X hits on this document

PDF document

[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 9 / 83





9 / 83

Many commenters asked whether the length of stay should be calculated from the time of

delivery. Under the interim rules, when delivery occurs in the hospital, the stay begins at the time

of delivery (or in the case of multiple births, at the time of the last delivery). When delivery

occurs outside the hospital, the stay begins at the time the mother or newborn is admitted.

An attending provider is an individual who is licensed under applicable State law to

provide maternity or pediatric care and who is directly responsible for providing such care to a

mother or newborn child. Therefore, a plan, hospital, managed care organization, or other issuer

is not an attending provider. However, a nurse midwife or a physician assistant may be an

attending provider if licensed in the State to provide maternity or pediatric care in connection with



As noted above, an exception to the 48-hour (or 96-hour) general rule applies if the

attending provider decides, in consultation with the mother, to discharge the mother or newborn

earlier. NMHPA and the interim rules prohibit certain practices to ensure that this exception will

not result in early discharges that could adversely affect the health or well-being of the mother or


Specifically, with respect to mothers, NMHPA provides that a group health plan or health

insurance issuer may not deny a mother or her newborn child eligibility or continued eligibility to

enroll or renew coverage under the terms of the plan or policy solely to avoid the NMHPA

requirements, or provide monetary payments or rebates to a mother to encourage her to accept

less than the minimum protections available under NMHPA. The interim rules clarify that such

prohibited payments include payments-in-kind. However, an example in the interim rules clarifies


Document info
Document views285
Page views285
Page last viewedFri Jan 20 16:19:56 UTC 2017