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§36-6060.3.
§36-6060.3.
A. Every health benefit plan contract issued, amended, renewed or
delivered 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 mother's discretion, 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 Oklahoma Board of Osteopathic Examiners or
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. Such 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 plan's evidence of coverage, and shall
provide additional written notice of the coverage to the insured or an
enrollee during the course of the insured's or enrollee's prenatal
care.
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 individual or
group hospital or medical insurance coverage, a not-for-profit
hospital or medical service or indemnity plan, a prepaid health plan,
a health maintenance organization plan, a preferred provider
organization plan, the State and Education Employees Group Health
Insurance Plan, any program funded under Title XIX of the Social
Security Act or such other publicly funded program, and coverage
provided by a Multiple Employer Welfare Arrangement (MEWA) or employee
self-insured plan except as exempt under federal ERISA provisions.
H. The Insurance Commissioner shall promulgate any rules necessary to
implement the provisions of this section.
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