[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 969 Reported in Senate (RS)]





                                                       Calendar No. 505

104th CONGRESS

  2d Session

                                 S. 969

                          [Report No. 104-326]

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                             July 19, 1996

                       Reported with an amendment





                                                       Calendar No. 505
104th CONGRESS
  2d Session
                                 S. 969

                          [Report No. 104-326]

 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 SENATE OF THE UNITED STATES

                June 27 (legislative day, June 19), 1995

Mr. Bradley (for himself, Mrs. Kassebaum, Mr. Rockefeller, Mrs. Boxer, 
Ms. Mikulski, Mrs. Murray, Mr. DeWine, Mr. Reid, Mr. Pell, Mr. Kennedy, 
Mr. Sarbanes, Mr. Simon, Mr. Wellstone, Mr. Kerrey, Ms. Moseley-Braun, 
  Mr. Bryan, Mr. Ford, Mr. Lautenberg, Mr. Inouye, Mr. Campbell, Mr. 
McConnell, Mr. Levin, Mr. Grassley, Mr. Helms, Mr. Domenici, Mr. Kerry, 
 Ms. Snowe, Mr. Simpson, Mr. Leahy, Mr. Glenn, Mr. Stevens, Mr. Robb, 
  Mrs. Feinstein, Mr. Frist, Mr. Biden,  Mr. Grams, Mr. D'Amato, Mr. 
   Kohl, Mrs. Hutchison, Mr. Graham, and Mr. Warner) introduced the 
 following bill; which was read twice and referred to the Committee on 
                       Labor and Human Resources

                             July 19, 1996

             Reported by Mrs. Kassebaum, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Newborns' and Mothers' 
Health Protection Act of 1996''.</DELETED>

<DELETED>SEC. 2. FINDING.</DELETED>

<DELETED>    Congress finds that--</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (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.</DELETED>

<DELETED>SEC. 3. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOLLOWING 
              BIRTH.</DELETED>

<DELETED>    (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.</DELETED>
<DELETED>    (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--
</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (2) the health plan or employee health benefit 
        plan provides coverage for post-delivery follow-up care as 
        described in section 4.</DELETED>

<DELETED>SEC. 4. POST-DELIVERY FOLLOW-UP CARE.</DELETED>

<DELETED>    (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--</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (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);</DELETED>
<DELETED>except that such coverage shall ensure that the mother has the 
option to be provided with such care in the home.</DELETED>
<DELETED>    (b) Timely Care.--As used in subsection (a), the term 
``timely post-delivery care'' means health care that is provided--
</DELETED>
        <DELETED>    (1) following the discharge of a mother and her 
        newborn child from the inpatient setting; and</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>

<DELETED>SEC. 5. PROHIBITIONS.</DELETED>

<DELETED>    (a) Terms and Conditions.--In implementing the 
requirements of this Act, a health plan or an employee health benefit 
plan may not--</DELETED>
        <DELETED>    (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;</DELETED>
        <DELETED>    (2) provide monetary incentives to mothers to 
        encourage such mothers to request less than the minimum 
        coverage required under this Act; or</DELETED>
        <DELETED>    (3) provide incentives (monetary or otherwise) to 
        an attending provider to induce such provider to provide 
        treatment in a manner inconsistent with this Act.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (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--</DELETED>
        <DELETED>    (1) give birth in a hospital; or</DELETED>
        <DELETED>    (2) stay in the hospital for a fixed period of 
        time following the birth of her child.</DELETED>

<DELETED>SEC. 6. NOTICE.</DELETED>

<DELETED>    (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.</DELETED>
<DELETED>    (b) Health Plan.--A health plan shall provide notice to 
each policyholder regarding coverage required under this Act.</DELETED>
<DELETED>    (c) Requirements.--Notice required under this section 
shall be in writing, prominently positioned in, and be transmitted--
</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (2) as part of the annual informational packet 
        sent to the participant or policyholder.</DELETED>

<DELETED>SEC. 7. APPLICABILITY.</DELETED>

<DELETED>    (a) Construction.--</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (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).</DELETED>

<DELETED>SEC. 8. ENFORCEMENT.</DELETED>

<DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>

<DELETED>SEC. 9. DEFINITIONS.</DELETED>

<DELETED>    As used in this Act:</DELETED>
        <DELETED>    (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).</DELETED>
        <DELETED>    (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)).</DELETED>
        <DELETED>    (3) Employee health benefit plan.--</DELETED>
                <DELETED>    (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--</DELETED>
                        <DELETED>    (i) directly;</DELETED>
                        <DELETED>    (ii) through a health plan offered 
                        by a health plan issuer as defined in paragraph 
                        (4); or</DELETED>
                        <DELETED>    (iii) otherwise.</DELETED>
                <DELETED>    (B) Rule of construction.--An employee 
                health benefit plan shall not be construed to be a 
                health plan or a health plan issuer.</DELETED>
                <DELETED>    (C) Arrangements not included.--Such term 
                does not include the following, or any combination 
                thereof:</DELETED>
                        <DELETED>    (i) Coverage only for accident, or 
                        disability income insurance, or any combination 
                        thereof.</DELETED>
                        <DELETED>    (ii) Medicare supplemental health 
                        insurance (as defined under section 1882(g)(1) 
                        of the Social Security Act).</DELETED>
                        <DELETED>    (iii) Coverage issued as a 
                        supplement to liability insurance.</DELETED>
                        <DELETED>    (iv) Liability insurance, 
                        including general liability insurance and 
                        automobile liability insurance.</DELETED>
                        <DELETED>    (v) Workers compensation or 
                        similar insurance.</DELETED>
                        <DELETED>    (vi) Automobile medical payment 
                        insurance.</DELETED>
                        <DELETED>    (vii) Coverage for a specified 
                        disease or illness.</DELETED>
                        <DELETED>    (viii) Hospital or fixed indemnity 
                        insurance.</DELETED>
                        <DELETED>    (ix) Short-term limited duration 
                        insurance.</DELETED>
                        <DELETED>    (x) Credit-only, dental-only, or 
                        vision-only insurance.</DELETED>
                        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (5) Health plan.--</DELETED>
                <DELETED>    (A) In general.--The term ``health plan'' 
                means any group health plan or individual health 
                plan.</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (D) Arrangements not included.--Such term 
                does not include the following, or any combination 
                thereof:</DELETED>
                        <DELETED>    (i) Coverage only for accident, or 
                        disability income insurance, or any combination 
                        thereof.</DELETED>
                        <DELETED>    (ii) Medicare supplemental health 
                        insurance (as defined under section 1882(g)(1) 
                        of the Social Security Act).</DELETED>
                        <DELETED>    (iii) Coverage issued as a 
                        supplement to liability insurance.</DELETED>
                        <DELETED>    (iv) Liability insurance, 
                        including general liability insurance and 
                        automobile liability insurance.</DELETED>
                        <DELETED>    (v) Workers compensation or 
                        similar insurance.</DELETED>
                        <DELETED>    (vi) Automobile medical payment 
                        insurance.</DELETED>
                        <DELETED>    (vii) Coverage for a specified 
                        disease or illness.</DELETED>
                        <DELETED>    (viii) Hospital or fixed indemnity 
                        insurance.</DELETED>
                        <DELETED>    (ix) Short-term limited duration 
                        insurance.</DELETED>
                        <DELETED>    (x) Credit-only, dental-only, or 
                        vision-only insurance.</DELETED>
                        <DELETED>    (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.</DELETED>
                <DELETED>    (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--</DELETED>
                        <DELETED>    (i) a specified disease or 
                        illness, or</DELETED>
                        <DELETED>    (ii) a period of 
                        hospitalization,</DELETED>
                <DELETED>without regard to the costs incurred or 
                services rendered during the period to which the 
                payments relate.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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)).</DELETED>
        <DELETED>    (8) Secretary.--The term ``Secretary'' unless 
        otherwise specified means the Secretary of Labor.</DELETED>

<DELETED>SEC. 10. PREEMPTION.</DELETED>

<DELETED>    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.</DELETED>

<DELETED>SEC. 11. EFFECTIVE DATE.</DELETED>

<DELETED>    Except as otherwise provided for in this Act, the 
provisions of this Act shall apply as follows:</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Newborns' and Mothers' Health 
Protection Act of 1996''.

SEC. 2. FINDINGS.

    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 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.--
            (1) General rule.--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, nurse practitioner, nurse midwife or physician 
        assistant experienced in maternal and child health in--
                    (A) 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
                    (B) another setting determined appropriate under 
                regulations promulgated by the Secretary, in 
                consultation with the Secretary of Health and Human 
                Services;
        except that such coverage shall ensure that the mother has the 
        option to be provided with such care in the home.
            (2) Considerations by secretary.--In promulgating 
        regulations under paragraph (1)(B), the Secretary shall 
        consider telemedicine and other innovative means to provide 
        follow-up care and shall consider care in both urban and rural 
        settings.
    (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 not later than the 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.

    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 the annual informational packet 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(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).
    (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.--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--
                    (A) the obstetrician-gynecologists, pediatricians, 
                family physicians, and other physicians primarily 
                responsible for the care of a mother and newborn; and
                    (B) the nurse midwives and nurse practitioners 
                primarily responsible for the care of a mother and her 
                newborn child in accordance withg State licensure and 
                certification laws.
            (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.

    (a) In General.--The provisions of sections 3, 5, and 6 relating to 
inpatient care shall not preempt a State law or regulation--
            (1) that provides greater protections to patients or 
        policyholders than those required in this Act;
            (2) that requires 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 requires 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 medical associations; or
            (4) that leaves decisions regarding appropriate length of 
        stay entirely to the attending provider, in consultation with 
        the mother.
    (b) Follow-Up Care.--The provisions of section 4 relating to 
follow-up care shall not preempt those provisions of State law or 
regulation that provide greater protection to patients or policyholders 
than those required under this Act or that provide mothers and newborns 
with an option of timely post delivery follow-up care (as defined in 
section 4(b)) in the home.
    (c) Employee Health Benefit Plans.--Nothing in this section affects 
the application of this Act to employee health benefit plans, as 
defined in section 9(3).

SEC. 11. 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 to--
                    (A) examine the issues and consequences associated 
                with the length of hospital stays following childbirth;
                    (B) examine the follow-up practices for mothers and 
                newborns used in conjunction with shorter hospital 
                stays;
                    (C) identify appropriate health care practices and 
                procedures with regard to the hospital discharge of 
                newborns and mothers;
                    (D) examine the extent to which such care is 
                affected by family and environmental factors; and
                    (E) 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 shall establish an advisory panel (hereafter referred 
        to in this section as the ``advisory panel'') to--
                    (A) guide and review methods, procedures, and data 
                collection necessary to conduct the study described in 
                subsection (c) that is intended to enhance the quality, 
                safety, and effectiveness of health care services 
                provided to mothers and newborns;
                    (B) develop a consensus among the members of the 
                advisory panel regarding the appropriateness of the 
                specific requirements of this Act; and
                    (C) prepare and submit to the Secretary of Health 
                and Human Services, as part of the report of the 
Secretary submitted under subsection (d), a report summarizing the 
consensus developed under subparagraph (B) if any, including the 
reasons for not reaching such a consensus.
            (2) Participation.--
                    (A) Department representatives.--The Secretary of 
                Health and Human Services 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 established under 
                paragraph (1).
                    (B) Representatives of public and private sector 
                entities.--
                            (i) In general.--The Secretary of Health 
                        and Human Services 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 from each of the following 
                        categories:
                                    (I) Health care practitioners.
                                    (II) Health plans.
                                    (III) Hospitals.
                                    (IV) Employers.
                                    (V) States.
                                    (VI) Consumers.
    (c) Studies.--
            (1) In general.--The Secretary of Health and Human Services 
        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;
                    (C) the diversity of negative or positive outcomes 
                affecting mothers, infants, and families;
                    (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 of Health and Human Services 
        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 of Health and Human Services 
        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 
                subsection (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 enactment of this Act.
            (2) Submission of reports.--The Secretary of Health and 
        Human Services shall prepare and submit to the Committees 
        referred to in paragraph (1)--
                    (A) an initial report concerning the study 
                conducted under subsection (c) and the report required 
                under subsection (d), not later than 18 months after 
                the date of enactment of this Act;
                    (B) an interim report concerning such study and 
                report not later than 3 years after the date of 
                enactment of this Act; and
                    (C) a final report concerning such study and report 
                not later than 5 years after the date of 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 this section.

SEC. 12. 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.