Newborn Health Protection Act

The Newborns’ and Mothers’ Health Protection Act (NMHPA) includes important protections for mothers and their newborn children with regard to the length of a hospital stay following childbirth. The NMHPA affects the amount of time a mother and her newborn child are covered for a hospital stay following childbirth.

Plans Covered

The type of coverage provided by your plan (insured vs. self-insured) and state law will determine whether the NMHPA applies to a mother’s or a newborn’s coverage.

Self-Insured coverage is subject to the NMHPA.

• If the coverage you provide is insured by an insurance company or HMO and your state has a law regulating coverage for newborns and mothers that meet specific criteria, then the coverage you provide may depend on state law, rather than the NMHPA.

If this is the case, the state law may differ slightly from the NMHPA requirements, so it is important for you to know which law applies to your coverage.

You should contact your State Insurance Commissioner’s Office for the most current information.

Provisions

Group health plans, insurance companies and health maintenance organizations (HMOs) that are subject to the 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.

• The attending provider (who may be a physician or nurse midwife) may decide, after consulting with you, to discharge you or your newborn child earlier.
  • The attending provider is any individual licensed under state law to provide maternity or pediatric care and is providing such care to a mother or newborn child.  This may include a physician, physician assistance or nurse midwife; however, this may NOT include a health plan, insurer or hospital.
• The NMHPA, and its regulations, prohibit incentives (either positive or negative) that could encourage less than the minimum protections under the Act as described above.
• A mother cannot be encouraged to accept less than the minimum protections available to her under the NMHPA and an attending provider cannot be induced to discharge a mother or newborn earlier than 48 or 96 hours after delivery.

A plan, insurance company or HMO cannot deny the mother of her newborn child coverage for a 48-hour stay (or 96-hour stay) because the plan claims that the mother or her attending provider, have failed to show that the 48-hour stay (or 96-hour stay) is medically necessary.

• However, plans, insurance companies and HMOs generally can require the family to notify the plan of the pregnancy in advance of an admission if the mother wishes to use certain providers or facilities, or to reduce her out-of-pocket costs.
• Plans may require precertification for hospital lengths of stay beyond the 48 or 96 hour period.

The NMHPA does not require plans, insurance companies or HMOs to provide coverage for hospital stays in connection with childbirth.  However, if this coverage is offered, the NMHPA applies.

Notice of Coverage

A plan subject to NMHPA must include a description of the NMHPA’s requirements for hospital stays for newborns and mothers in its Summary Plan Description (SPD).  If state law applies to a fully-insured plan, the SPD should describe the applicable benefits/requirements.  In cases where an employer has both self-insured and fully-insured plans in different areas, the SPD should describe the areas and the applicable requirements in each.

Click Here for sample language of the NMHPA notice.

Additional Resources

NMHPA Sample Language for SPD

Department of Labor Web Site

DOL Self-Compliance Tool