAN.—The term
‘‘group health plan’’ means any contract, policy,
certificate or other arrangement offered by a
health plan issuer to a group purchaser that pro-
vides or pays for health benefits (such as pro-
vider and hospital benefits) in connection with
an employee health benefit plan.
(C) INDIVIDUAL HEALTH PLAN.—The term
‘‘individual health plan’’ means any contract,
policy, certificate or other arrangement offered to
individuals by a health plan issuer that provides
or pays for health benefits (such as provider and
hospital benefits) and that is not a group health
plan.
(D) ARRANGEMENTS NOT INCLUDED.—Such
term does not include the following, or any com-
bination thereof:
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home care, home health care, community-
based care, or any combination thereof.
(E) CERTAIN PLANS INCLUDED.—Such term
includes any plan or arrangement not described
in any clause of subparagraph (D) which pro-
vides for benefit payments, on a periodic basis,
for—
(i) a specified disease or illness, or
(ii) a period of hospitalization,
without regard to the costs incurred or services
rendered during the period to which the pay-
ments relate.
(6) HEALTH PLAN ISSUER.—The term ‘‘health
plan issuer’’ means any entity that is licensed (prior
to or after the date of enactment of this title) by a
State to offer a health plan.
(7) PARTICIPANT.—The term ‘‘participant’’ has
the meaning given such term under section 3(7) of the
Employee Retirement Income Security Act of 1974
(29 U.S.C. 1002(7)).
(8) SECRETARY.—The term ‘‘Secretary’’ unless
otherwise specified means the Secretary of Labor.
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SEC. 610. PREEMPTION.
(a) IN GENERAL.—The provisions of sections 603, 605,
and 606 relating to inpatient care shall not preempt a State
law or regulation—
(1) that provides greater protections to patients
or policyholders than those required in this title;
(2) that requires health plans to provide coverage
for at least 48 hours of inpatient length of stay fol-
lowing a normal vaginal delivery, and at least 96
hours of inpatient length of stay following a caesar-
ean section;
(3) that requires health plans to provide coverage
for maternity and pediatric care in accordance with
guidelines established by the American College of Ob-
stetricians and Gynecologists, the American Academy
of Pediatrics, or other established professional medical
associations; or
(4) that leaves decisions regarding appropriate
length of stay entirely to the attending provider, in
consultation with the mother.
(b) FOLLOW-UP CARE.—The provisions of section 604
relating to follow-up care shall not preempt those provisions
of State law or regulation that provide comparable or great-
er protection to patients or policyholders than those re-
quired under this title or that provide mothers and
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newborns with an option of timely post delivery follow-up
care (as defined in section 604(b)) in the home.
(c) EMPLOYEE HEALTH BENEFIT PLANS.—Nothing in
this section affects the application of this title to employee
health benefit plans, as defined in section 609(3).
SEC. 611. REPORTS TO CONGRESS CONCERNING CHILD-
BIRTH.
(a) FINDINGS.—Congress finds that—
(1) childbirth is one part of a continuum of ex-
perience that includes prepregnancy, pregnancy and
prenatal care, labor and delivery, the immediate
postpartum period, and a longer period of adjustment
for the newborn, the mother, and the family;
(2) health care practices across this continuum
are changing in response to health care financing and
delivery system changes, science and clinical research,
and patient preferences; and
(3) there is a need to—
(A) examine the issues and consequences as-
sociated with the length of hospital stays follow-
ing childbirth;
(B) examine the follow-up practices for
mothers and newborns used in conjunction with
shorter hospital stays;
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(C) identify appropriate health care prac-
tices and procedures with regard to the hospital
discharge of newborns and mothers;
(D) examine the extent to which such care
is affected by family and environmental factors;
and
(E) examine the content of care during hos-
pital stays following childbirth.
(b) ADVISORY PANEL.—
(1) IN GENERAL.—Not later than 90 days after
the date of enactment of this title, the Secretary of
Health and Human Services shall establish an advi-
sory panel (hereafter referred to in this section as the
‘‘advisory panel’’) to—
(A) guide and review methods, procedures,
and data collection necessary to conduct the
study described in subsection (c) that is intended
to enhance the quality, safety, and effectiveness
of health care services provided to mothers and
newborns;
(B) develop a consensus among the members
of the advisory panel regarding the appropriate-
ness of the specific requirements of this title; and
(C) prepare and submit to the Secretary of
Health and Human Services, as part of the re-
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port of the Secretary submitted under subsection
(d), a report summarizing the consensus devel-
oped under subparagraph (B) if any, including
the reasons for not reaching such a consensus.
(2) PARTICIPATION.—
(A) DEPARTMENT REPRESENTATIVES.—The
Secretary of Health and Human Services shall
ensure that representatives from within the De-
partment of Health and Human Services that
have expertise in the area of maternal and child
health or in outcomes research are appointed to
the advisory panel established under paragraph
(1).
(B) REPRESENTATIVES OF PUBLIC AND PRI-
VATE SECTOR ENTITIES.—
(i) IN
GENERAL.—The Secretary of
Health and Human Services shall ensure
that members of the advisory panel include
representatives of public and private sector
entities having knowledge or experience in
one or more of the following areas:
(I) Patient care.
(II) Patient education.
(III) Quality assurance.
(IV) Outcomes research.
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(V) Consumer issues.
(ii) REQUIREMENT.—The panel shall
include representatives from each of the fol-
lowing categories:
(I) Health care practitioners.
(II) Health plans.
(III) Hospitals.
(IV) Employers.
(V) States.
(VI) Consumers.
(c) STUDIES.—
(1) IN GENERAL.—The Secretary of Health and
Human Services shall conduct a study of—
(A) the factors affecting the continuum of
care with respect to maternal and child health
care, including outcomes following childbirth;
(B) the factors determining the length of
hospital stay following childbirth;
(C) the diversity of negative or positive out-
comes affecting mothers, infants, and families;
(D) the manner in which post natal care
has changed over time and the manner in which
that care has adapted or related to changes in
the length of hospital stay, taking into account—
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(i) the types of post natal care avail-
able and the extent to which such care is
accessed; and
(ii) the challenges associated with pro-
viding post natal care to all populations,
including vulnerable populations, and solu-
tions for overcoming these challenges; and
(E) the financial incentives that may—
(i) impact the health of newborns and
mothers; and
(ii) influence the clinical decisionmak-
ing of health care providers.
(2) RESOURCES.—The Secretary of Health and
Human Services shall provide to the advisory panel
the resources necessary to carry out the duties of the
advisory panel.
(d) REPORTS.—
(1) IN GENERAL.—The Secretary of Health and
Human Services shall prepare and submit to the
Committee on Labor and Human Resources of the
Senate and the Committee on Commerce of the House
of Representatives a report that contains—
(A) a summary of the study conducted
under subsection (c);
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(e) TERMINATION
OF PANEL.—The advisory panel
shall terminate on the date that occurs 60 days after the
date on which the last report is submitted under this sec-
tion.
SEC. 612. SALE OF GOVERNORS ISLAND, NEW YORK.
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, the Administrator of General Services shall dis-
pose of by sale at fair market value all rights, title, and
interests of the United States in and to the land of, and
improvements to, Governors Island, New York.
(b) RIGHT OF FIRST REFUSAL.—Before a sale is made
under subsection (a) to any other parties, the State of New
York and the city of New York shall be given the right of
first refusal to purchase all or part of Governors Island.
Such right may be exercised by either the State of New York
or the city of New York or by both parties acting jointly.
(c) PROCEEDS.—Proceeds from the disposal of Gov-
ernors Island under subsection (a) shall be deposited in the
general fund of the Treasury and credited as miscellaneous
receipts.
SEC. 613. SALE OF AIR RIGHTS.
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, the Administrator of General Services shall sell,
at fair market value and in a manner to be determined
by the Administrator, the air rights adjacent to Washington
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Union Station described in subsection (b), including air
rights conveyed to the Administrator under subsection (d).
The Administrator shall complete the sale by such date as
is necessary to ensure that the proceeds from the sale will
be deposited in accordance with subsection (c).
(b) DESCRIPTION.—The air rights referred to in sub-
section (a) total approximately 16.5 acres and are depicted
on the plat map of the District of Columbia as follows:
(1) Part of lot 172, square 720.
(2) Part of lots 172 and 823, square 720.
(3) Part of lot 811, square 717.
(c) PROCEEDS.—Before September 30, 1997, proceeds
from the sale of air rights under subsection (a) shall be de-
posited in the general fund of the Treasury and credited
as miscellaneous receipts.
(d) CONVEYANCE OF AMTRAK AIR RIGHTS.—
(1) GENERAL RULE.—As a condition of future
Federal financial assistance, Amtrak shall convey to
the Administrator of General Services on or before
December 31, 1996, at no charge, all of the air rights
of Amtrak described in subsection (b).
(2) FAILURE TO COMPLY.—If Amtrak does not
meet the condition established by paragraph (1), Am-
trak shall be prohibited from obligating Federal funds
after March 1, 1997.
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SEC. 614. EFFECTIVE DATE.
Except as otherwise provided for in this title, the pro-
visions of this title shall apply as follows:
(1) With respect to health plans, such provisions
shall apply to such plans on the first day of the con-
tract year beginning on or after January 1, 1998.
(2) With respect to employee health benefit plans,
such provisions shall apply to such plans on the first
day of the first plan year beginning on or after Janu-
ary 1, 1998.
Ω118æTITLE VII—MENTAL HEALTH
PARITY
SEC. 701. SHORT TITLE.
This title may be cited as the ‘‘Mental Health Parity
Act of 1996’’.
SEC. 702. PLAN PROTECTIONS FOR INDIVIDUALS WITH A
MENTAL ILLNESS.
(a) PERMISSIBLE COVERAGE LIMITS UNDER A GROUP
HEALTH PLAN.—
(1) AGGREGATE LIFETIME LIMITS.—
(A) IN GENERAL.—With respect to a group
health plan offered by a health insurance issuer,
that applies an aggregate lifetime limit to plan
payments for medical or surgical services covered
under the plan, if such plan also provides a
mental health benefit such plan shall—
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(i) include plan payments made for
mental health services under the plan in
such aggregate lifetime limit; or
(ii) establish a separate aggregate life-
time limit applicable to plan payments for
mental health services under which the dol-
lar amount of such limit (with respect to
mental health services) is equal to or greater
than the dollar amount of the aggregate life-
time limit on plan payments for medical or
surgical services.
(B) NO LIFETIME LIMIT.—With respect to a
group health plan offered by a health insurance
issuer, that does not apply an aggregate lifetime
limit to plan payments for medical or surgical
services covered under the plan, such plan may
not apply an aggregate lifetime limit to plan
payments for mental health services covered
under the plan.
(2) ANNUAL LIMITS.—
(A) IN GENERAL.—With respect to a group
health plan offered by a health insurance issuer,
that applies an annual limit to plan payments
for medical or surgical services covered under the
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plan, if such plan also provides a mental health
benefit such plan shall—
(i) include plan payments made for
mental health services under the plan in
such annual limit; or
(ii) establish a separate annual limit
applicable to plan payments for mental
health services under which the dollar
amount of such limit (with respect to men-
tal health services) is equal to or greater
than the dollar amount of the annual limit
on plan payments for medical or surgical
services.
(B) NO ANNUAL LIMIT.—With respect to a
group health plan offered by a health insurance
issuer, that does not apply an annual limit to
plan payments for medical or surgical services
covered under the plan, such plan may not apply
an annual limit to plan payments for mental
health services covered under the plan.
(b) RULE OF CONSTRUCTION.—
(1) IN GENERAL.—Nothing in this section shall
be construed as prohibiting a group health plan of-
fered by a health insurance issuer, from—