Topic

THE NEWBORNS AND MOTHERS HEALTH PROTECTION ACT

--TITLE VI OF THE FY 1997 VETERANS ADMINISTRATION AND HOUSING AND URBAN DEVELOPMENT APPROPRIATIONS ACT, P.L. 104-204
Signed into law: Sept. 26, 1996
Effective: January 1, 1998

Summary

Congress passed and President Clinton Sept. 26 signed into law PL. 104-204, which requires health insurance plans to cover 48-hour hospital stays for mothers and their newborns, and 96-hour-stays after a Caesarean section. The law applies to commercial insurance and ERISA health plans. The legislation addresses concerns that some mothers and newborns are discharged too early because of health plan guidelines. It puts more control in the caregiver's hands by requiring coverage for the second day if the physician and the mother believe the time is necessary. The patient, however, would be permitted to leave the hospital in less than 48 hours if her caregiver, in consultation with the new mother, agrees.

The law doesn't immediately affect the level of payment to providers, but down the road could lead to health plans renegotiating payments for maternity stays (see implications). Consumers are protected by a provision that bars health plans from charging higher co-pays for the second day of care. The law also clamps down on health plan incentives that could encourage a provider to discharge a mother earlier.

The law also requires the Department of Health and Human Services to set up, by April 1998, an advisory panel to study the adequacy of health care services provided to mothers and newborns. HHS also must study issues related to quality of care and maternity length of stay and report to Congress within five years.

Implications for hospitals and health systems

  • The law does not preempt state law guaranteeing 48-hour hospital stays for new mothers -- and 96 hours for a Caesarean section -- when states follow maternity and pediatric care guidelines set by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, or other recognized medical associations, or leave length-of-stay decisions with the patient and provider. Consequently, PL. 104-204 probably won't preempt many of the 25 state minimum-length-of-stay laws now on the books.
  • Insurers and hospitals may want to renegotiate provider payment for maternity stays. States that have similar legislation have reported that health plans are looking to pay hospitals on a per-case or lower per-diem fee.
  • Some of the hospital's and health plan's costs of second-day care could be avoided by replacing the second day with appropriate follow-up services for patients. Some hospitals and health plans find follow-up care is a useful tool in assessing the condition of newborns and mothers, and is well-received by their families.

For copies of case studies on follow-up care, call the AHA's Center for Health Care Leadership at

(312) 422-EXEC. You also may want to look at a September study by the General Accounting Office: Maternity Care.- Appropriate Follow- Up Services Critical With Short Hospital Stays. You can access it by going to GAO's World Wide Web home page at: http://www.gao.gov and click on GAO reports.

The legislation, Title VI of the FY 1997 HUD-VA Appropriations Act, was published in the Sept. 20 Congressional Record. You can find the conference report language on page H 10756; the legislative language is on pages H 10742-44. If you're on the Internet, you can find the act's legislative language by accessing http://thomas.loc.gov and click on bill, then search for either H.R. 3666, the House maternity-stay bill that was enacted into law, or P.L. 104-204.

 

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