What is the Newborns' and Mothers' Health Protection Act?
By Melissa McCall, J.D. | Legally reviewed by Aviana Cooper, Esq. | Last reviewed July 22, 2023
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The Newborns' and Mothers' Health Protection Act of 1996 (NMHPA) is a federal law that deals with how long a mother and newborn can stay in the hospital after birth. Under this public health law, some health insurance issuers must pay for hospital stays following delivery.
The type of delivery determines the length of time you can stay in the hospital. For vaginal delivery, it is at least 48 hours. For cesarean sections, it is 96 hours. These periods begin at the time of delivery, not when the hospital admits the pregnant woman. Only the attending provider can discharge the mother and her newborn child before the time ends. The provider must consult the mother before discharge.
This article explores the purpose of the NMHPA and examines a few of its regulations.
Purpose of the Newborns' and Mothers' Health Protection Act of 1996
New moms face many health conditions following labor requiring further medical care. Some of these conditions include the following:
- Incontinence
- Continued contractions
- Cesarean section wounds
- Uterine or breast infections
- Blood clots or heavy bleeding
Maternal Well-Being
Maternal well-being is an essential aspect of women's health. Before Congress enacted this bill, health insurance companies pressured health care providers to quickly discharge mothers after birth. Often this was against their professional judgment.
Early birth increases "health risks for mothers and newborns." This includes preventable risks, such as newborn jaundice. This also includes mental health conditions like postpartum depression. Maternity care and maternal well-being are not limited to the prenatal period.
Postpartum Care
Congress modeled the NMHPA after guidelines set forth by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). Allowing a minimum 48-hour stay ensures the mother and newborn receive adequate postpartum care.
Maternal health care providers can screen the newborn child for metabolic and genetic disorders and educate the mother. They can also plan follow-up care based on test results. The minimum stay also allows health care providers to fulfill initiatives like breastfeeding.
Coverage Requirements
The NMHPA has a few unique rules. First, health insurance companies cannot provide incentives to the mother in exchange for not accepting all the benefits under the NMHPA. They cannot incentivize health care providers (including nurse midwives and physician assistants) to discharge mothers before the time is up. Pre-authorization for pregnant women is not necessary under the NMHPA.
Special Enrollment
A new birth or adoption triggers a special enrollment period. Special enrollment allows new parents or dependents to enroll in a new health care plan. If they enroll in their employer's plan, they must notify their plan within 30 days of the birth or adoption. This timeframe doubles if they enroll in a health care plan on the Health Exchange Marketplace.
Health Insurance Portability and Accountability Act (HIPAA)
As with any health benefit plan, HIPAA protects your right to privacy. Unless there is an exception to HIPAA's rules, your attending provider cannot share any information without your consent.
Health Care Plans Subject to the Newborns' Act
The NMHPA applies to health insurance coverage self-insured by the employment-based plan. State laws may offer similar protections if you get your insurance from an HMO.
The Act applies to two types of health insurance:
- Group health plans (through an employer or union), and
- Individual health insurance plans (self-insured).
The U.S. Department of Labor regulates private employer group health plans. The Centers for Medicare & Medicaid Services (CMS) regulates state and local government plans. A State's insurance department handles group health plans. It is the insurance company's regulator. Your plan administrator can share the status of your plan.
The Employee Retirement Income Security Act (ERISA) enforces private employer-based health care plans.
Group Market
On Oct. 20, 2008, the Internal Revenue Service (IRS), the U.S. Department of Labor (USDOL), and the Department of Health and Human Services (HHS), together, issued interim final rules implementing the group market provisions of the NMHPA. Group market refers to group health insurance plans.
Cost-Sharing
If your hospital length of stay exceeds 48 or 96 hours, as outlined in the NMPHA, your share of the costs should stay the same. The Final Rules for the NMHPA are clear on cost-sharing. Your health insurance provider can only charge up if your stay is within the stated hours. The cost-sharing rate must remain consistent throughout your entire stay.
Get Help
The Newborns' and Mother's Health Protection Act provides health protection for mothers. Speak to an experienced local health care attorney for help or guidance.
Next Steps
Contact a qualified health care attorney to help navigate legal issues around your health care.