Home > Resources > Compliance Resources > Compliance Quarterly > February 2009 Compliance Quarterly > The Newborns’ and Mothers’ Health Protection Act

Final Regulations Issued Regarding The Newborns’ and Mothers’ Health Protection Act

This Act is sometimes referred to as the “Drive-Through Delivery Act.”  It mandates minimum covered hospital stays following childbirth. The final regulations replace the interim rules that many health plans have been operating under for years. As you are aware, the Newborns’ and Mothers’ Health Protection Act prohibits group health plans and health insurance issuers from restricting mothers’ and newborns’ benefits for a hospital length of stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a cesarean delivery. 

To whom does the Act apply?
Applies to both large and small group health plans, including self-funded, fully insured, governmental and church plans.

What do the final regulations do?
For the most part, the final rules did not change much from the interim rules. The interim rules originally provided, among other things, that:

• In order to calculate the 48 hour/96 hour requirement, a hospital stay is considered to start at the time of delivery and not admission.
• The mother, in consultation with her physician, may be discharged earlier if she wishes.
• A group health plan may not require prior authorization during the initial 48 hours/96 hour timeframe. However, group health plans may require advance notice for hospital stays in connection with childbirth and certainly can require prior authorization after the initial 48 hours/96 hour timeframe.

There were a few minor clarifications to the interim rules that are outlined below:

• A plan, hospital, managed care organization or other issuer will never be considered an attending provider.
• Notice requirements are clarified to provide that: (a) nonfederal government plans must provide notice of the Acts’ provisions either in the plan document or the document that is generally used to inform participants and beneficiaries of benefit changes and (b) ERISA group health plans can provide the notice electronically, consistent with the DOL regulations. (These requirements were identified in last quarter’s Question of the Quarter; please refer to that article for more detail.)
• State law exemption applies when a state law requires health insurance coverage in accordance with professional guidelines that deal with care following childbirth.

When do the regulations go into effect?
The regulations went into effect December 19, 2008 and will apply to group health plans on the first day of the first plan year on or after January 1, 2009.

How does the Act impact employers?
For most the most part, Meritain Health’s clients are already in compliance with these final regulations. If you have concerns that your plan is not in compliance, contact your Client Relationship Manager to request a review of your benefit design.

Compliance Quarterly is being provided as an informational tool. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this publication and any attachments, Meritain Health is not exercising discretionary authority over the plan and is not assuming a plan fiduciary role, nor is Meritain Health providing legal advice.