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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 10 / 83





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that a plan or issuer does not violate this prohibition by providing after-discharge, follow-up

services to a mother and newborn discharged early if those services are not more than what the

mother and newborn would have received if they had stayed in the hospital the full 48 hours (or

96 hours).

In addition, with respect to benefit restrictions, NMHPA and the interim rules provide that

a plan or issuer may not restrict the benefits for any portion of a 48-hour (or 96-hour) hospital

length of stay in a manner that is less favorable than the benefits provided for any preceding

portion of the stay. This prohibition includes certain types of precertification requirements,

discussed below in the Authorization and precertification section.

Finally, with respect to attending providers, NMHPA provides that a plan or issuer may

not penalize, or otherwise reduce or limit the reimbursement of, an attending provider because the

provider furnished care to a mother or newborn in accordance with NMHPA, or provide

monetary or other incentives to an attending provider to induce the provider to furnish care to a

mother or newborn in a manner inconsistent with NMHPA. The interim rules clarify this

prohibition in four ways. First, the prohibition applies to both direct and indirect incentives to

attending providers. Second, penalties against an attending provider include taking disciplinary

action against or retaliating against the attending provider. Third, the term “compensation” is

used in the interim rules rather than the term “reimbursement” to clarify that all forms of

remuneration to attending providers are included in the prohibition, and to avoid any confusion

that otherwise could result from the fact that the term “reimbursement” has a narrower meaning in

some insurance contexts. Fourth, the statutory phrase “to induce” is interpreted to include

providing any incentive that could induce an attending provider to furnish care inconsistent with


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