[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3101 Introduced in House (IH)]

  2d Session
                                H. R. 3101

  To require health plans to provide coverage for a minimum period of 
     time for a mother and child following the birth of the child.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 14, 1996

  Mr. Towns introduced the following bill; which was referred to the 
                         Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
  To require health plans to provide coverage for a minimum period of 
     time for a mother and child following the birth of the child.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Mother and Child Protection Act of 
1996''.

SEC. 2. REQUIRED COVERAGE FOLLOWING CHILDBIRTH.

    (a) Coverage for Inpatient Care.--An entity that offers a health 
plan that provides maternity benefits, including benefits for 
childbirth, shall ensure that, in the case of delivery in a hospital or 
other inpatient setting, coverage is provided for a mother and her 
newly born child for a minimum of 48 hours of inpatient care following 
a vaginal delivery and a minimum of 120 hours of inpatient care 
following a caesarean section. A health plan shall provide coverage for 
additional inpatient care following a delivery if a licensed health 
care practitioner who is directly involved in the inpatient care 
determines that it is medically necessary for the mother or newly born 
child.
    (b) Limited Coverage for Outpatient Care.--An entity that offers a 
health plan that provides maternity benefits, including benefits for 
childbirth, shall ensure that, in a case in which a mother who delivers 
a child in a hospital or other inpatient setting elects to leave the 
inpatient setting before the expiration of 48 hours in the case of a 
vaginal delivery or 120 hours in the case of a caesarean section, 
coverage is provided for the mother and her newly born child for one 
home service visit within 24 hours after the discharge.
    (c) Coverage for Other Maternity Benefits.--An entity that offers a 
health plan that provides maternity benefits shall ensure that coverage 
is provided for parental education, including training in breast or 
bottle feeding, and performance of any maternal or newborn clinical 
assessments.
    (d) Prohibition.--The Secretary of Health and Human Services shall 
promulgate regulations to ensure that an entity that offers a health 
plan does not penalize a licensed health care practitioner for 
administering care consistent with this section.
    (e) Notice.--An entity that offers a health plan shall provide 
notice to each enrollee under such plan regarding the coverage required 
by this section. Such notice shall be in writing and prominently 
positioned in any literature or correspondence made available or 
distributed by the health plan and shall be transmitted in the next 
mailing of general information made by the plan to the enrollee as part 
of the yearly informational packet sent to the enrollee.
    (f) Regulations.--The Secretary of Health and Human Services, in 
consultation with the National Association of Insurance Commissioners, 
shall promulgate regulations to carry out this section. Such 
regulations shall include standards for home visits.

SEC. 3. ENFORCEMENT.

    (a) Failure To Provide Coverage or Notice.--Any entity that offers 
a health plan that violates the provisions of this Act shall be subject 
to a civil money penalty in an amount determined by the Secretary of 
Health and Human Services.
    (b) Process.--The provisions of section 1128A of the Social 
Security Act (42 U.S.C. 1320a-7a) (other than subsections (a) and (b)) 
shall apply to civil money penalties under this section in the same 
manner as they apply to a penalty or proceeding under section 1128A(a) 
of such Act.

SEC. 4. DEFINITIONS.

    For purposes of this Act:
            (1) Health plan.--The term ``health plan'' means a plan 
        that provides health insurance coverage.
            (2) Health insurance coverage.--The term ``health insurance 
        coverage'' means any hospital or medical service policy or 
        certificate, hospital or medical service plan contract, or 
        health maintenance organization contract offered by an insurer.
            (3) Licensed health care practitioner.--The term ``licensed 
        health care practitioner'' has the meaning given such term in 
        section 431(6) of the Health Care Quality Improvement Act of 
        1986 (Public Law 99-660; 42 U.S.C. 11151(6)).

SEC. 5. EFFECTIVE DATE.

    The provisions of section 2 shall apply to all health plans 
offered, sold, issued, or renewed after the date of the enactment of 
this Act.
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