[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3226 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 3226

 To require that health plans provide coverage for a minimum hospital 
 stay for a mother and child following the birth of the child, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 29, 1996

 Mr. Solomon (for himself and Mr. Miller of California) introduced the 
following bill; which was referred to the Committee 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 within the jurisdiction of 
                        the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To require that health plans provide coverage for a minimum hospital 
 stay for a mother and child following the birth of the child, and for 
                            other purposes.

    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 ``Newborns' and Mothers' Health 
Protection Act of 1996''.

SEC. 2. FINDING.

    Congress finds that--
            (1) 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 infant, the ability and 
        confidence of the mother to care for her infant, the adequacy 
        of support systems at home, and the access of the mother and 
        infant 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 childbirth, shall ensure that coverage 
is provided with respect to a mother who is a participant, beneficiary, 
or policyholder under such plan and her newborn child for a minimum of 
48 hours of in-patient care following a normal vaginal delivery, and a 
minimum of 96 hours of in-patient care following a caesarean section, 
without requiring the attending provider to obtain authorization from 
the health plan or employee health benefit plan in order to keep a 
mother and her newborn child in the inpatient setting for such period 
of time.
    (b) Exception.--Notwithstanding subsection (a), a health plan or an 
employee health benefit plan shall not be required to provide coverage 
for post-delivery in-patient care for a mother who is a participant, 
beneficiary, or policyholder under such plan and her newborn child 
during 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 discharge a mother 
and her newborn child from the inpatient setting prior to the 
expiration of 48 hours in the case of a normal vaginal delivery or 96 
hours in the case of a caesarean section, 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, nurse practitioner, nurse 
midwife or physician assistant experienced in maternal and child health 
in--
            (1) the home, a provider's office, a hospital, a federally 
        qualified health center, a federally qualified rural health 
        clinic, or a State health department maternity clinic; or
            (2) another setting determined appropriate under 
        regulations promulgated by the Secretary, in consultation with 
        the Secretary of Health and Human Services, (including a 
        birthing center or an intermediate care facility);
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) following 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, that provides for the appropriate 
        monitoring of the conditions of the mother and child, and that 
        occurs within the 24- to 72-hour period immediately following 
        discharge.
    (c) Consistency With State Law.--The Secretary shall, with respect 
to regulations promulgated under subsection (a) concerning appropriate 
post-delivery care settings, ensure that, to the extent practicable, 
such regulations are consistent with State licensing and practice laws.

SEC. 5. PROHIBITIONS.

    (a) Terms and Conditions.--In implementing the requirements of this 
Act, a health plan or an employee health benefit plan may not--
            (1) deny enrollment, renewal, or continued coverage to a 
        mother and her newborn child who are participants, 
        beneficiaries or policyholders based on compliance with this 
        Act;
            (2) provide monetary incentives to mothers to encourage 
        such mothers to request less than the minimum coverage required 
        under this Act; or
            (3) provide incentives (monetary or otherwise) to an 
        attending provider to induce such provider to provide treatment 
        in a manner inconsistent with this Act.
    (b) Providers.--In implementing the requirements of this section, a 
health plan or an employee health benefit plan may not penalize or 
otherwise reduce or limit the reimbursement of an attending provider 
because such provider provided treatment in accordance with this Act.
    (c) Rule of Construction.--Nothing in this Act shall be construed 
to require that a mother who is a participant, beneficiary, or 
policyholder covered under this Act--
            (1) give birth in a hospital; or
            (2) stay in the hospital for a fixed period of time 
        following the birth of her child.

SEC. 6. NOTICE.

    (a) Employee Health Benefit Plan.--An employee health benefit plan 
shall provide notice to each participant regarding coverage required 
under this Act in accordance with regulations promulgated by the 
Secretary.
    (b) Health Plan.--A health plan shall provide notice to each 
policyholder regarding coverage required under this Act.
    (c) Requirements.--Notice required under this section shall be in 
writing, prominently positioned in, and be transmitted--
            (1) in a mailing made within 120 days of the date of 
        enactment of this Act by such plan to the participant or 
        policyholder; and
            (2) as part of the annual informational packet sent to the 
        participant or 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 standards shall be enforced 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. 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.
            (2) Limitation.--Except as provided in section 8(c), the 
        Secretary shall not enforce the requirements or standards of 
        this Act as they relate to health plan issuers or health plans. 
        In no case shall a State enforce the requirements or standards 
        of this Act as they relate to employee health benefit plans.
    (b) Rule of Construction.--Nothing in this Act shall be construed 
to affect or modify the provisions of section 514 of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1144).

SEC. 8. ENFORCEMENT.

    (a) Health Plan Issuers.--Each State shall require that each health 
plan issued, sold, renewed, offered for sale or operated in such State 
by a health plan issuer meet the standards established under this Act. 
A State shall submit such information as required by the Secretary 
demonstrating effective implementation of the requirements of this Act.
    (b) Employee Health Benefit Plans.--With respect to employee health 
benefit plans, the standards established 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) 
(1) and (2)) shall apply to any information required by the Secretary 
to be disclosed and reported under this section.
    (c) Failure To Enforce.--In the case of the failure of a State to 
substantially enforce the standards and requirements set forth in this 
Act with respect to health plans, the Secretary, in consultation with 
the Secretary of Health and Human Services, shall enforce the standards 
of this Act in such State. In the case of a State that fails to 
substantially enforce the standards set forth in this Act, each health 
plan issuer operating in such State shall be subject to civil 
enforcement 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) (1) and (2)) 
shall apply to any information required by the Secretary to be 
disclosed and reported under this section.
    (d) Regulations.--The Secretary, in consultation with the Secretary 
of Health and Human Services, may promulgate such regulations as may be 
necessary or appropriate to carry out this Act.

SEC. 9. DEFINITIONS.

    As used in this Act:
            (1) Attending provider.--The term ``attending provider'' 
        shall include the obstetrician-gynecologists, pediatrician, 
        family physician, or other physician attending the mother or 
        newly born child. Such term shall also include any other health 
        care provider who, in accordance with applicable State law, may 
        be primarily responsible for the care of a mother and her 
        newborn child (including nurse midwives and nurse 
        practitioners).
            (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 welfare benefit plan, 
                governmental plan, or church plan (as defined under 
                paragraphs (1), (32), and (33) of section 3 of the 
                Employee Retirement 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 hospital 
                benefits) for participants and beneficiaries whether--
                            (i) directly;
                            (ii) through a health plan offered by a 
                        health plan issuer as defined in paragraph (4); 
                        or
                            (iii) otherwise.
                    (B) Rule of construction.--An employee health 
                benefit plan shall not be construed to be a health plan 
                or a health plan issuer.
                    (C) Arrangements not included.--Such term does not 
                include the following, or any combination thereof:
                            (i) Coverage only for accident, or 
                        disability income insurance, or any combination 
                        thereof.
                            (ii) Medicare supplemental health insurance 
                        (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 general 
                        liability insurance and automobile liability 
                        insurance.
                            (v) Workers compensation or similar 
                        insurance.
                            (vi) Automobile medical payment insurance.
                            (vii) Coverage for a specified disease or 
                        illness.
                            (viii) Hospital or fixed indemnity 
                        insurance.
                            (ix) Short-term limited duration insurance.
                            (x) Credit-only, dental-only, or vision-
                        only insurance.
                            (xi) A health insurance policy providing 
                        benefits only for long-term care, nursing home 
                        care, home health care, community-based care, 
                        or any combination thereof.
            (4) Group purchaser.--The term ``group purchaser'' means 
        any person (as defined under paragraph (9) of section 3 of the 
        Employee Retirement 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 provides or pays for health benefits 
                (such as provider 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 
                        disability income insurance, or any combination 
                        thereof.
                            (ii) Medicare supplemental health insurance 
                        (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 general 
                        liability insurance and automobile liability 
                        insurance.
                            (v) Workers compensation or similar 
                        insurance.
                            (vi) Automobile medical payment insurance.
                            (vii) Coverage for a specified disease or 
                        illness.
                            (viii) Hospital or fixed indemnity 
                        insurance.
                            (ix) Short-term limited duration insurance.
                            (x) Credit-only, dental-only, or vision-
                        only insurance.
                            (xi) A health insurance policy providing 
                        benefits only for long-term care, nursing home 
                        care, home health care, community-based care, 
                        or any combination thereof.
                    (E) Certain plans included.--Such term includes any 
                plan or arrangement not described in any clause of 
                subparagraph (D) which provides for benefit payments, 
                on a periodic basis, for--
                            (i) a specified disease or illness, or
                            (ii) a period of hospitalization,
                without regard to the costs incurred or services 
                rendered 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)).
            (8) Secretary.--The term ``Secretary'' unless otherwise 
        specified means the Secretary of Labor.

SEC. 10. PREEMPTION.

    The provisions of this Act shall not preempt those provisions of 
State law that require health plans to provide a minimum of 48 hours of 
in-patient care in the case of a normal vaginal delivery, and 96 hours 
of in-patient care in the case of a caesarean section, or that require 
health plans to provide for maternity and pediatric care that is in 
accordance with guidelines established by the American College of 
Obstetricians and Gynecologists and the American Academy of Pediatrics, 
and to provide follow-up care consistent with this Act.

SEC. 11. EFFECTIVE DATE.

    Except as otherwise provided for in this Act, the provisions of 
this Act shall apply as follows:
            (1) With respect to health plans, such provisions shall 
        apply to plans offered, sold, issued, renewed, in effect, or 
        operated 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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