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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 63 / 83

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following the initial 48-hour stay is prohibite paragraph (b)(2) because benefits for the latte are restricted in a manner that is less favorab for a preceding portion of the stay. (However, not prohibit a plan from requiring precertifica period after the first 96 hours.) In addition, utilization reviewer denied any mother or her n within the 96-hour stay, the plan would also vi (a) of this section.

d by this r part of the stay le than benefits

this section does tion for any

if the plan’s ewborn benefits olate paragraph

(3) plan, and insurance

With respect to attending providers. a health insurance issuer offering gr coverage, may not directly or indirec

(i) Penalize (for example, take disciplina or retaliate against), or otherwise reduce or l compensation of, an attending provider because furnished care to a participant or beneficiary this section; or

A group health oup health tly ry action against imit the the provider in accordance with

(ii) Provide monetary or other incentives provider to induce the provider to furnish care or beneficiary in a manner inconsistent with th including providing any incentive that could in provider to discharge a mother or newborn earli (or 96 hours) after delivery.

to an attending

to a participant is section, duce an attending er than 48 hours

(c) following

Construction.

With respect to

rules

of

construction

apply:

this

s

ection, the

(1) Hospital stays not mandatory. require a mother to

This section does not

  • (i)

    Give birth in a hospital; or

  • (ii)

    Stay in the hospital for a fixed peri

following the birth of her child.

od of time

63

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