2023 Oklahoma Statutes › Title 36. Insurance › §36-6060.3. Maternity benefits - Postpartum care.

A. Every health benefit plan issued, amended, renewed or delivered in this state on or after July 1, 1996, that provides maternity benefits shall provide for coverage of:
1. A minimum of forty-eight (48) hours of inpatient care at a hospital, or a birthing center licensed as a hospital, following a vaginal delivery, for the mother and newborn infant after childbirth, except as otherwise provided in this section;
2. A minimum of ninety-six (96) hours of inpatient care at a hospital following a delivery by caesarean section for the mother and newborn infant after childbirth, except as otherwise provided in this section; and
3.
a.
Postpartum home care following a vaginal delivery if childbirth occurs at home or in a birthing center licensed as a birthing center. The coverage shall provide for one home visit within forty-eight (48) hours of childbirth by a licensed health care provider whose scope of practice includes providing postpartum care. Visits shall include, at a minimum:
(1)
physical assessment of the mother and the newborn infant,
(2)
parent education, to include, but not be limited to:
(a)
the recommended childhood immunization schedule,
(b)
the importance of childhood immunizations, and
(c)
resources for obtaining childhood immunizations,
(3)
training or assistance with breast or bottle feeding, and
(4)
the performance of any medically necessary and appropriate clinical tests.
b.
At the discretion of the mother, visits may occur at the facility of the plan or the provider.
B. Inpatient care shall include, at a minimum:
1. Physical assessment of the mother and the newborn infant;
2. Parent education, to include, but not be limited to:
a.
the recommended childhood immunization schedule,
b.
the importance of childhood immunizations, and
c.
resources for obtaining childhood immunizations;
3. Training or assistance with breast or bottle feeding; and
4. The performance of any medically necessary and appropriate clinical tests.
C. A plan may limit coverage to a shorter length of hospital inpatient stay for services related to maternity and newborn infant care provided that:
1. In the sole medical discretion or judgment of the attending physician licensed by the Oklahoma State Board of Medical Licensure and Supervision or the State Board of Osteopathic Examiners or the certified nurse midwife licensed by the Oklahoma Board of Nursing providing care to the mother and to the newborn infant, it is determined prior to discharge that an earlier discharge of the mother and newborn infant is appropriate and meets medical criteria contained in the most current treatment standards of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists that determine the appropriate length of stay based upon:
a.
evaluation of the antepartum, intrapartum and postpartum course of the mother and newborn infant,
b.
the gestational age, birth weight and clinical condition of the newborn infant,
c.
the demonstrated ability of the mother to care for the newborn infant postdischarge, and
d.
the availability of postdischarge follow-up to verify the condition of the newborn infant in the first forty-eight (48) hours after delivery.
A plan shall adopt these guidelines by July 1, 1996; and
2. The plan covers one home visit, within forty-eight (48) hours of discharge, by a licensed health care provider whose scope of practice includes providing postpartum care. The visits shall include, at a minimum:
a.
physical assessment of the mother and the newborn infant,
b.
parent education, to include, but not be limited to:
(1)
the recommended childhood immunization schedule,
(2)
the importance of childhood immunizations, and
(3)
resources for obtaining childhood immunizations,
c.
training or assistance with breast or bottle feeding, and
d.
the performance of any medically necessary and clinical tests.
At the mother's discretion, visits may occur at the facility of the plan or the provider.
D. The plan shall include, but is not limited to, notice of the coverage required by this section in the evidence of coverage of the plan, and shall provide additional written notice of the coverage to the insured or an enrollee during the course of the prenatal care of the insured or enrollee.
E. In the event the coverage required by this section is provided under a contract that is subject to a capitated or global rate, the plan shall be required to provide supplementary reimbursement to providers for any additional services required by that coverage if it is not included in the capitation or global rate.
F. No health benefit plan subject to the provisions of this section shall terminate the services of, reduce capitation payments for, refuse payment for services, or otherwise discipline a licensed health care provider who orders care consistent with the provisions of this section.
G. As used in this section, "health benefit plan" means any plan or arrangement as defined in subsection C of Section 6060.4 of this title.
H. The Insurance Commissioner shall promulgate any rules necessary to implement the provisions of this section.
Added by Laws 1996, c. 164, § 1, emerg. eff. May 14, 1996. Amended by Laws 1997, c. 149, § 1, eff. Nov. 1, 1997; Laws 2003, c. 464, § 5, eff. July 1, 2003; Laws 2010, c. 222, § 31, eff. Nov. 1, 2010.