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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 58 / 83

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connection with a group health plan. ****

*

Subpart C--Requirements Relating to Benefits

3. follows:

Section 146.130

is added

to

Subpart

C

to

read

as

§ 146.130 Standards relating to benefits for mothers newborns. (a) Hospital length of stay (1) General rule.

and

Except as

provided in paragraph (a)(5) of this section, a group health plan, or a health insurance issuer offering group health insurance coverage, that provides benefits for a hospital length of stay in connection with childbirth for a mother or her newborn may not restrict benefits for the stay to less than

(i) 48 hours following a vaginal delivery; or

  • (ii)

    96 hours

    • (2)

      When stay

delivery occurs in

following a delivery by cesarean section.

begins

(i)

Delivery

in

a

hospital.

If

a

hospital,

the

hospital

length

of

stay

for

the the

mother or newborn child begins at the time of delivery (or in case of multiple births, at the time of the last delivery).

(ii) outside a

Delivery hospital,

outside a hospital. the hospital length

If delivery occurs of stay begins at the

time

the

mother

or

newborn

is

admitted

as

a

hospital

inpatient

in

connection with childbirth.

The determination of whether an

admission is in connection with childbirth to be made by the attending provider.

is

a

medical

decision

(3)

Examples.

The

rules

of

paragraphs

(a)(1)

and

(a)(2)

of

58

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