QUEST Integration - Maternity - Length of Stay and Provisions of the Newborns' and Mothers' Health Protection Act (NMHPA)

Original Effective Date:
08/01/1994
Current Effective Date:
01/01/2015

The period of confinement for delivery may vary according to the complexity of the delivery. Length-of-stay allowances begin at the time of delivery.

It is not necessary to obtain precertification for delivery. HMSA's Plan for QUEST Integration Members provides benefit payments for patients who are discharged within the following guidelines:

• Normal vaginal delivery - 48 hours or less from time of delivery
• Normal cesarean delivery - 96 hours or less from time of delivery

HMSA allows physicians and members to make length-of-stay decisions. Payment will be allowed when an extended stay is for a medical reason and the stay meets the payment determination requirements. It is not necessary to obtain precertification for extended stays.

HMSA QUEST Integration does not provide monetary payments or rebates to mothers to encourage them to accept less than the minimum stays available under the Newborns' and Mothers' Health Protection Act (NMHPA).

HMSA QUEST Integration does not penalize, reduce or limit the reimbursement of an attending provider because the provider provided care in a manner consistent with NMHPA.

HMSA QUEST Integration does not provide incentives (monetary or otherwise) to an attending provider to induce provider to provide care inconsistent with NMHPA.

Revision History