imposing deductibles, coinsurance, or other cost-
sharing in relation to benefits for hospital lengths of
stay under the plan, health insurance coverage of-
fered in connection with a group health plan, or the
supplemental policy, except that such coinsurance or
other cost-sharing for any portion of a period within
a hospital length of stay required under subsection
(a) may not be greater than such coinsurance or
cost-sharing for any preceding portion of such stay.
‘‘(d) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
714(d) of the Employee Retirement Income Security Act
of 1974 with respect to the requirements of this section
as if such section applied to such plan.
‘‘(e) LEVEL
AND TYPE
OF REIMBURSEMENTS.—
Nothing in this section shall be construed to prevent a
group health plan or a health insurance issuer offering
group health insurance coverage in connection with a
group health plan (including a self-insured issuer) from
negotiating the level and type of reimbursement with a
provider for care provided in accordance with this section.
‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
ANCE COVERAGE IN CERTAIN STATES.—
‘‘(1) IN GENERAL.—The requirements of this
section shall not apply with respect to health insur-
ance coverage if there is a State law (as defined in
section 2723(d)(1)) for a State that regulates such
coverage and provides greater protections to patients
than those provided under this section.
‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(B) CONFORMING
AMENDMENT.—Section
2723(c) of the Public Health Service Act (42
U.S.C. 300gg–23(c)) is amended by striking
‘‘section 2704’’ and inserting ‘‘sections 2704
and 2707’’.
(2) ERISA AMENDMENTS.—
(A) IN GENERAL.—Subpart B of part 7 of
subtitle B of title I of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1185
et seq.) is amended by adding at the end the
following new section:
‘‘SEC. 714. STANDARDS RELATING TO COVERAGE OF HOS-
PITAL LENGTHS OF STAY.
‘‘(a) REQUIREMENT.—A group health plan and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan (including
a self-insured issuer), that provides coverage for inpatient
hospital services—
‘‘(1) shall provide coverage for the length of an
inpatient hospital stay as determined by the attend-
ing physician (or other attending health care pro-
vider to the extent permitted under State law) in
consultation with the patient to be medically appro-
priate; and
‘‘(2) may not require that a provider obtain au-
thorization from the plan or the issuer for prescrib-
ing any length of stay required under paragraph (1).
‘‘(b) PROHIBITIONS.—A group health plan and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan (including
a self-insured issuer), may not—
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under
the terms of the plan, solely for the purpose of
avoiding the requirements of this section;
‘‘(2) provide monetary payments or rebates to
an individual to encourage the individual to accept
less than the minimum protections available under
this section;
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of an attending provider because
such provider provided care to an individual partici-
pant or beneficiary in accordance with this section;
‘‘(4) provide incentives (monetary or otherwise)
to an attending provider to induce such provider to
provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section; or
‘‘(5) subject to subsection (c)(4), restrict bene-
fits for any portion of a period within a hospital
length of stay required under subsection (a) in a
manner which is less favorable than the benefits pro-
vided for any preceding portion of such stay.
‘‘(c) RULES OF CONSTRUCTION.—
‘‘(1) NO REQUIREMENT TO STAY.—Nothing in
this section shall be construed to require an individ-
ual who is a participant or beneficiary to stay in the
hospital for a fixed period of time for any procedure.
‘‘(2) NO EFFECT ON REQUIREMENTS FOR MINI-
MUM HOSPITAL STAY FOLLOWING BIRTH.—Nothing
in this section shall be construed as modifying the
requirements of section 711.
‘‘(3) NONAPPLICABILITY.—This section shall
not apply with respect to any group health plan or
any group health insurance coverage offered by a
health insurance issuer (including a self-insured
issuer), which does not provide benefits for hospital
lengths of stay.
‘‘(4) COST-SHARING.—Nothing in this section
shall be construed as preventing a group health plan
or a health insurance issuer offering group health
insurance coverage in connection with a group health
plan (including a self-insured issuer), from imposing
deductibles, coinsurance, or other cost-sharing in re-
lation to benefits for hospital lengths of stay under
the plan or health insurance coverage offered in con-
nection with a group health plan, except that such
coinsurance or other cost-sharing for any portion of
a period within a hospital length of stay required
under subsection (a) may not be greater than such
coinsurance or cost-sharing for any preceding por-
tion of such stay.
‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The
imposition of the requirements of this section shall be
treated as a material modification in the terms of the plan
described in section 102(a)(1), for purposes of assuring
notice of such requirements under the plan; except that
the summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such
modification shall be provided by not later than 60 days
after the first day of the first plan year in which such
requirements apply.
‘‘(e) LEVEL
AND TYPE
OF REIMBURSEMENTS.—
Nothing in this section shall be construed to prevent a
group health plan or a health insurance issuer offering
group health insurance coverage in connection with a
group health plan (including a self-insured issuer), from
negotiating the level and type of reimbursement with a
provider for care provided in accordance with this section.
‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
ANCE COVERAGE IN CERTAIN STATES.—
‘‘(1) IN GENERAL.—The requirements of this
section shall not apply with respect to health insur-
ance coverage if there is a State law (as defined in
section 731(d)(1)) for a State that regulates such
coverage and provides greater protections to patients
than those provided under this section.
‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(B) CONFORMING AMENDMENTS.—
(i) Section 731(c) of the Employee
Retirement Income Security Act of 1974
(29 U.S.C. 1191(c)) is amended by strik-
ing ‘‘section 711’’ and inserting ‘‘sections
711 and 714’’.
(ii) Section 732(a) of the Employee
Retirement Income Security Act of 1974
(29 U.S.C. 1191a(a)), as amended by sec-
tion 603(b)(2) of Public Law 104–204, is
amended by striking ‘‘section 711’’ and in-
serting ‘‘sections 711 and 714’’.
(iii) The table of contents in section 1
of the Employee Retirement Income Secu-
rity Act of 1974 is amended by inserting
after the item relating to section 713 the
following new item:
‘‘Sec. 714. Standards relating to coverage of hospital lengths of stay.’’.
(b) INDIVIDUAL MARKET.—Subpart 3 of part B of
title XXVII of the Public Health Service Act (42 U.S.C.
300gg–51 et seq.) is amended by adding at the end the
following new section:
‘‘SEC. 2753. STANDARDS RELATING TO COVERAGE OF HOS-
PITAL LENGTHS OF STAY.
‘‘The provisions of section 2707 shall apply to health
insurance coverage offered by a health insurance issuer
in the individual market in the same manner as they apply
to health insurance coverage offered by a health insurance
issuer in connection with a group health plan in the small
or large group market.’’.
(c) EFFECTIVE DATES.—