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.
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 ‘‘Mother and Child Pro-
tection Act of 1996’’.
SEC. 2. REQUIRED COVERAGE FOLLOWING CHILDBIRTH.
(a) COVERAGE FOR INPATIENT CARE.—An entity
that offers a health plan that provides maternity benefits,
including benefits for childbirth, shall ensure that, in the
case of delivery in a hospital or other inpatient setting,
coverage is provided for a mother and her newly born child
for a minimum of 48 hours of inpatient care following a
vaginal delivery and a minimum of 120 hours of inpatient
care following a caesarean section. A health plan shall pro-
vide coverage for additional inpatient care following a de-
livery if a licensed health care practitioner who is directly
involved in the inpatient care determines that it is medi-
cally necessary for the mother or newly born child.
(b) LIMITED COVERAGE FOR OUTPATIENT CARE.—
An entity that offers a health plan that provides maternity
benefits, including benefits for childbirth, shall ensure
that, in a case in which a mother who delivers a child in
a hospital or other inpatient setting elects to leave the in-
patient setting before the expiration of 48 hours in the
case of a vaginal delivery or 120 hours in the case of a
caesarean section, coverage is provided for the mother and
her newly born child for one home service visit within 24
hours after the discharge.
(c) COVERAGE
FOR
OTHER
MATERNITY
BENE-
FITS.—An entity that offers a health plan that provides
maternity benefits shall ensure that coverage is provided
for parental education, including training in breast or bot-
tle feeding, and performance of any maternal or newborn
clinical assessments.
(d) PROHIBITION.—The Secretary of Health and
Human Services shall promulgate regulations to ensure
that an entity that offers a health plan does not penalize
a licensed health care practitioner for administering care
consistent with this section.
(e) NOTICE.—An entity that offers a health plan
shall provide notice to each enrollee under such plan re-
garding the coverage required by this section. Such notice
shall be in writing and prominently positioned in any lit-
erature or correspondence made available or distributed
by the health plan and shall be transmitted in the next
mailing of general information made by the plan to the
enrollee as part of the yearly informational packet sent
to the enrollee.
(f) REGULATIONS.—The Secretary of Health and
Human Services, in consultation with the National Asso-
ciation of Insurance Commissioners, shall promulgate reg-
ulations to carry out this section. Such regulations shall
include standards for home visits.
SEC. 3. ENFORCEMENT.
(a) FAILURE TO PROVIDE COVERAGE OR NOTICE.—
Any entity that offers a health plan that violates the provi-
sions of this Act shall be subject to a civil money penalty
in an amount determined by the Secretary of Health and
Human Services.
(b) PROCESS.—The provisions of section 1128A of
the Social Security Act (42 U.S.C. 1320a–7a) (other than
subsections (a) and (b)) shall apply to civil money pen-
alties under this section in the same manner as they apply
to a penalty or proceeding under section 1128A(a) of such
Act.
SEC. 4. DEFINITIONS.
For purposes of this Act:
(1) HEALTH PLAN.—The term ‘‘health plan’’
means a plan that provides health insurance cov-
erage.
(2) HEALTH INSURANCE COVERAGE.—The term
‘‘health insurance coverage’’ means any hospital or
medical service policy or certificate, hospital or medi-
cal service plan contract, or health maintenance or-
ganization contract offered by an insurer.
(3) LICENSED HEALTH CARE PRACTITIONER.—
The term ‘‘licensed health care practitioner’’ has the
meaning given such term in section 431(6) of the
Health Care Quality Improvement Act of 1986
(Public Law 99–660; 42 U.S.C. 11151(6)).
SEC. 5. EFFECTIVE DATE.
The provisions of section 2 shall apply to all health
plans offered, sold, issued, or renewed after the date of
the enactment of this Act.
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