illustrated by the following example:
(i) In the case of a delivery by cesarean section,
a group health plan subject to the requirements of this section automatically provides benefits for any hospital length of stay
of up to 72 hours. attending provider
For any longer stay, the to complete a certificate
plan requires of medical
The plan then makes a
certificate of medical medically necessary.
determination, based on the whether a longer stay is
In this Example, the requirement that an attending
provider complete authorization for
a certificate of medical necessity the period between 72 hours and 96
to obtain hours
paragraph (a)(4). (5) Exceptions
(i) Discharge of mother.
If a decision to
discharge a mother earlier than the period specified in paragraph (a)(1) of this section is made by an attending provider, in consultation with the mother, the requirements of paragraph (a)(1) of this section do not apply for any period after the
discharge. (ii) Discharge of newborn.
If a decision to discharge a
newborn chi (a)(1) of t consultatio representat section do
(iii) section, at under appli and who is pediatric c
ld earlier than the period specified in p his section is made by an attending provi n with the mother (or the newborn’s autho ive), the requirements of paragraph (a)(1 not apply for any period after the discha
Attending provider defined.
tending provider means an individual cable State law to provide maternity
who or p
directly are to a xample.
responsible for providing matern mother or newborn child. The rules of this paragraph (a)(
aragraph der, in rized ) of this rge. s of this is licensed ediatric care ity or