I
104TH CONGRESS
1ST SESSION
H. R. 1955
To amend title I of the Employee Retirement Income Security Act of 1974
to provide for certain minimum requirements for group health plans
with respect to obstetrical benefits.
IN THE HOUSE OF REPRESENTATIVES
JUNE 29, 1995
Mr. DEFAZIO (for himself, Mr. MILLER of California, Mr. SANDERS, Mr.
WAXMAN, Mr. MCDERMOTT, Mr. DELLUMS, Mr. OWENS, Ms. NORTON,
Ms. PELOSI, Mr. STARK, Mr. FRAZER, Mr. BORSKI, Mr. SERRANO, Mr.
MATSUI, Mr. OBERSTAR, Mr. TORRICELLI, Mr. DURBIN, Mr. LIPINSKI,
Mr. EVANS, Mr. ABERCROMBIE, Ms. SLAUGHTER, Ms. WOOLSEY, and
Ms. FURSE) introduced the following bill; which was referred to the Com-
mittee on Economic and Educational Opportunities
A BILL
To amend title I of the Employee Retirement Income Secu-
rity Act of 1974 to provide for certain minimum require-
ments for group health plans with respect to obstetrical
benefits.
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-Infant Health
Protection Act of 1995’’.
SEC. 2. GROUP HEALTH PLAN REQUIREMENT.
Section 609 of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1169) is amended—
(1) by redesignating subsection (e) as sub-
section (f); and
(2) by inserting after subsection (d) the follow-
ing new subsection:
‘‘(e) REQUIREMENTS RELATING
TO OBSTETRICAL
BENEFITS.—
‘‘(1) IN GENERAL.—A group health plan which
provides obstetrical benefits shall provide coverage
for at least—
‘‘(A) 48 hours of inpatient care following a
vaginal delivery, and
‘‘(B) 96 hours of inpatient care following
a delivery by caesarean section,
for the mother and her newborn child in a licensed
hospital.
‘‘(2) EXCEPTION IF CERTAIN POST-DELIVERY
CARE IS PROVIDED.—
‘‘(A) IN
GENERAL.—Paragraph (1) shall
not apply if the plan provides coverage for post-
delivery care which satisfies subparagraph (B).
‘‘(B) REQUIREMENTS.—In order to satisfy
this subparagraph, under the terms of the plan
providing for coverage for post-delivery care—
‘‘(i) Discharge of the mother and new-
born child may not be required unless they
meet the medical criteria for discharge as
enumerated in the Guidelines for Perinatal
Care, as last issued before January 1,
1996 (or such later date as may be pro-
vided in regulations of the Secretary), by
the American Academy of Pediatrics and
the American College of Obstetricians and
Gynecologists.
‘‘(ii) Discharge of the newborn child
may not be required before opportunity for
appropriate screenings, including PKU,
has been provided. If the screening for
PKU is done prior to 24 hours after birth,
the plan must provide opportunity for a
second home visit for PKU screening with-
in two days after discharge.
‘‘(iii) Discharge must not be before 24
hours of milk feeding.
‘‘(iv) The mother and newborn child
must be allowed at least one overnight
stay.
‘‘(v) Appropriate management of the
mother and newborn child must be estab-
lished in advance of discharge, including
home visits by qualified health profes-
sionals, office visits, hospital stay, or any
combination thereof, including a home visit
with 24 hours after discharge.
‘‘(vi) Discharge of the mother or new-
born child may not be required without a
link to a continuing care provider.’’.
SEC. 3. EFFECTIVE DATE.
The amendment made by section 2 shall apply with
respect to plan years beginning at least 6 months after
the date of the enactment of this Act.
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