1 STATE OF OKLAHOMA
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2 2nd Session of the 59th Legislature (2024)
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3 SENATE BILL 1739 By: Thompson (Kristen)
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6 AS INTRODUCED
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7 An Act relating to birthing centers; amending 36 O.S.
7 2021, Section 6060.3, which relates to maternity
8 benefits; modifying criteria for coverage of certain
8 benefits; conforming language; defining term;
9 amending 63 O.S. 2021, Section 1-701, as amended by
9 Section 1, Chapter 117, O.S.L. 2023 (63 O.S. Supp.
10 2023, Section 1-701), which relates to hospitals;
10 modifying definitions; conforming language; amending
11 63 O.S. 2021, Section 1-702a, which relates to
11 voluntary licensing of birthing centers; eliminating
12 license for birthing centers; providing certain
12 construction; amending 63 O.S. 2021, Section 3129,
13 which relates to Lily’s Law; defining term;
13 conforming language; updating statutory language;
14 directing the Oklahoma Health Care Authority to seek
14 certain federal approval; providing for codification;
15 and providing an effective date.
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18 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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19 SECTION 1. AMENDATORY 36 O.S. 2021, Section 6060.3, is
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20 amended to read as follows:
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21 Section 6060.3. A. Every health benefit plan issued, amended,
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22 renewed or delivered in this state on or after July 1, 1996, that
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23 provides maternity benefits shall provide for coverage of:
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 1 1. A minimum of forty-eight (48) hours of inpatient care at a
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2 hospital, or a birthing center licensed as a hospital, following a
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3 vaginal delivery, for the mother and newborn infant after
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4 childbirth, except as otherwise provided in this section;
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5 2. A minimum of ninety-six (96) hours of inpatient care at a
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6 hospital following a delivery by caesarean section for the mother
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7 and newborn infant after childbirth, except as otherwise provided in
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8 this section; and
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9 3. a. Postpartum home care following a vaginal delivery if
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10 childbirth occurs at home or in a birthing center
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11 licensed as a birthing center that is not licensed as
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12 a hospital but that is accredited as a freestanding
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13 birth center by the Commission for the Accreditation
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14 of Birth Centers. The coverage shall provide for one
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15 home visit within forty-eight (48) hours of childbirth
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16 by a licensed health care provider whose scope of
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17 practice includes providing postpartum care. Visits
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18 shall include, at a minimum:
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19 (1) physical assessment of the mother and the newborn
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20 infant,
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21 (2) parent education, to include, but not be limited
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22 to:
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23 (a) the recommended childhood immunization
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24 schedule,
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 1 (b) the importance of childhood immunizations,
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2 and
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3 (c) resources for obtaining childhood
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4 immunizations,
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5 (3) training or assistance with breast or bottle
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6 feeding, and
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7 (4) the performance of any medically necessary and
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8 appropriate clinical tests.
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9 b. At the discretion of the mother, visits may occur at
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10 the facility of the plan or the provider.
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11 B. Inpatient care shall include, at a minimum:
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12 1. Physical assessment of the mother and the newborn infant;
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13 2. Parent education, to include, but not be limited to:
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14 a. the recommended childhood immunization schedule,
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15 b. the importance of childhood immunizations, and
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16 c. resources for obtaining childhood immunizations;
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17 3. Training or assistance with breast or bottle feeding; and
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18 4. The performance of any medically necessary and appropriate
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19 clinical tests.
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20 C. A plan may limit coverage to a shorter length of hospital
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21 inpatient stay for services related to maternity and newborn infant
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22 care provided that:
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23 1. In the sole medical discretion or judgment of the attending
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24 physician licensed by the Oklahoma State Board of Medical Licensure
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 1 and Supervision or the State Board of Osteopathic Examiners or the
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2 certified nurse midwife licensed by the Oklahoma Board of Nursing
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3 providing care to the mother and to the newborn infant, it is
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4 determined prior to discharge that an earlier discharge of the
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5 mother and newborn infant is appropriate and meets medical criteria
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6 contained in the most current treatment standards of the American
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7 Academy of Pediatrics and the American College of Obstetricians and
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8 Gynecologists that determine the appropriate length of stay based
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9 upon:
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10 a. evaluation of the antepartum, intrapartum and
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11 postpartum course of the mother and newborn infant,
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12 b. the gestational age, birth weight and clinical
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13 condition of the newborn infant,
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14 c. the demonstrated ability of the mother to care for the
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15 newborn infant postdischarge post-discharge, and
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16 d. the availability of postdischarge post-discharge
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17 follow-up to verify the condition of the newborn
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18 infant in the first forty-eight (48) hours after
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19 delivery.
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20 A plan shall adopt these guidelines by July 1, 1996; and
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21 2. The plan covers one home visit, within forty-eight (48)
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22 hours of discharge, by a licensed health care provider whose scope
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23 of practice includes providing postpartum care. The visits shall
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24 include, at a minimum:
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 1 a. physical assessment of the mother and the newborn
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2 infant,
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3 b. parent education, to include, but not be limited to:
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4 (1) the recommended childhood immunization schedule,
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5 (2) the importance of childhood immunizations, and
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6 (3) resources for obtaining childhood immunizations,
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7 c. training or assistance with breast or bottle feeding,
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8 and
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9 d. the performance of any medically necessary and
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10 clinical tests.
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11 At the mother’s discretion, visits may occur at the facility of
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12 the plan or the provider.
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13 D. The plan shall include, but is not limited to, notice of the
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14 coverage required by this section in the evidence of coverage of the
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15 plan, and shall provide additional written notice of the coverage to
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16 the insured or an enrollee during the course of the prenatal care of
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17 the insured or enrollee.
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18 E. In the event the coverage required by this section is
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19 provided under a contract that is subject to a capitated or global
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20 rate, the plan shall be required to provide supplementary
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21 reimbursement to providers for any additional services required by
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22 that coverage if it is not included in the capitation or global
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23 rate.
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 1 F. No health benefit plan subject to the provisions of this
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2 section shall terminate the services of, reduce capitation payments
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3 for, refuse payment for services, or otherwise discipline a licensed
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4 health care provider who orders care consistent with the provisions
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5 of this section.
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6 G. As used in this section, “health:
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7 1. “Birthing center” has the same meaning as provided by
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8 Section 1-701 of Title 63 of the Oklahoma Statutes; and
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9 2. “Health benefit plan” means any plan or arrangement as
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10 defined in subsection C of Section 6060.4 of this title.
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11 H. The Insurance Commissioner shall promulgate any rules
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12 necessary to implement the provisions of this section.
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13 SECTION 2. AMENDATORY 63 O.S. 2021, Section 1-701, as
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14 amended by Section 1, Chapter 117, O.S.L. 2023 (63 O.S. Supp. 2023,
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15 Section 1-701), is amended to read as follows:
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16 Section 1-701. For the purposes of Section 1-701 et seq. of
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17 this title:
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18 1. “Hospital” means any institution, place, building or agency,
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19 public or private, whether organized for profit or not, primarily
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20 engaged in the maintenance and operation of facilities for the
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21 diagnosis, treatment or care of patients admitted for overnight stay
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22 or longer in order to obtain medical care, surgical care,
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23 obstetrical care, or nursing care for illness, disease, injury,
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24 infirmity, or deformity. Except as otherwise provided by paragraph
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 1 7 of this section, places where pregnant females are admitted and
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2 receive care incident to pregnancy, abortion or delivery shall be
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3 considered to be a “hospital” hospital within the meaning of this
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4 article, regardless of the number of patients received or the
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5 duration of their stay. The term “hospital” hospital includes
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6 general medical surgical hospitals, specialized hospitals, critical
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7 access hospitals, emergency hospitals, and rural emergency
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8 hospitals, and but does not include birthing centers except to the
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9 extent a birthing center is licensed as a hospital;
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10 2. “General medical surgical hospital” means a hospital
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11 maintained for the purpose of providing hospital care in a broad
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12 category of illness and injury;
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13 3. “Specialized hospital” means a hospital maintained for the
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14 purpose of providing hospital care in a certain category, or
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15 categories, of illness and injury;
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16 4. “Critical access hospital” means a hospital determined by
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17 the State Department of Health to be a necessary provider of health
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18 care services to residents of a rural community;
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19 5. “Emergency hospital” means a hospital that provides
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20 emergency treatment and stabilization services on a twenty-four-hour
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21 basis that has the ability to admit and treat patients for short
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22 periods of time;
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 1 6. “Rural emergency hospital” means a hospital that provides
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2 emergency treatment and stabilization services for an average length
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3 of stay of twenty-four (24) hours or less;
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4 7. “Birthing center” means any facility, place or institution,
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5 which that is maintained or established primarily for the purpose of
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6 providing services of a certified midwife or licensed medical doctor
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7 to assist or attend a woman in delivery and birth, and where a woman
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8 is scheduled in advance to give birth following a normal,
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9 uncomplicated, low-risk pregnancy. Such services are performed by:
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10 a. a licensed Advanced Practice Registered Nurse
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11 recognized by the Oklahoma Board of Nursing as a
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12 Certified Nurse-Midwife,
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13 b. a Certified Professional Midwife or Certified Midwife
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14 licensed under Section 3040.6 of Title 59 of the
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15 Oklahoma Statutes, or
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16 c. a licensed allopathic or osteopathic physician.
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17 Provided, however, licensure for a birthing center shall not be
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18 compulsory available or required for birthing centers unless the
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19 birthing center is a hospital, in which case the hospital shall be
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20 licensed as a hospital under Section 1-702 of this title;
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21 8. “Day treatment program” means nonresidential, partial
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22 hospitalization programs, day treatment programs, and day hospital
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23 programs as defined by subsection A of Section 175.20 of Title 10 of
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24 the Oklahoma Statutes; and
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 1 9. a. “Primarily engaged” means a hospital shall be
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2 primarily engaged, defined by this section and as
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3 determined by the State Department of Health, in
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4 providing to inpatients the following care by or under
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5 the supervision of physicians:
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6 (1) diagnostic services and therapeutic services for
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7 medical diagnosis, treatment and care of injured,
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8 disabled or sick persons, or
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9 (2) rehabilitation services for the rehabilitation of
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10 injured, disabled or sick persons.
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11 b. In reaching a determination as to whether an entity is
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12 primarily engaged in providing inpatient hospital
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13 services to inpatients of a hospital, the Department
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14 shall evaluate the total facility operations and
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15 consider multiple factors as provided in subparagraphs
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16 c and d of this subsection paragraph.
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17 c. In evaluating the total facility operations, the
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18 Department shall review the actual provision of care
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19 and services to two or more inpatients, and the
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20 effects of that care, to assess whether the care
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21 provided meets the needs of individual patients by way
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22 of patient outcomes.
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23 d. The factors that the Department shall consider for
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24 determination of whether an entity meets the
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 1 definition of primarily engaged include, but are not
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2 limited to:
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3 (1) a minimum of four inpatient beds,
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4 (2) the entity’s average daily census (ADC),
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5 (3) the average length of stay (ALOS),
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6 (4) the number of off-site campus outpatient
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7 locations,
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8 (5) the number of provider-based emergency
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9 departments for the entity,
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10 (6) the number of inpatient beds related to the size
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11 of the entity and the scope of the services
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12 offered,
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13 (7) the volume of outpatient surgical procedures
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14 compared to the inpatient surgical procedures, if
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15 surgical services are provided,
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16 (8) staffing patterns, and
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17 (9) patterns of ADC by day of the week.
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18 e. Notwithstanding any other provision of this section,
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19 an entity shall be considered primarily engaged in
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20 providing inpatient hospital services to inpatients if
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21 the hospital has had an ADC of at least two (2) and an
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22 ALOS of at least two (2) midnights over the past
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23 twelve (12) months. A critical access hospital shall
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24 be exempt from the ADC and ALOS determination. ADC
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 1 shall be calculated by adding the midnight daily
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2 census for each day of the twelve-month period and
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3 then dividing the total number by days i