I
104TH CONGRESS
2D SESSION
H. R. 3436
To protect the health of mothers and newborns against the premature
termination of inpatient care based on denial of health coverage.
IN THE HOUSE OF REPRESENTATIVES
MAY 10, 1996
Mr. DINGELL introduced the following bill; which was referred to the Commit-
tee 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 with-
in the jurisdiction of the committee concerned
A BILL
To protect the health of mothers and newborns against the
premature termination of inpatient care based on denial
of health coverage.
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 ‘‘Minimum Obstetrical
Medical Security Act of 1996’’ or the ‘‘MOMS Act of
1996’’.
SEC. 2. FINDINGS.
Congress finds that—
(1) health care for mothers and newborn chil-
dren, including the length of post-delivery inpatient
care, should be based on the unique characteristics
of each mother and her newborn child, taking into
consideration the health of the mother, the health
and stability of the newborn, the ability and con-
fidence of the mother and father to care for the new-
born, the adequacy 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.
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 inpatient length of stay following a
normal vaginal delivery, and a minimum of 96 hours of
inpatient length of stay following a caesarean section,
without requiring the attending provider to obtain author-
ization 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 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 following a nor-
mal vaginal delivery or 96 hours following a caesarean sec-
tion, the health plan or employee 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 registered nurse, physician, osteopathic physician,
nurse practitioner, nurse midwife, or physician assistant
experienced in maternal and child health in—
(1) the home, a provider’s office, a hospital, a
birthing center, an intermediate care facility, a fed-
erally qualified health center, a federally qualified
rural health clinic, or a State health department ma-
ternity clinic; or
(2)another setting determined appropriate by
the attending provider and the mother;
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) within the 72-hour period immediately fol-
lowing 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 and that
provides for the appropriate monitoring of the condi-
tions of the mother and child.
SEC. 5. PROHIBITIONS.
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 payments or rebates to
mothers to encourage such mothers to request less
than the minimum coverage required under this Act;
(3) penalize or otherwise reduce or limit the re-
imbursement of an attending provider because such
provider provided treatment in accordance with this
Act; or
(4) provide incentives (monetary or otherwise)
to an attending provider to induce such provider to
provide treatment to an individual policyholder, par-
ticipant, or beneficiary in a manner inconsistent with
this Act.
SEC. 6. 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 Act, and as part of its summary plan description.
(b) HEALTH PLAN.—A health plan shall provide no-
tice to each policyholder regarding coverage required
under this Act. Such notice shall be in writing, promi-
nently positioned, and be transmitted—
(1) in a mailing made within 120 days of the
date of enactment of this Act by such plan to the
policyholder; and
(2) as part of any annual enrollment packet or
brochure sent to the policyholder.
SEC. 7. APPLICABILITY.
(a) CONSTRUCTION.—
(1) IN GENERAL.—A requirement or standard
imposed under this Act 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 com-
missioner for the State involved or the official or of-
ficials designated by the State to enforce the re-
quirements of this Act. 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 imposed under this Act shall be enforced
with respect to the health plan issuer by the State
insurance commissioner for the State involved or the
official or officials designated by the State to enforce
the requirements of this Act.
under this Act. A State shall submit such informa-
tion as required by the Secretary of Health and
Human Services demonstrating effective implemen-
tation of the requirements of this Act.
(2) FALLBACK
FEDERAL
ENFORCEMENT.—In
the case of the failure of a State to substantially en-
force the standards and requirements set forth in
this Act with respect to health plans, the Secretary
of Health and Human Services shall enforce the
standards of this Act in such State. In enforcing
such standards, the Secretary may apply against a
health plan issuer the sanctions similar to the sanc-
tions described in sections 502, 504, 506, and 510
of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1132, 1134, 1136, and 1140).
(b) EMPLOYEE HEALTH BENEFIT PLANS.—With re-
spect to employee health benefit plans, the standards es-
tablished under this Act 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)) shall apply to any
information required by the Secretary of Labor to be dis-
closed and reported under this section.
(c) REGULATIONS.—The Secretaries of Health and
Human Services and Labor (as the case may be) may pro-
mulgate such regulations as may be necessary or appro-
priate to carry out this Act.
SEC. 9. DEFINITIONS.
As used in this Act:
(1) ATTENDING PROVIDER.—The term ‘‘attend-
ing provider’’ means an obstetrician-gynecologist, pe-
diatrician, family physician, osteopathic physician, or
other physician or a nurse practitioner, nurse mid-
wife, or other health care provider primarily respon-
sible for the care of a mother and her newborn child,
and includes a group including such a provider.
(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 wel-
fare benefit plan, governmental plan, or church
plan (as defined under paragraphs (1), (32),
and (33) of section 3 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C.
1002 (1), (32), and (33))) that provides or pays
for health benefits (such as provider and hos-
pital benefits) for participants and beneficiaries
whether—
(i) directly;
(ii) through a health plan offered by
a health plan issuer as defined in para-
graph (4); or
(iii) otherwise.
(B) RULE
OF
CONSTRUCTION.—An em-
ployee health benefit plan shall not be con-
strued to be a health plan or a health plan is-
suer.
(C) ARRANGEMENTS
NOT
INCLUDED.—
Such term does not include the following, or
any combination 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).
(iii) Coverage issued as a supplement
to liability insurance.
(iv) Liability insurance, including gen-
eral liability insurance and automobile li-
ability 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 in-
surance.
(x) Credit-only, dental-only, or vision-
only insurance.
(xi) A health insurance policy provid-
ing benefits only for long-term care, nurs-
ing home care, home health care, commu-
nity-based care, or any combination there-
of.
(4) GROUP
PURCHASER.—The term ‘‘group
purchaser’’ means any person (as defined under
paragraph (9) of section 3 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C.
1002(9))) or entity that purchases or pays for health
benefits (such as provider or hospital benefits) on
behalf of participants 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
provides or pays for health benefits (such as
provider 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 pro-
vides or pays for health benefits (such as pro-
vider and hospital benefits) and that is not a
group health plan.
(D) ARRANGEMENTS
NOT
INCLUDED.—
Such term does not include the following, or
any combination 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).
(iii) Coverage issued as a supplement
to liability insurance.
(iv) Liability insurance, including gen-
eral liability insurance and automobile li-
ability 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 in-
surance.
(x) Credit-only, dental-only, or vision-
only insurance.
(xi) A health insurance policy provid-
ing benefits only for long-term care, nurs-
ing home care, home health care, commu-
nity-based care, or any combination there-
of.
(E) CERTAIN
PLANS
INCLUDED.—Such
term includes any plan or arrangement not de-
scribed in any clause of subparagraph (D)
which provides for benefit payments, on a peri-
odic basis, for a period of hospitalization, with-
out regard to the costs incurred or services ren-
dered during the period to which the payments
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 Act) 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)).
SEC. 10. PREEMPTION.
(a) IN GENERAL.—The provisions of this Act shall
not preempt those provisions of State law—
(1) that provide greater protections to patients
or policyholders than those required in this Act;
(2) that require health plans to provide cov-
erage for at least 48 hours of inpatient length of
stay following a normal vaginal delivery, and at least
96 hours of inpatient length of stay following a cae-
sarean section;
(3) that require health plans to provide cov-
erage for maternity and pediatric care in accordance
with guidelines established by the American College
of Obstetricians and Gynecologists, the American
Academy of Pediatrics, or other established profes-
sional associations of licensed health care providers
specializing in obstetrical, gynecological, or pediatric
care; or
(4) that leave decisions regarding appropriate
length of stay entirely to the attending provider in
consultation with the mother.
(b) FOLLOW-UP CARE.—The provisions of this Act
with respect to follow-up care as described in section 4
shall not preempt those provisions of State law that pro-
vide greater protections to patients or policyholders than
those required under this Act or that provide mothers and
newborns with an option of timely post-discharge follow-
up care in the home.
SEC. 11. EFFECTIVE DATE.
Except as otherwise provided for in this Act, the pro-
visions of this Act shall apply as follows:
(1) With respect to health plans, such provi-
sions shall apply to such plans on the first day of
the contract year beginning on or after January 1,
1997.
(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 January 1, 1997.
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