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Final regulations for the Newborns' and Mothers' Health Protection Act of 1996 were published by the US Departments of Labor, Health and Human Services and Treasury on October 20, 2008.
Clarifications: Interim 1998 rules prohibit group health plans and health insurers from restricting mothers' and newborns' benefits for a hospital stay for childbirth to less than 48 hours following a vaginal delivery or 96 hours
following a delivery by cesarean section. An exception to this rule permits earlier discharges if agreed to by the mother and attending medical provider. These requirements have not changed but the new, final regulations add these
clarifications:
1. When the delivery occurs in a hospital, the 48/96 hour period begins at the time of delivery or last delivery for multiple births;
2. When the delivery occurs outside the hospital, such as en route or at a birthing center, the 48/96 hour period begins when the mother or newborn is admitted to the hospital;
3. Health plans and insurers are required to provide benefits for the minimum stays but hospitals and other facilities are not regulated by these rules; and
4. An "attending medical provider" who may approve an earlier discharge need not be a physician; it is an individual who is:
- licensed under applicable state law to provide maternal or pediatric care and
- is directly responsible for providing such care to a mother or newborn child.
Notices: Employers are NOT required to distribute separate or annual notices of childbirth hospitalization benefits, but:
- Summary plan descriptions must include a description of post-childbirth hospitalization benefits.
- State and local government employers may provide an initial notice of these benefits and must include the notice in the plan document that describes benefits or in whatever document the plan generally uses to inform participants and
beneficiaries of plan benefit changes.
Dates Applicable: These regulations will apply to group health plans for plan years beginning on or after January 1, 2009 and for individual health insurance coverage offered, sold, issued, renewed, in effect, or operated on or after
January 1, 2009.
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