Newborns' and Mothers' Health Protection Act Provisons

Issued and entered September 26, 2000 by Frank M. Fitzgerald, Commissioner of Financial and Insurance Services
 

In 1996, Congress passed the Health Insurance Portability and Accountability Act. An amendment was added in September of 1996 titled "The Newborns' and Mothers' Health Protection Act of 1996 (NMHPA)" and was effective January 1, 1998. The act establishes a minimum hospital stay in connection with childbirth. The law applies to group health plans, to health insurance issuers that offer insurance in the group health market, and to health insurance issuers who sell coverage in the individual market.

The act does not require group health plans or health insurance issuers to offer benefits for a hospital stay in connection with childbirth. However, if they chose to offer these benefits, then the group health plans and health insurance issuers must comply with NMHPA, and implement the following guidelines in their plans:

A group health plan and a health insurance issuer offering group health insurance or individual insurance may not restrict benefits for any length of hospital stay in connection with childbirth for the mother or the newborn child, following a normal vaginal delivery, to less than 48 hours, or

Restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a cesarean section, to less than 96 hours, or

Require the provider to obtain authorization for any portion of the 48/96 hour hospital stay. The timeline does not apply if the provider and the mother determine a shorter length of stay may be appropriate.

Nothing in this law requires a mother to give birth in a hospital or to stay in the hospital for a fixed period of time following the birth of her child.

The law does not prohibit health plans and issuers from instituting copayments, deductibles, or other cost-sharing on childbirth hospital stays, as long as the coinsurance or other cost-sharing for any portion of a period within a hospital stay required under this law is not greater than that required for any preceding portion of the stay.

A group health plan or a health insurance issuer offering group health insurance or individual insurance coverage may not:

• Deny to the mother or her newborn child eligibility, or continued eligibility, to enroll or to renew coverage solely for the purpose of avoiding the requirements of this section.
   
• Provide monetary payments or rebates to mothers to encourage such mothers to accept less than minimum protections available under this section.
   
• Penalize or reduce or limit the reimbursement of an attending provider because the provider provided care in accordance with this law.
   
• Provide incentives to an attending provider to induce them to provide care to an individual participant or beneficiary in a manner inconsistent with this section.
   
• Restrict benefits for any portion of a period within a hospital length of stay required in this law in a manner, which is less favorable than the benefits provided for any preceding portion of such stay.
   

The Federal law requires plans and issuers that are subject to the NMHPA to provide notice to plan participants or to covered individuals about covered benefits. A group health plan must comply with the notice requirements under section 711(d) of the Employee Retirement Income Security Act of 1974 (ERISA). Insurers providing coverage in the individual market must comply with the notice requirements under section 2751(b) of the Public Health Services (PHS) Act.

In Michigan, when a commercial insurer, HMO or Blue Cross plan writes employer group health coverage or individual coverage, then the coverage must meet the Newborns' and Mothers' Health Protection Act requirements as described above. Any employer group health coverage or individual coverage documents submitted for prior approval to the Commissioner will not be approved unless they comply with the NMHPA requirement because failure to comply with such requirements may violate the unfair trade practices sections of Michigan's Insurance Code and Blue Cross Act.

Failure by an insurer, HMO, Or a Blue Cross plan to comply with NMHPA would constitute a violation of Chapter 20, Unfair and Prohibited Trade Practices and Fraud, of the Michigan Insurance Code of 1956 (MCL500.2001 through 500.2093: MSA 24.12001 through 24.12093) or the Nonprofit Health Care Corporation Reform Act (MCL 550.1101 through 550.1704: MSA 24.660(101) through 24.660(704) and invoke appropriate administrative action. Noncompliance may also result in withdrawal of approval of forms or in implementation of fines.

Any questions regarding this bulletin should be directed to:

Office of Financial and Insurance Services
Division of Insurance Research and Consumer Services
611 West Ottawa Street
P.O. Box 30220
Lansing, Michigan 48909-7720

Phone: (517) 373-2984
Toll Free (877) 999-6442