
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC300gg-4]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
   SUBCHAPTER XXV--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
 
                      Part A--Group Market Reforms
 
                      subpart 2--other requirements
 
Sec. 300gg-4. Standards relating to benefits for mothers and 
        newborns
        

(a) Requirements for minimum hospital stay following birth

                           (1) In general

        A group health plan, and a health insurance issuer offering 
    group health insurance coverage, may not--
            (A) except as provided in paragraph (2)--
                (i) restrict benefits for any hospital length of stay in 
            connection with childbirth for the mother or newborn child, 
            following a normal vaginal delivery, to less than 48 hours, 
            or
                (ii) 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

            (B) require that a provider obtain authorization from the 
        plan or the issuer for prescribing any length of stay required 
        under subparagraph (A) (without regard to paragraph (2)).

                            (2) Exception

        Paragraph (1)(A) shall not apply in connection with any group 
    health plan or health insurance issuer in any case in which the 
    decision to discharge the mother or her newborn child prior to the 
    expiration of the minimum length of stay otherwise required under 
    paragraph (1)(A) is made by an attending provider in consultation 
    with the mother.

(b) Prohibitions

    A group health plan, and a health insurance issuer offering group 
health insurance coverage in connection with a group health plan, may 
not--
        (1) deny to the mother or her newborn child eligibility, or 
    continued eligibility, to enroll or to renew coverage under the 
    terms of the plan, solely for the purpose of avoiding the 
    requirements of this section;
        (2) provide monetary payments or rebates to mothers to encourage 
    such mothers to accept less than the minimum protections available 
    under this section;
        (3) penalize or otherwise reduce or limit the reimbursement of 
    an attending provider because such provider provided care to an 
    individual participant or beneficiary in accordance with this 
    section;
        (4) provide incentives (monetary or otherwise) to an attending 
    provider to induce such provider to provide care to an individual 
    participant or beneficiary in a manner inconsistent with this 
    section; or
        (5) subject to subsection (c)(3) of this section, restrict 
    benefits for any portion of a period within a hospital length of 
    stay required under subsection (a) of this section in a manner which 
    is less favorable than the benefits provided for any preceding 
    portion of such stay.

(c) Rules of construction

    (1) Nothing in this section shall be construed to require a mother 
who is a participant or beneficiary--
        (A) to give birth in a hospital; or
        (B) to stay in the hospital for a fixed period of time following 
    the birth of her child.

    (2) This section shall not apply with respect to any group health 
plan, or any group health insurance coverage offered by a health 
insurance issuer, which does not provide benefits for hospital lengths 
of stay in connection with childbirth for a mother or her newborn child.
    (3) Nothing in this section shall be construed as preventing a group 
health plan or issuer from imposing deductibles, coinsurance, or other 
cost-sharing in relation to benefits for hospital lengths of stay in 
connection with childbirth for a mother or newborn child under the plan 
(or under health insurance coverage offered in connection with a group 
health plan), except that such coinsurance or other cost-sharing for any 
portion of a period within a hospital length of stay required under 
subsection (a) of this section may not be greater than such coinsurance 
or cost-sharing for any preceding portion of such stay.

(d) Notice

    A group health plan under this part shall comply with the notice 
requirement under section 1185(d) of title 29 with respect to the 
requirements of this section as if such section applied to such plan.

(e) Level and type of reimbursements

    Nothing in this section shall be construed to prevent a group health 
plan or a health insurance issuer offering group health insurance 
coverage from negotiating the level and type of reimbursement with a 
provider for care provided in accordance with this section.

(f) Preemption; exception for health insurance coverage in certain 
        States

                           (1) In general

        The requirements of this section shall not apply with respect to 
    health insurance coverage if there is a State law (as defined in 
    section 300gg-23(d)(1) of this title) for a State that regulates 
    such coverage that is described in any of the following 
    subparagraphs:
            (A) Such State law requires such coverage to provide for at 
        least a 48-hour hospital length of stay following a normal 
        vaginal delivery and at least a 96-hour hospital length of stay 
        following a cesarean section.
            (B) Such State law requires such coverage to provide for 
        maternity and pediatric care in accordance with guidelines 
        established by the American College of Obstetricians and 
        Gynecologists, the American Academy of Pediatrics, or other 
        established professional medical associations.
            (C) Such State law requires, in connection with such 
        coverage for maternity care, that the hospital length of stay 
        for such care is left to the decision of (or required to be made 
        by) the attending provider in consultation with the mother.

                          (2) Construction

        Section 300gg-23(a)(1) of this title shall not be construed as 
    superseding a State law described in paragraph (1).

(July 1, 1944, ch. 373, title XXVII, Sec. 2704, as added Pub. L. 104-
204, title VI, Sec. 604(a)(3), Sept. 26, 1996, 110 Stat. 2939.)


                            Prior Provisions

    A prior section 2704 of act July 1, 1944, was successively 
renumbered by subsequent acts and transferred, see section 238c of this 
title.


                             Effective Date

    Section 604(c) of Pub. L. 104-204 provided that: ``The amendments 
made by this section [enacting this section and amending sections 300gg-
21 and 300gg-23 of this title] shall apply with respect to group health 
plans for plan years beginning on or after January 1, 1998.''


                         Congressional Findings

    Section 602 of title VI of Pub. L. 104-204 provided that: ``Congress 
finds that--
        ``(1) the length of post-delivery hospital stay should be based 
    on the unique characteristics of each mother and her newborn child, 
    taking into consideration the health of the mother, the health and 
    stability of the newborn, the ability and confidence of the mother 
    and the father to care for their newborn, the adequacy of support 
    systems at home, and the access of the mother and her newborn to 
    appropriate follow-up health care; and
        ``(2) the timing of the discharge of a mother and her newborn 
    child from the hospital should be made by the attending provider in 
    consultation with the mother.''


                Reports to Congress Concerning Childbirth

    Section 606 of title VI of Pub. L. 104-204 provided that:
    ``(a) Findings.--Congress finds that--
        ``(1) childbirth is one part of a continuum of experience that 
    includes prepregnancy, pregnancy and prenatal care, labor and 
    delivery, the immediate postpartum period, and a longer period of 
    adjustment for the newborn, the mother, and the family;
        ``(2) health care practices across this continuum are changing 
    in response to health care financing and delivery system changes, 
    science and clinical research, and patient preferences; and
        ``(3) there is a need--
            ``(A) to examine the issues and consequences associated with 
        the length of hospital stays following childbirth;
            ``(B) to examine the follow-up practices for mothers and 
        newborns used in conjunction with shorter hospital stays;
            ``(C) to identify appropriate health care practices and 
        procedures with regard to the hospital discharge of newborns and 
        mothers;
            ``(D) to examine the extent to which such care is affected 
        by family and environmental factors; and
            ``(E) to examine the content of care during hospital stays 
        following childbirth.
    ``(b) Advisory Panel.--
        ``(1) In general.--Not later than 90 days after the date of 
    enactment of this Act [Sept. 26, 1996], the Secretary of Health and 
    Human Services (in this section referred to as the `Secretary') 
    shall establish an advisory panel (referred to in this section as 
    the `advisory panel')--
            ``(A) to guide and review methods, procedures, and data 
        collection necessary to conduct the study described in 
        subsection (c) in a manner that is intended to enhance the 
        quality, safety, and effectiveness of health care services 
        provided to mothers and newborns;
            ``(B) to develop a consensus among the members of the 
        advisory panel regarding the appropriateness of the specific 
        requirements of this title [see section 601 of Pub. L. 104-204, 
        set out as a Short Title of 1996 Amendment note under section 
        201 of this title]; and
            ``(C) to prepare and submit to the Secretary, as part of the 
        report of the Secretary submitted under subsection (d), a report 
        summarizing the consensus (if any) developed under subparagraph 
        (B) or the reasons for not reaching such a consensus.
        ``(2) Participation.--
            ``(A) Department representatives.--The Secretary shall 
        ensure that representatives from within the Department of Health 
        and Human Services that have expertise in the area of maternal 
        and child health or in outcomes research are appointed to the 
        advisory panel.
            ``(B) Representatives of public and private sector 
        entities.--
                ``(i) In general.--The Secretary shall ensure that 
            members of the advisory panel include representatives of 
            public and private sector entities having knowledge or 
            experience in one or more of the following areas:
          ``(I) Patient care.
          ``(II) Patient education.
          ``(III) Quality assurance.
          ``(IV) Outcomes research.
          ``(V) Consumer issues.
                ``(ii) Requirement.--The panel shall include 
            representatives of each of the following categories:
          ``(I) Health care practitioners.
          ``(II) Health plans.
          ``(III) Hospitals.
          ``(IV) Employers.
          ``(V) States.
          ``(VI) Consumers.
    ``(c) Studies.--
        ``(1) In general.--The Secretary shall conduct a study of--
            ``(A) the factors affecting the continuum of care with 
        respect to maternal and child health care, including outcomes 
        following childbirth;
            ``(B) the factors determining the length of hospital stay 
        following childbirth;
            ``(C) the diversity of negative or positive outcomes 
        affecting mothers, infants, and families;
            ``(D) the manner in which post natal care has changed over 
        time and the manner in which that care has adapted or related to 
        changes in the length of hospital stay, taking into account--
                ``(i) the types of post natal care available and the 
            extent to which such care is accessed; and
                ``(ii) the challenges associated with providing post 
            natal care to all populations, including vulnerable 
            populations, and solutions for overcoming these challenges; 
            and
            ``(E) the financial incentives that may--
                ``(i) impact the health of newborns and mothers; and
                ``(ii) influence the clinical decisionmaking of health 
            care providers.
        ``(2) Resources.--The Secretary shall provide to the advisory 
    panel the resources necessary to carry out the duties of the 
    advisory panel.
    ``(d) Reports.--
        ``(1) In general.--The Secretary shall prepare and submit to the 
    Committee on Labor and Human Resources of the Senate and the 
    Committee on Commerce of the House of Representatives a report that 
    contains--
            ``(A) a summary of the study conducted under subsection (c);
            ``(B) a summary of the best practices used in the public and 
        private sectors for the care of newborns and mothers;
            ``(C) recommendations for improvements in prenatal care, 
        post natal care, delivery and follow-up care, and whether the 
        implementation of such improvements should be accomplished by 
        the private health care sector, Federal or State governments, or 
        any combination thereof; and
            ``(D) limitations on the databases in existence on the date 
        of the enactment of this Act [Sept. 26, 1996].
        ``(2) Deadlines.--The Secretary shall prepare and submit to the 
    Committees referred to in paragraph (1)--
            ``(A) an initial report concerning the study conducted under 
        subsection (c) and elements described in paragraph (1), not 
        later than 18 months after the date of the enactment of this 
        Act;
            ``(B) an interim report concerning such study and elements 
        not later than 3 years after the date of the enactment of this 
        Act; and
            ``(C) a final report concerning such study and elements not 
        later than 5 years after the date of the enactment of this Act.
    ``(e) Termination of Panel.--The advisory panel shall terminate on 
the date that occurs 60 days after the date on which the last report is 
submitted under subsection (d).''

                  Section Referred to in Other Sections

    This section is referred to in sections 300gg-23, 300gg-51 of this 
title.
