I
104TH CONGRESS
2D SESSION
H. R. 3226
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 HOUSE OF REPRESENTATIVES
MARCH 29, 1996
Mr. SOLOMON (for himself and Mr. MILLER of California) introduced the fol-
lowing bill; which was referred to the Committee on Commerce, and in
addition to the Committee on Economic and Educational Opportunities,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
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.
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 ‘‘Newborns’ and Moth-
ers’ Health Protection Act of 1996’’.
SEC. 2. FINDING.
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 con-
sideration the health of the mother, the health and
stability of the infant, the ability and confidence of
the mother to care for her infant, the adequacy of
support systems at home, and the access of the
mother and infant 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.
SEC. 3. 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 in-patient care following a normal
vaginal delivery, and a minimum of 96 hours of in-patient
care following a caesarean section, without requiring the
attending provider to obtain authorization from the health
plan or employee health benefit plan in order to keep a
mother and her newborn child in the inpatient setting for
such period of time.
(b) EXCEPTION.—Notwithstanding subsection (a), a
health plan or an employee health benefit plan shall not
be required to provide coverage for post-delivery in-patient
care for a mother who is a participant, beneficiary, or pol-
icyholder under such plan and her newborn child during
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 4.
SEC. 4. POST-DELIVERY FOLLOW-UP CARE.
(a) IN GENERAL.—In the case of a decision to dis-
charge a mother and her newborn child from the inpatient
setting prior to the expiration of 48 hours in the case of
a normal vaginal delivery or 96 hours in the case of a
caesarean section, the health plan or employee health ben-
efit plan shall provide coverage for timely post-delivery
care. Such health care shall be provided to a mother and
her newborn child by a registered nurse, physician, nurse
practitioner, nurse midwife or physician assistant experi-
enced in maternal and child health in—
(1) the home, a provider’s office, a hospital, a
federally qualified health center, a federally qualified
rural health clinic, or a State health department ma-
ternity clinic; or
(2) another setting determined appropriate
under regulations promulgated by the Secretary, in
consultation with the Secretary of Health and
Human Services, (including a birthing center or an
intermediate care facility);
except that such coverage shall ensure that the mother has
the option to be provided with such care in the home.
(b) TIMELY CARE.—As used in subsection (a), the
term ‘‘timely post-delivery care’’ means health care that
is provided—
(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 condi-
tions of the mother and child, and that occurs within
the 24- to 72-hour period immediately following dis-
charge.
(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 regula-
tions are consistent with State licensing and practice laws.
SEC. 5. PROHIBITIONS.
(a) TERMS AND CONDITIONS.—In implementing the
requirements of this Act, 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
participants, beneficiaries or policyholders based on
compliance with this Act;
(2) provide monetary incentives to mothers to
encourage such mothers to request less than the
minimum coverage required under this Act; or
(3) provide incentives (monetary or otherwise)
to an attending provider to induce such provider to
provide treatment in a manner inconsistent with this
Act.
(b) PROVIDERS.—In implementing the requirements
of this section, a health plan or an employee health benefit
plan may not penalize or otherwise reduce or limit the re-
imbursement of an attending provider because such pro-
vider provided treatment in accordance with this Act.
(c) RULE OF CONSTRUCTION.—Nothing in this Act
shall be construed to require that a mother who is a par-
ticipant, beneficiary, or policyholder covered under this
Act—
(1) give birth in a hospital; or
(2) stay in the hospital for a fixed period of
time following the birth of her child.
SEC. 6. NOTICE.
(a) EMPLOYEE HEALTH BENEFIT PLAN.—An em-
ployee health benefit plan shall provide notice to each par-
ticipant regarding coverage required under this Act in ac-
cordance with regulations promulgated by the Secretary.
(b) HEALTH PLAN.—A health plan shall provide no-
tice to each policyholder regarding coverage required
under this Act.
(c) REQUIREMENTS.—Notice required under this sec-
tion shall be in writing, prominently positioned in, and be
transmitted—
(1) in a mailing made within 120 days of the
date of enactment of this Act by such plan to the
participant or policyholder; and
(2) as part of the annual informational packet
sent to the participant or policyholder.
SEC. 7. APPLICABILITY.
(a) CONSTRUCTION.—