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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 22 / 83

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of the following criteria: (1) requires such coverage to provide for at least a 48-hour hospital

length of stay following a vaginal delivery and at least a 96-hour length of stay following a

delivery by cesarean section, (2) requires such 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 other established professional medical

associations, or (3) requires, in connection with such coverage for maternity care, that the hospital

length of stay for such care is left to the decision of (or is required to be made by) the attending

provider in consultation with the mother.

Accordingly, the federal NMHPA requirements do not apply to insured plans (and

partially-insured plans, to the extent benefits for hospital lengths of stay in connection with

childbirth are provided through insurance coverage) in States in which a State law meets one or

more of the above criteria. Moreover, the federal NMHPA requirements do not apply to issuers

(both in the group market and the individual market) in States in which State law meets one or

more of the above criteria. However, the federal NMHPA requirements apply to self-insured

plans (and partially-insured plans, to the extent benefits for hospital lengths of stay in connection

with childbirth are provided other than through insurance coverage), regardless of State law.

According to a chart developed by the National Association of Insurance Commissioners

for a hearing in September 1997 before the House Committee on Ways and Means, Subcommittee

on Health, many States already had provisions in their laws or regulations prescribing benefits for

hospital lengths of stay in connection with childbirth before the enactment of NMHPA.

. . . which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance . . . . Such term does not include a group health plan.” ERISA section 733(b)(2) and PHS Act section 2791(b)(2).

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