[Congressional Record Volume 142, Number 65 (Friday, May 10, 1996)]
[Extensions of Remarks]
[Pages E767-E768]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            MINIMUM OBSTETRICAL MEDICAL SECURITY ACT OF 1996

                                 ______


                          HON. JOHN D. DINGELL

                              of michigan

                    in the house of representatives

                          Friday, May 10, 1996

  Mr. DINGELL. Mr. Speaker, I am pleased today to introduce the MOMS 
Act, the Minimum Obstetrical Medical Security Act of 1996.
  The legislation would guarantee that insurers provide coverage for 
new mothers and their newborn children to remain in the hospital for a 
minimum of 48 hours after a normal delivery and 96 hours after a 
Caesarean section, unless the attending provider and the mother 
together decide that this is not the best course of action.
  This bill responds to the concerns of pregnant women and their 
physicians in my district who have become increasingly concerned about 
the risks involved for mothers and their children when they are sent 
home from the hospital too soon. This is happening more and more 
frequently because insurance companies are deciding that an early 
hospital discharge is in their best interest--even if both the doctor 
and the new mother believe that the longer stay is medically 
appropriate. Length of stay for new mothers and their babies ought not 
to be based on the financial concerns of an insurer, but on the health 
and welfare of the new mother and her new baby. Studies have shown that 
early release of infants can result in feeding problems, respiratory 
difficulties, mental retardation, brain damage, and infections of the 
ears, eyes, and navel cords. Premature hospital discharge also puts 
mothers at risk for hemorrhaging, infected episiotomies, urinary tract 
infections, and exhaustion.
  The American Medical Association has urged hospitals and insurance 
companies to allow the discharge of mothers and infants to be 
determined by the clinical judgment of attending physicians, not by 
economic considerations. Over 80,000 physicians in the American College 
of Obstetrics and Gynecologists and the American Academy of 
Pediatricians have endorsed legislative measures addressing these same 
concerns.
  This bill would prevent insurance company policies that result in the 
premature hospital discharge of mothers and their newborns. The 
increasing reluctance of some insurance plans to adequately cover 
obstetric hospital stays in accordance with current medical society 
guidelines has, and will continue to have, serious implications for the 
health and well-being of many mothers and newborns.
  The bill does not preempt responsible State legislation that either 
meets or exceeds the minimum requirements of this bill or guidelines 
established by the American College of Obstetricians and Gynecologists, 
the American Academy of Pediatrics, or other medical professional 
associations. I commend this legislation to my colleagues and urge its 
passage.

                      Section-by-Section Analysis

       Section 1. Short Title: The act is named the ``Minimum 
     Obstetrical Medical Security Act of 1996'', or MOMS Act.
       Section 2. Findings: The findings section states that: (1) 
     the length of post-delivery inpatient care should be based on 
     unique characteristics of each mother and her newborn child, 
     and (2) the decision to discharge a mother and newborn from 
     the hospital should be made by the attending provides in 
     consultation with the mother.

[[Page E768]]

       Section 3. Required Coverage for Minimum Hospital Stay 
     Following Birth: This section requires health plans that 
     provide maternity benefits, including benefits for 
     childbirth, to provide coverage to mothers and their newborns 
     for at least 48 hours of inpatient stay following a normal 
     vaginal delivery and at least 96 hours following a caesarean 
     section without requiring the attending provider to obtain 
     authorization from the health plan. Health plans are not 
     required to provide coverage for the 48 or 96 hour period if 
     two conditions are met: (1) the attending provides, in 
     consultation with the mother, decides to discharge the mother 
     earlier, and (2) the health plan provides coverage for post-
     delivery follow-up care.
       Section 4. Post-Delivery Follow-up Care: Where a mother and 
     newborn are discharged from the hospital prior to 48 hours 
     following a normal vaginal delivery or 96 hours following a 
     caesarean section, health plans are required to provide post-
     delivery follow-up care not more than 72 hours following the 
     discharge. Such care is to be provided by a registered nurse, 
     physician, osteopathic physician, nurse practitioner, nurse 
     midwife, or physician assistant experienced in maternal and 
     child health. Care may be provided at home, hospital, 
     doctor's office, birthing center, intermediate care facility, 
     federally qualified health center, State health department 
     maternity clinic, or other setting determined appropriate by 
     the attending provider and the mother, mothers must be given 
     the option of receiving care in the home.
       Section 5. Prohibitions: Health plans are prohibited from: 
     (1) denying enrollment, renewal, or continued coverage to 
     mothers and newborns on compliance with this Act; (2) 
     providing monetary payments or rebates to mothers to 
     encourage them to request fewer than 48/96 hours of stay; (3) 
     penalizing doctors because they comply with the Act; or (4) 
     providing incentives to doctors to induce them to provide 
     treatment in a manner inconsistent with the Act.
       Section 6. Notice: Insurers and employer-sponsored plans 
     are required to notify plan participants and policy holders 
     of the coverage required by this Act.
       Section 7. Applicability: This section, which works in 
     conjunction with Section 8 on ``Enforcement,'' clarifies that 
     States have primary responsibility for enforcing the 
     requirements of this Act with respect to insurers and HMO's--
     as they do under current law--that the Secretary of Labor has 
     sole responsibility for ensuring that the requirements of the 
     Act are met by employer-sponsored ERISA plans, and that 
     nothing in this Act should be construed to affect or modify 
     the preemption provisions of ERISA.
       Section 8. Enforcement: This section specifies that States 
     enforce the requirements of the Act with respect to insurers 
     and HMOs, and they may apply whatever penalties for non-
     compliance they wish. Employer-sponsored plans may be subject 
     to civil enforcement penalties contained in sections 502, 
     504, 506, and 510 of ERISA. If a State fails to 
     ``substantially'' enforce the requirements of the Act, the 
     Secretary of HHS will enforce the requirements with respect 
     to insurers and HMOs using penalties similar to the sanctions 
     provided under ERISA. This construct is necessary to ensure 
     enforcement.
       Section 9. Definitions: This section defines the terms 
     ``attending provider,'' ``beneficiary,'' ``employee health 
     benefit plan,'' ``group purchaser,'' ``health plan,'' 
     ``health plan issuer,'' ``participant,'' and ``secretary.''
       Section 10. Preemption: The Act does not preempt State laws 
     that (1) provide greater protection to patients and 
     policyholders; (2) require health plans to provide coverage 
     for at least 48/96 hours; (3) require health plans to provide 
     coverage in accordance with guidelines established by the 
     American College of Obstetricians and Gynecologists, the 
     American Academy of Pediatrics, or other appropriate 
     professional medical associations; or (4) leave decisions 
     about length of stay entirely to the doctor in consultation 
     with the mother. With regard to follow-up care, the Act does 
     not preempt State laws providing greater protection to 
     patients and policyholders or providing an option of timely 
     follow-up care in the home.
       Section 11. Effective Date: The Act is effective on the 
     first day of the plan year or contract year beginning on or 
     after January 1, 1997.

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