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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 13 / 83

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NMHPA and the interim rules do not prevent a group health plan or a health insurance

issuer from negotiating with an attending provider the level and type of compensation for care

furnished in accordance with the interim rules (including the prohibitions section).

Applicability in certain States

There is an exception to the NMHPA requirements for health insurance coverage in

certain States.6 Specifically, NMHPA and the interim rules do not apply with respect to health

insurance coverage if there is a State law 7 that meets any of the following criteria:

the State law requires health insurance coverage to provide at least a 48-hour (or 96-hour)

hospital length of stay in connection with childbirth,

the State law requires health insurance coverage to provide for maternity and pediatric

care in accordance with guidelines established by the American College of Obstetricians

and Gynecologists, the American Academy of Pediatrics, or any other established

professional medical association, or

the State law requires that decisions regarding the appropriate hospital length of stay in

connection with childbirth be left entirely to the attending provider in consultation with the

6 The term State includes the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, American Samoa, Guam, Wake Island, the Northern Mariana Islands, and the Canal Zone (i.e., the areas and installations in the Republic of Panama made available to the United States pursuant to the Panama Canal Treaty of 1977 and related agreements, until December 31, 1999.)

7 Generally, under Part 7 of ERISA and Title XXVII of the PHS Act, a State law that “prevents the application of ” those provisions is preempted by section 731(a)(1) of ERISA and sections 2723(a)(1) and 2762(a)(1) of the PHS Act. However, NMHPA specifies that State laws that meet the statutory criteria will apply even though they might otherwise “prevent the application of” the NMHPA requirements. See section 711(f) of ERISA and sections 2704(f) and 2751(c) of the PHS Act.

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