[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3436 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 3436

  To protect the health of mothers and newborns against the premature 
   termination of inpatient care based on denial of health coverage.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 10, 1996

 Mr. Dingell 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 protect the health of mothers and newborns against the premature 
   termination of inpatient care based on denial of health coverage.

    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 ``Minimum Obstetrical Medical Security 
Act of 1996'' or the ``MOMS Act of 1996''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) health care for mothers and newborn children, including 
        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 newborn, the ability and confidence 
        of the mother and father to care for the newborn, the adequacy 
        of support systems at home, and the access of the mother and 
        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. 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 inpatient length of stay following a normal vaginal 
delivery, and a minimum of 96 hours of inpatient length of stay 
following a caesarean section, without requiring the attending provider 
to obtain authorization from the health plan or employee health benefit 
plan.
    (b) Exception.--Notwithstanding subsection (a), a health plan or an 
employee health benefit plan shall not be required to provide coverage 
for post-delivery inpatient length of stay for a mother who is a 
participant, beneficiary, or policyholder under such plan and her 
newborn child for 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 following a normal vaginal delivery or 96 hours 
following 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, osteopathic 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 birthing 
        center, an intermediate care facility, a federally qualified 
        health center, a federally qualified rural health clinic, or a 
        State health department maternity clinic; or
            (2)another setting determined appropriate by the attending 
        provider and the mother;
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) within the 72-hour period immediately 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 and that provides for the 
        appropriate monitoring of the conditions of the mother and 
        child.

SEC. 5. PROHIBITIONS.

    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 payments or rebates to mothers to 
        encourage such mothers to request less than the minimum 
        coverage required under this Act;
            (3) penalize or otherwise reduce or limit the reimbursement 
        of an attending provider because such provider provided 
        treatment in accordance with this Act; or
            (4) provide incentives (monetary or otherwise) to an 
        attending provider to induce such provider to provide treatment 
        to an individual policyholder, participant, or beneficiary in a 
        manner inconsistent with this Act.

SEC. 6. NOTICE.

    (a) Employee Health Benefit Plan.--An employee health benefit plan 
shall provide conspicuous notice to each participant regarding coverage 
required under this Act not later than 120 days after the date of 
enactment of this Act, and as part of its summary plan description.
    (b) Health Plan.--A health plan shall provide notice to each 
policyholder regarding coverage required under this Act. Such notice 
shall be in writing, prominently positioned, and be transmitted--
            (1) in a mailing made within 120 days of the date of 
        enactment of this Act by such plan to the policyholder; and
            (2) as part of any annual enrollment packet or brochure 
        sent to the 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(a)(2), the 
        Secretary of Health and Human Services 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 of the 
        Secretary of Health and Human Services 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).
    (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. 8. ENFORCEMENT.

    (a) Health Plan Issuers.--
            (1) State enforcement.--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 of Health and Human 
        Services demonstrating effective implementation of the 
        requirements of this Act.
            (2) Fallback federal enforcement.--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 of Health and Human Services shall enforce 
        the standards of this Act in such State. In enforcing such 
        standards, the Secretary may apply against a health plan issuer 
        the sanctions similar to the sanctions described in sections 
        502, 504, 506, and 510 of the Employee Retirement Income 
        Security Act of 1974 (29 U.S.C. 1132, 1134, 1136, and 1140).
    (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)) shall apply to any information required by the Secretary of 
Labor to be disclosed and reported under this section.
    (c) Regulations.--The Secretaries of Health and Human Services and 
Labor (as the case may be) 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'' 
        means an obstetrician-gynecologist, pediatrician, family 
        physician, osteopathic physician, or other physician or a nurse 
        practitioner, nurse midwife, or other health care provider 
        primarily responsible for the care of a mother and her newborn 
        child, and includes a group including such a provider.
            (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 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)).

SEC. 10. PREEMPTION.

    (a) In General.--The provisions of this Act shall not preempt those 
provisions of State law--
            (1) that provide greater protections to patients or 
        policyholders than those required in this Act;
            (2) that require health plans to provide coverage for at 
        least 48 hours of inpatient length of stay following a normal 
        vaginal delivery, and at least 96 hours of inpatient length of 
        stay following a caesarean section;
            (3) that require health plans to provide coverage 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 associations of licensed health care 
        providers specializing in obstetrical, gynecological, or 
        pediatric care; or
            (4) that leave decisions regarding appropriate length of 
        stay entirely to the attending provider in consultation with 
        the mother.
    (b) Follow-Up Care.--The provisions of this Act with respect to 
follow-up care as described in section 4 shall not preempt those 
provisions of State law that provide greater protections to patients or 
policyholders than those required under this Act or that provide 
mothers and newborns with an option of timely post-discharge follow-up 
care in the home.

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 such plans on the first day of the contract year 
        beginning 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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