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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 21 / 83





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now cover at least 48 hours following a vaginal delivery and at least 96 hours following a delivery

by cesarean section unless the attending provider, in consultation with the mother, decides to

discharge earlier.

Many believe that the minimum length of stay requirements of 48 hours for a vaginal

delivery and 96 hours for a cesarean section will have a positive impact on the overall health and

well-being of mothers and newborns. The longer stays will allow health care providers sufficient

time to screen for metabolic and genetic disorders in newborns. It will also permit time to provide

parental education to mothers and to assess their ability to care for their newborn.

Although some services performed in an inpatient hospital setting may be effectively

provided in other settings, such as clinics or physicians’ offices, not all women have had access to

the full range of appropriate follow-up care. NMHPA ensures that many women and newborns

with health coverage will now be provided an acceptable level of postpartum care.

Many States11 have enacted laws that prescribe benefits for hospital lengths of stay in

connection with childbirth. NMHPA provides that the federal NMHPA requirements do not

apply with respect to health insurance coverage12 if there is a State law that satisfies one or more

11 For purposes of Part 7 of ERISA and Title XXVII of the PHS Act (including the NMHPA provisions), 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.)

12 The term health insurance coverage means “benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including any items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer.” ERISA section 733(b)(1) and PHS Act section 2791(b)(1). The term health insurance issuer means “an insurance company, insurance service, or insurance organization


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