labor lawAdivision of labor law center

The U.S. Department of Labor recently issued final rules under the Newborns’ and Mothers’ Health Protection Act of 1996. These new regulations take effect on December 19, 2008, according to a recent news bulletin by the SHRM, the Society of Human Resource Management.  The regulations apply to health insurance plans issued on or after January 1, 2009.

The rules were issued in conjunction with the U.S. Department of Health and Human Services and the Treasury Department. The rules apply to group health plans and health insurers, including businesses that are self-ensured.

The new U.S. Department of Labor rule extends the length of time mothers and newborn babies may stay in the hospital, following childbirth.

Under the “general rule”, employers or their healthcare plans cannot limit benefits for a hospital stay after a normal delivery to 48 hours. However, the employer or healthcare plan cannot restrict the hospital stay to a shorter period. In addition, employers can restrict the hospital stay after a cesarean to 96 hours – but cannot require that mothers leave the hospital sooner.

This rule was implemented because many healthcare plans, in an effort to control costs, were limiting hospital stays for mothers and newborns to 12 hours or less after delivery.

The new federal regulations do not require that new mothers stay in the hospital that long. Under an exception, the attending doctor is free to authorize an earlier discharge after consulting with the mother. However, the regulations contain a long list of restrictions to ensure that the early discharge does not endanger the health of mother or infant. In particular, the insurance company cannot provide financial incentives to healthcare providers to release mothers from the hospital earlier.

The regulations give the attending provider the discretion to decide when a hospital admission is in connection with a childbirth, and when the hospital stay begins for the purposes of these regulations. In one change to the rules, the definition of attending provider has been changed to specifically exclude an insurance plan, HMO, hospital or other issuer, including an employer who is self-ensured. The attending provider must be an individual licensed to provide maternal or pediatric care, such as a doctor or midwife.

Health care plans, including employers who are self-insured, are required to provide notice of these new rules to employees under ERISA regulations. The notice can be in benefit handbooks, in print, or distributed electronically.

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