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The Newborns' and Mothers' Health Protection Act

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Summary
Questions and Answers
Interim Rules
Statutory Text

Summary

The Newborns' and Mothers' Health Protection Act of 1996 (NMHPA) affects the amount of time you and your newborn child are covered for a hospital stay following childbirth. The law applies both to persons enrolled in group health plans and to persons who have individual health care coverage. In general, plans and health insurance issuers that are subject to NMHPA may NOT restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section.

If you deliver in the hospital, the 48-hour (or 96-hour) period starts at the time of delivery. If you deliver outside the hospital and you are later admitted to the hospital in connection with childbirth, the period begins at the time of the admission.

Although the NMHPA prohibits group health plans and health insurance issuers from restricting the length of a hospital stay in connection with childbirth, the plan or health insurance issuer does not have to cover the full 48 or 96 hours in all cases. If an attending provider, after speaking with you, determines that either you or your child can be discharged before the 48-hour (or 96-hour) period, the group health plan and health insurance issuers do not have to continue covering the stay for whichever one of you is ready for discharge. An attending provider is an individual, licensed under State law, who is directly responsible for providing maternity or pediatric care to you or your newborn child. In addition to physicians, an individual such as a nurse midwife, physician assistant, or nurse practitioner may be an attending provider. A plan, hospital, insurance company, or HMO would NOT be an attending provider.

Two key factors determine whether NMHPA protections apply to your health insurance coverage. First, protection depends on whether the benefits under your group health plan or insurance policy include coverage for hospital stays following childbirth. NMHPA does NOT require group health plans and health insurance issuers to provide that kind of coverage. Second, even if your group health plan or health insurance issuer chooses to cover hospital stays in connection with childbirth, you need to find out how your group health plan provides nefits. Group health plans that provide benefits through insurance are known as insured plans. Group health plans that pay for coverage directly, without purchasing health insurance from an issuer, are called self-insured plans.

Contact your plan administrator to find out if your coverage is insured or self-insured.

If you are in a self-insured group health plan, your health coverage must comply with NMHPA standards. If you are in an insured group plan or if you have individual insurance coverage, the NMHPA might NOT apply if your State has a law with certain protections for hospital stays following childbirth. As of mid-2000, more than 40 states and the District of Columbia had laws that take precedence over NMHPA.

Click on the name of your State insurance department under 'Contacts' to find out what requirements exist under State law for benefits related to hospital stays following childbirth.

Answers to Commonly Asked Questions

• General Questions on the NMHPA

Interim Rules

The Department of Health and Human Services (DHHS), the Department of Labor, and the Department of the Treasury (the Departments) share authority for implementation and enforcement of the NMHPA. Under this shared authority, the Departments cooperatively developed a Joint Interim Rule that was issued on October 27, 1998. The Joint Interim Rule applies to plans and issuers in the group market for plan years beginning on or after January 1, 1999. The Interim Rule also contains regulations issued exclusively by the DHHS that govern the individual market. The individual market rules apply to health insurance coverage on or after January 1, 1999.

• Joint Interim Rule
  Full text of the Joint Interim Rule issued October 27, 1998. The Joint Interim Rule provides guidance on how the NMHPA will be implemented and enforced and explains the jurisdiction of each Department. With few exceptions, the rules for each Department are substantively identical.
   
• DHHS Interim Rules
  Provisions of the October 27, 1998 Interim Rule issued by the DHHS. These provisions include the provisions shared with the Department of Labor and the Treasury, as well as those provisions related to the individual market that are within the sole jurisdiction of the DHHS.

Statutory Text

Statutory provisions of the NMHPA (P.L. 104-204), enacted September 26, 1996, including the amendments to Title XVII of the Public Health Service Act (PHS Act). The statutory language sets forth the general rules, exceptions and prohibitions in the law. For more detailed information on how the law is implemented and enforced, please see the Joint Interim Rule issued October 27, 1998 and the Interim Rule issued by the DHHS, also issued October 27, 1998.

• NMHPA Statutory Text
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