Newborn — Health Hippo

newborn

H.R.3666

PUBLIC LAW: 104-204, (became law 09/26/96)

SPONSOR: Rep Lewis, Jerry, (introduced 06/18/96)

TITLE VI–NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996

SEC. 601. SHORT TITLE– This title may be cited as the `Newborns’ and Mothers’ Health Protection Act of 1996′.

SEC. 602. FINDINGS– Congress finds that–

(1) the length of post-delivery hospital stay 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 confidence of the mother and the father to care for their newborn, the adequacy of support systems at home, and the access of the mother and her 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. 603. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974-

(a) IN GENERAL- Part 7 of subtitle B of title I of the
Employee Retirement Income Security Act of 1974 (added by section 101(a) of the Health Insurance Portability and Accountability Act of 1996) is amended–

(1) by amending the heading of the part to read as follows:

`Part 7–Group Health Plan Requirements’;

(2) by inserting after the part heading the following:

`Subpart A–Requirements Relating to Portability, Access, and Renewability’;

(3) by redesignating sections 704 through 707 as sections 731
through 734, respectively;

(4) by inserting before section 731 (as so redesignated) the
following new heading:

`Subpart C–General Provisions’;

and

(5) by inserting after section 703 the following new subpart:

`Subpart B–Other Requirements

`SEC. 711. STANDARDS RELATING TO BENEFITS FOR MOTHERS ANDNEWBORNS.

`(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY FOLLOWING BIRTH-

`(1) IN GENERAL- A group health plan, and a health insurance
issuer offering group health insurance coverage, may not–

`(A) except as provided in paragraph (2)–

`(i) restrict benefits for any hospital length of stay in
connection with childbirth for the mother or newborn child, following a normal
vaginal delivery, to less than 48 hours, or

`(ii) restrict benefits for any hospital length of stay in
connection with childbirth for the mother or newborn child, following a cesarean
section, to less than 96 hours; or

`(B) require that a provider obtain authorization from the plan or
the issuer for prescribing any length of stay required under subparagraph (A)
(without regard to paragraph (2)).

`(2) EXCEPTION- Paragraph (1)(A) shall not apply in connection
with any group health plan or health insurance issuer in any case in which the decision to discharge the mother or her newborn child prior to the expiration of the minimum length of stay otherwise required under paragraph (1)(A) is made by an attending provider in consultation with the mother.

`(b) PROHIBITIONS- A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a group health plan, may not–

`(1) deny to the mother or her newborn child eligibility, or
continued 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 mothers
to encourage such mothers 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 participant 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
beneficiary in a manner inconsistent with this section; or

`(5) subject to subsection (c)(3), restrict benefits 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 provided for any preceding portion of such stay.

`(c) RULES OF CONSTRUCTION-

`(1) Nothing in this section shall be construed to require a
mother who is a participant or beneficiary–

`(A) to give birth in a hospital; or

`(B) to stay in the hospital for a fixed period of time following
the birth of her child.

`(2) This section shall not apply with respect to any group health
plan, or any group health insurance coverage offered by a health insurance issuer, which does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.

`(3) Nothing in this section shall be construed as preventing a
group health plan or issuer from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for hospital lengths of stay in connection with childbirth for a mother or newborn child under the plan (or under health insurance coverage offered in connection 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 portion 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 from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.

`(f) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN
CERTAIN

STATES-

`(1) IN GENERAL- The requirements of this section shall not apply
with respect to health insurance coverage if there is a State law (as defined in section 731(d)(1)) for a State that regulates such coverage that is described in any of the following subparagraphs:

`(A) Such State law requires such coverage to provide for at least
a 48-hour hospital length of stay following a normal vaginal delivery and at
least a 96-hour hospital length of stay following a cesarean section.

`(B) Such State law requires such coverage to provide 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 professional medical associations.

`(C) Such State law requires, in connection with such coverage for
maternity care, that the hospital length of stay for such care is left to the
decision of (or required to be made by) the attending provider in consultation with the mother.

`(2) CONSTRUCTION- Section 731(a)(1) shall not be construed as
superseding a State law described in paragraph (1).’.

(b) CONFORMING AMENDMENTS-

(1) Section 731(c) of such Act (as added by section 101 of the
Health Insurance Portability and Accountability Act of 1996 and redesignated by the preceding provisions of this section) is amended by striking `Nothing’ and inserting `Except as provided in section 711, nothing’.

(2) Section 732(a) of such Act (as added by section 101 of the
Health Insurance Portability and Accountability Act of 1996 and redesignated by the preceding provisions of this section) is amended by inserting `(other than section 711)’ after `part’.

(3) Title I of such Act (as amended by section 101 of the Health
Insurance Portability and Accountability Act of 1996 and the preceding provisions of this section) is further amended–

(A) in the last sentence of section 4(b), by striking `section
706(b)(2)’, `section 706(b)(1)’, and `section 706(a)(1)’ and inserting `section
733(b)(2)’, `section 733(b)(1)’, and `section 733(a)(1)’, respectively;

(B) in section 101(g), by striking `section 706(a)(2)’ and
inserting `section 733(a)(2)’;

(C) in section 102(b), by striking `section 706(a)(1)’ each place
it appears and inserting `section 733(a)(1), and by striking `section 706(b)(2)’
and inserting `section 733(b)(2)’;

(D) in section 104(b)(1), by striking `section 706(a)(1)’ each
place it appears and inserting `section 733(a)(1)’;

(E) in section 502(b)(3), by striking `section 706(a)(1)’ and
inserting `section 733(a)(1)’;

(F) in section 506(c), by striking `section 706(a)(2)’ and
inserting `section 733(a)(2)’;

(G) in section 514(b)(9), by striking `section 704′ and inserting
`section 731′;

(H) in the last sentence of section 701(c)(1), by striking
`section 706(c)’ and inserting `section 733(c)’;

(I) in section 732(b), by striking `section 706(c)(1)’ and
inserting `section 733(c)(1)’;

(J) in section 732(c)(1), by striking `section 706(c)(2)’ and
inserting `section 733(c)(2)’;

(K) in section 732(c)(2), by striking `section 706(c)(3)’ and
inserting `section 733(c)(3)’; and

(L) in section 732(c)(3), by striking `section 706(c)(4)’ and
inserting `section 733(c)(4)’.

(4) The table of contents in section 1 of such Act is amended by
striking the items relating to part 7 and inserting the following:

`Part 7–Group Health Plan Requirements

`Subpart A–Requirements Relating to Portability, Access, and
Renewability

`Sec. 701. Increased portability through limitation on preexisting
condition exclusions.

`Sec. 702. Prohibiting discrimination against individual
participants and beneficiaries based on health status.

`Sec. 703. Guaranteed renewability in multiemployer plans and
multiple employer welfare arrangements.

`Subpart B–Other Requirements

`Sec. 711. Standards relating to benefits for mothers and
newborns.

`Subpart C–General Provisions

`Sec. 731. Preemption; State flexibility; construction.

`Sec. 732. Special rules relating to group health plans.

`Sec. 733. Definitions.

`Sec. 734. Regulations.’.

(c) EFFECTIVE DATE- The amendments made by this section shall
apply with respect to group health plans for plan years beginning on or after January 1, 1998.

SEC. 604. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT
RELATING TO THE GROUP MARKET–

(a) IN GENERAL- Title XXVII of the Public Health Service Act (as
added by section 102 of the Health Insurance Portability and Accountability
Act of 1996) is amended–

(1) by amending the title heading to read as follows:

`TITLE XXVII–REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE’;

(2) by redesignating subparts 2 and 3 of part A as subparts 3 and
4 of such part;

(3) by inserting after subpart 1 of part A the following new
subpart:

`Subpart 2–Other Requirements

`SEC. 2704. STANDARDS RELATING TO BENEFITS FOR MOTHERS AND
NEWBORNS.

`(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY FOLLOWING BIRTH-

`(1) IN GENERAL- A group health plan, and a health insurance
issuer offering group health insurance coverage, may not–

`(A) except as provided in paragraph (2)–

`(i) restrict benefits for any hospital length of stay in
connection with childbirth for the mother or newborn child, following a normal
vaginal delivery, to less than 48 hours, or

`(ii) restrict benefits for any hospital length of stay in
connection with childbirth for the mother or newborn child, following a cesarean
section, to less than 96 hours, or

`(B) require that a provider obtain authorization from the plan or
the issuer for prescribing any length of stay required under subparagraph (A)
(without regard to paragraph (2)).

`(2) EXCEPTION- Paragraph (1)(A) shall not apply in connection
with any group healthplan or health insurance issuer in any case in which the decision
to discharge the mother orher newborn child prior to the expiration of the minimum length of
stay otherwise required under paragraph (1)(A) is made by an attending provider in consultation with the mother.

`(b) PROHIBITIONS- A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a group health plan, may not–

`(2) provide monetary payments or rebates to mothers to encourage
such mothers 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 participant or beneficiary in accordance with this section;

`(c) RULES OF CONSTRUCTION-

`(1) Nothing in this section shall be construed to require a
mother who is a participant or beneficiary–

`(A) to give birth in a hospital; or

`(B) to stay in the hospital for a fixed period of time following
the birth of her child.

`(d) NOTICE- A group health plan under this part shall comply with
the notice requirement under section 711(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.

`(f) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN
CERTAIN

STATES-

`(1) IN GENERAL- The requirements of this section shall not apply
with respect to health insurance coverage if there is a State law (as defined in section 2723(d)(1)) for a State that regulates such coverage that is described in any of the following subparagraphs:

`(2) CONSTRUCTION- Section 2723(a)(1) shall not be construed as
superseding a State law described in paragraph (1).’.

(b) CONFORMING AMENDMENTS-

(1) Section 2721 of such Act (as added by section 102 of the
Health Insurance Portability and Accountability Act of 1996) is amended–

(A) in subsection (a), by striking `subparts 1 and 2′ and inserting `subparts 1 and 3′, and

(B) in subsections (b) through (d), by striking `subparts 1 and 2′ each place it appears and inserting `subparts 1 through 3′.

(2) Section 2723(c) of such Act (as added by section 102 of the Health Insurance Portability and Accountability Act of 1996) is amended by inserting `(other than section 2704)’ after `part’.

(c) EFFECTIVE DATE- The amendments made by this section shall apply with respect to group health plans for plan years beginning on or after January 1, 1998.

SEC. 605. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING
TO THE INDIVIDUAL MARKET-

(a) IN GENERAL- Part B of title XXVII of the Public Health Service Act (as added by section 111 of the Health Insurance Portability and Accountability Act of 1996) is amended–

(1) by inserting after the part heading the following:

`Subpart 1–Portability, Access, and Renewability Requirements’;

(2) by redesignating sections 2745, 2746, and 2747 as sections
2761, 2762, and 2763, respectively;

(3) by inserting before section 2761 (as so redesignated) the
following:

`Subpart 3–General Provisions’; and

(4) by inserting after section 2744 the following:

`Subpart 3–Other Requirements

`SEC. 2751. STANDARDS RELATING TO BENEFITS FOR MOTHERS AND
NEWBORNS.

`(a) IN GENERAL- The provisions of section 2704 (other than
subsections (d) and (f)) shall apply to health insurance coverage
offered by a health insurance issuer in the individual market in the
same manner as it applies to health insurance coverage offered by a
health insurance issuer in connection with a group health plan in the
small or large group market.

`(b) NOTICE REQUIREMENT- A health insurance issuer under this part
shall comply with the notice requirement under section 711(d) of the
Employee Retirement Income Security Act of 1974 with respect to the
requirements referred to in subsection (a) as if such section applied
to such issuer and such issuer were a group health plan.

`(c) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN
CERTAIN STATES-

`(B) Such State law requires such coverage to provide 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 professional medical associations.

`(2) CONSTRUCTION- Section 2762(a) shall not be construed as
superseding a State law described in paragraph (1).’.

(b) CONFORMING AMENDMENTS- Such part (as so added) is further
amended as follows:

(1) In section 2744(a)(1), strike `2746(b)’ and insert `2762(b)’.

(2) In section 2745(a)(1) (before redesignation under subsection
(a)(1)), strike `2746′ and insert `2762′.

(3) In section 2746(b) (before redesignation under subsection
(a)(1))–

(A) by inserting `(1)’ after the dash, and

(B) by adding at the end the following:

`(2) Nothing in this part (other than section 2751) shall be
construed as requiring health insurance

coverage offered in the individual market to provide specific
benefits under the terms of such coverage.’.

(c) EFFECTIVE DATE- The amendments made by this section shall
apply with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market on or after January 1, 1998.

SEC. 606. REPORTS TO CONGRESS CONCERNING CHILDBIRTH–

(a) FINDINGS-

Congress finds that–

(1) childbirth is one part of a continuum of experience that
includes prepregnancy, pregnancy and prenatal care, labor and delivery, the immediate postpartum period, and a longer period of adjustment for the newborn, the mother, and the family;

(2) health care practices across this continuum are changing in
response to health care financing and delivery system changes, science and clinical research, and patient preferences; and

(3) there is a need–

(A) to examine the issues and consequences associated with the
length of hospital stays following childbirth;

(B) to examine the follow-up practices for mothers and newborns
used in conjunction with shorter hospital stays;

(C) to identify appropriate health care practices and procedures
with regard to the hospital discharge of newborns and mothers;

(D) to examine the extent to which such care is affected by family
and environmental factors; and

(E) to examine the content of care during hospital stays following
childbirth.

(b) ADVISORY PANEL-

(1) IN GENERAL- Not later than 90 days after the date of enactment
of this Act, the Secretary of Health and Human Services (in this section referred
to as the `Secretary’) shall establish an advisory panel (referred to in this section as the`advisory panel’)–

(A) to guide and review methods, procedures, and data collection
necessary to conduct the study described in subsection (c) in a manner that is
intended to enhance the quality, safety, and effectiveness of health care
services provided to mothers and newborns;

(B) to develop a consensus among the members of the advisory panel
regarding the appropriateness of the specific requirements of this title; and

(C) to prepare and submit to the Secretary, as part of the report
of the Secretary submitted under subsection (d), a report summarizing the consensus (if any) developed under subparagraph (B) or the reasons for not reaching such a consensus.

(2) PARTICIPATION-

(A) DEPARTMENT REPRESENTATIVES- The Secretary shall ensure that representatives from within the Department of Health and Human Services that have expertise in the area of maternal and child health or in outcomes research are appointed to the advisory panel.

(B) REPRESENTATIVES OF PUBLIC AND PRIVATE SECTOR ENTITIES-

(i) IN GENERAL- The Secretary shall ensure that members of the advisory panel include representatives of public and private sector entities having knowledge or experience in one or more of the following areas:

(I) Patient care.

(II) Patient education.

(III) Quality assurance.

(IV) Outcomes research.

(V) Consumer issues.

(ii) REQUIREMENT- The panel shall include representatives of each
of

the following categories:

(I) Health care practitioners.

(II) Health plans.

(III) Hospitals.

(IV) Employers.

(V) States.

(VI) Consumers.

(1) IN GENERAL- The Secretary shall conduct a study of–

(A) the factors affecting the continuum of care with respect to
maternal and child health care, including outcomes following childbirth;

(B) the factors determining the length of hospital stay following
childbirth;

(D) the manner in which post natal care has changed over time and
the manner in

which that care has adapted or related to changes in the length of
hospital stay,taking into account–

(i) the types of post natal care available and the extent to which
such care is accessed; and

(ii) the challenges associated with providing post natal care to
all populations, including vulnerable populations, and solutions for overcoming these challenges; and

(E) the financial incentives that may–

(i) impact the health of newborns and mothers; and

(ii) influence the clinical decisionmaking of health care
providers.

(2) RESOURCES- The Secretary shall provide to the advisory panel
the resources necessary to carry out the duties of the advisory panel.

(d) REPORTS-

(1) IN GENERAL- The Secretary shall prepare and submit to the
Committee on Labor and Human Resources of the Senate and the Committee on Commerce of the House of Representatives a report that contains–

(A) a summary of the study conducted under sub-section (c);

(B) a summary of the best practices used in the public and private
sectors for the care of newborns and mothers;

(C) recommendations for improvements in prenatal care, post natal
care, delivery and follow-up care, and whether the implementation of such
improvements should be accomplished by the private health care sector, Federal or
State governments, or any combination thereof; and

(D) limitations on the databases in existence on the date of the
enactment of this Act.

(2) DEADLINES- The Secretary shall prepare and submit to the
Committees referred to in paragraph (1)–

(A) an initial report concerning the study conducted under
subsection (c) and elements described in paragraph (1), not later than 18 months
after the date of the enactment of this Act;

(B) an interim report concerning such study and elements not later
than 3 years after the date of the enactment of this Act; and

(C) a final report concerning such study and elements not later
than 5 years after the date of the enactment of this Act.

(e) TERMINATION OF PANEL- The advisory panel shall terminate on
the date that occurs 60 days after the date on which the last report is submitted under
subsection (d).