48 96 mandate rule The Newborns Act requires that group health plans that offer maternity coverage pay for at least a 48 hour hospital stay following childbirth 96 hour stay in the case of Cesarean section
No A plan cannot deny you or your newborn child coverage for a 48 hour stay or 96 hour stay because the plan claims that you or your attending provider have failed to show that the 48 hour stay or 96 hour stay is medically necessary The 48 hour or 96 hour period starts at the time of delivery unless a woman delivers outside of the hospital In that case the period begins at the time of the hospital admission The attending provider may decide after consulting with the mother to discharge the mother and or her newborn child earlier
48 96 mandate rule
48 96 mandate rule
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This section shall apply to Medi Cal managed care plan contracts only to the extent that the State Department of Health Care Services obtains any necessary federal approvals and federal financial participation under the Medi Cal program is available and not otherwise jeopardized The Newborns and Mothers Health Protection Act P L 104 204 enacted September 26 1996 including the amendments to Title XVII of the Public Health Service Act PHS Act
If your hospital length of stay exceeds 48 or 96 hours as outlined in the NMPHA your share of the costs should stay the same The Final Rules for the NMHPA are clear on cost sharing Your health insurance provider can only charge up if your stay is within the stated hours The law provides protection on how long mothers and their newborn infants may stay in the hospital following childbirth Group health plans and health issuers may not restrict benefits for a hospital stay following childbirth to less than 48 hours 96 hours following a cesarean section
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The interim final rules and these final regulations provide under paragraph a that a group health plan or a health insurance issuer may not require a physician or other health care provider to obtain authorization from the plan or issuer to prescribe a hospital length of stay that is subject to the general rule print page 62412 Jane is entitled to the 48 hour period which begins upon delivery and ends on Thursday June 4th at 10 00 am
Plans generally may not restrict benefits for a hospital length of stay in connection with childbirth to less than 48 hours in the case of a vaginal delivery See ERISA section 711 a 1 A i or less than 96 hours in the case of a cesarean section See ERISA section 711 a 1 A ii The Newborns and Mothers Health Protection Act of 1996 NMHPA is a federal law that affects the length of time a mother and newborn child are covered for a hospital stay in connection with childbirth Additional ResourcesFact Sheets FAQs
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48 96 mandate rule - In addition to recommending stays ranging from 48 hours for uncomplicated vaginal deliveries to 96 hours for cesarean deliveries the most recent guidelines further specify that early discharge is acceptable as long as certain criteria are met