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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 8 / 83





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Except to the extent needed to reflect the statutory differences described above, the interim rules

of each Department are substantively identical. However, there are certain nonsubstantive

differences, including certain stylistic differences in language and structure to conform to

conventions used by a particular Department. These differences have been minimized and any

differences in wording (other than those reflecting differences in the NMHPA statutory provisions

described above) are not intended to create any substantive difference. Finally, the individual

market regulations are issued solely by HHS.

B. Overview of NMHPA and the Interim Rules

The general rule for hospital lengths of stay

NMHPA and the interim rules provide a general rule under which a group health plan and

a health insurance issuer may not restrict mothers’ and newborns’ benefits for a hospital length of

stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours

following a delivery by cesarean section.4 The general rule requires plans and issuers providing

benefits for hospital lengths of stay in connection with childbirth to cover the minimum length of

stay for all deliveries. The interim rules provide that the determination of whether an admission is

in connection with childbirth is a medical decision to be made by the attending provider. An

example clarifies that delivery does not have to occur inside a hospital in order for an admission to

be “in connection with childbirth.” NMHPA and the interim rules permit an exception to the 48-

hour (or 96-hour) general rule if the attending provider decides, in consultation with the mother,

to discharge the mother or her newborn earlier.

4 The interim rules use the term “vaginal delivery” to clarify that all vaginal deliveries, whether with complications or without complications, are subject to the 48-hour length-of-stay requirement.


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