Newborns’ and Mothers’ Health Protection Act (NMHPA)

Overview
Signed into law in 1996, the NMHPA is intended to prevent group health plans and health insurance issuers from restricting hospital stay benefits to less than 48 hours following childbirth; 96 hours following a C-section.)

Final Rules
Effective January 1, 2009, the final regulations for the NMHPA do not vary significantly from the previous interim regulations. However, they do introduce the following important clarifications:

• Hospital Stay Determination: Only the patient’s attending provider (i.e.., physician, physician assistant, nurse midwife, or nurse practitioner) can determine:
• When a hospital admission is in connection with childbirth.
• When the hospital stay begins.
• When to make an exception to the 48/96-hour rule (in consultation with the mother).

• State Law Exception: The Act does not preempt existing state laws governing hospital stay coverage for newborns and mothers (provided that the state law provides protection at least as good as the Act). Wisconsin health plans and health insurance issuers must follow the federal mandate as Wisconsin has not passed a separate newborns’ and mothers’ statute.

• Initial Notice of Post-Childbirth Hospitalization Benefits: All ERISA-covered group health plans are required to follow their normal procedures for notifying groups about benefit updates. For nonfederal government plans, the Act calls for similar, ERISA-like notice requirements. WPS currently complies with federal notification requirements for our risk plans and assists with notification requirements for our self-funded plans.