HCFA’s new rules on newborn LOS take effect
HCFA’s new rules on newborn LOS take effect
Rules may shield providers from liability
With little fanfare, new rules from the Baltimore-based Health Care Financing Administration (HCFA) that set guidelines for hospital lengths of stay in connection with childbirth have just taken effect. The rules govern implementation of Newborns’ and Mothers’ Health Protection Act (NMHPA), which was passed in September 1996.
NMHPA adds to existing protections under the Health Insurance Portability and Accountability Act, which significantly expanded the federal government’s ability to aggressively pursue alleged health care fraud and abuse.
Basically, the new rules state that a group health plan or other insurance carrier is not allowed to 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. The rules also assert that the only the attending provider — not the insurance company — is allowed to determine whether an admission is in connection with childbirth.
According to the rules, length of stay should be calculated from the time of delivery, if the delivery occurs in the hospital. If delivery occurs outside the hospital, length of stay begins upon admission. There is one exception to the 48-hour rule: The attending provider is allowed to discharge the mother or newborn earlier if the mother agrees to the discharge.
The rules also seek to protect providers from the pressure of payers to discharge mother or newborns early. Specifically, they state that "a plan or issuer may not penalize or otherwise reduce or limit the reimbursement of an attending provider because the provider furnished care to a mother or newborn in accordance with NMHPA."
For a copy of the Department of Labor’s booklet "Questions and Answers: Recent Changes in Health Care Law," which includes information about the Newborns’ and Mothers’ Health Protection Act, call (800) 998-7542. Information on the Act is also available on-line at both the Department of Labor’s Web site (www.dol.gov/dol/pwba) and at HCFA’s site (www.hcfa.gov).
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