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SENATE FLOOR VERSION
February 15, 2024
SENATE BILL NO. 1739 By: Thompson (Kristen) of the
Senate
and
McEntire of the House
An Act relating to birthing centers; amending 36 O.S.
2021, Section 6060.3 , which relates to matern ity
benefits; modifying criteria for coverage of certain
benefits; conforming language; defining term;
amending 63 O.S. 2021, Section 1 -701, as amended by
Section 1, Chapter 117, O.S.L. 2023 (63 O.S. Supp.
2023, Section 1-701), which relates to hospitals ;
modifying definitions ; conforming language; amending
63 O.S. 2021, Section 1 -702a, which relates to
voluntary licensing of birthing centers; eliminating
license for birthing centers; providing certain
construction; amending 63 O.S. 2021, Section 3129 ,
which relates to Lily’s Law; defining term;
conforming language; updating statutory language;
directing the Oklahoma Health Care Authority to seek
certain federal approval ; providing for codification;
and providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE O F OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 6060.3, is
amended to read as follows:
Section 6060.3. A. Every health benefit plan issued, amended,
renewed or delivered in this state on or after July 1, 1996, that
provides maternity benefits shall provid e for coverage of:
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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 del ivery if
childbirth occurs at home or in a birthing center
licensed as a birthing center that is not licensed as
a hospital but that is accredited as a freestanding
birth center by the Commission for the Accreditation
of Birth Centers. The coverage shall provide for one
home visit within forty -eight (48) hours of childbir th
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,
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(b) the importance of childhood immunizations,
and
(c) resources for obtaining child hood
immunizations,
(3) training or assistance with breast or bottle
feeding, and
(4) the performance of any medically ne cessary and
appropriate clinical tests.
b. At the discretion of the mother, visits may occur at
the facility of the plan or the provide r.
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 imm unizations, and
c. resources for obtaining childhood immunizations;
3. Training or assistance with breast or bottle feed ing; and
4. The performance of any medically necessary and appropriate
clinical tests.
C. A plan may limit co verage to a shorter leng th 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
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and Supervision or th e State Board of Osteopathic Ex aminers 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 Obste tricians 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 post-discharge, and
d. the availability of postdischarge post-discharge
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 f orty-eight (48)
hours of discharge, by a licensed health care provider whose scope
of practice includes providin g postpartum care. The visits shall
include, at a minimum:
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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 obtain ing childhood immunizations,
c. training or assistance with breast or bottle feeding,
and
d. the performance of any m edically 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 ca re of
the insured or enrollee.
E. In the event the coverage required by this section is
provided under a contract th at 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 incl uded in the capitation or global
rate.
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F. No health benefit plan subject to the provi sions 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 p rovisions
of this section.
G. As used in this section , “health:
1. “Birthing center” has the same meaning as provided by
Section 1-701 of Title 63 of the Oklahoma Statutes ; and
2. “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 rul es
necessary to implement the provisions of this section.
SECTION 2. AMENDATORY 63 O.S. 2021, Section 1-701, as
amended by Section 1, Ch apter 117, O.S.L. 2023 (63 O.S. Supp. 2023,
Section 1-701), is amended to read as follows:
Section 1-701. For the purposes of Sectio n 1-701 et seq. of
this title:
1. “Hospital” means any institution, place, building or agency,
public or private, whether organized for profit or not, primarily
engaged in the maintenance and operation of facilities for the
diagnosis, treatment or care o f patients admitted for overnight stay
or longer in order to obtain medical care, sur gical care,
obstetrical care, or nursing care for illness, disease, injury,
infirmity, or deformity. Except as otherwise provided by paragraph
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7 of this section, places where pregnant females are admitted and
receive care incident to pregnancy, aborti on or delivery shall be
considered to be a “hospital” hospital within the meaning of this
article, regardless of the number of pat ients received or the
duration of their stay. The term “hospital” hospital includes
general medical surgical hospitals, specializ ed hospitals, critical
access hospitals, emergency hospitals, and rural emergency
hospitals, and but does not include birthing centers except to the
extent a birthing center is licensed as a hospital ;
2. “General medical surgi cal hospital” means a hospital
maintained for the purpose of providing hospital care i n a broad
category of illness and injury;
3. “Specialized hospital ” means a hospital mainta ined for the
purpose of providing hospital care in a certain category, or
categories, of illness and injury;
4. “Critical access hospital” means a hospital determi ned by
the State Department of He alth to be a necessary provider of health
care services to residents of a rural community;
5. “Emergency hospital” means a hospital that provides
emergency treatment and stabilization services on a twenty -four-hour
basis that has the ability to admit and treat patients for short
periods of time;
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6. “Rural emergency hospital” means a hospital that provides
emergency treatment and stabilization services for an average length
of stay of twenty-four (24) hours or less;
7. “Birthing center” means any facility, pla ce or institution,
which that is maintained or established prima rily for the purpose of
providing services of a certified midwife or licensed medical doctor
to assist or attend a woman in delivery and birth, and where a wom an
is scheduled in advance to give bir th following a normal,
uncomplicated, low-risk pregnancy. Such services are performed by :
a. a licensed Advanced Practice Registered Nurse
recognized by the Oklahoma Board of Nursing as a
Certified Nurse-Midwife,
b. a Certified Professional Midwife or Certified Midwife
licensed under Section 3040.6 of Title 59 of the
Oklahoma Statutes, or
c. a licensed allopathic or osteopathic physician .
Provided, however, licensure for a birthing center shall not be
compulsory available or required for birthing centers unless the
birthing center is a hospital, in which case the hospital shall be
licensed as a hospital under Section 1-702 of this title;
8. “Day treatment program” means nonresidential, partial
hospitalization programs, day treat ment programs, and d ay hospital
programs as defined by subsection A of Section 175.2 0 of Title 10 of
the Oklahoma Statutes; and
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9. a. “Primarily engaged” means a hospital shall be
primarily engaged, defined by this section and as
determined by the State Department of Health, i n
providing to inpatients the following care by or under
the supervision of physicians:
(1) diagnostic services and therapeutic services for
medical diagnosis, treatment and care of injured,
disabled or sick persons, or
(2) rehabilitation services fo r the rehabilitation of
injured, disabled or sick persons.
b. In reaching a determination as to whether an entity is
primarily engaged in providing inpatient hospital
services to inpatients of a hospital, the Department
shall evaluate the total facility operatio ns and
consider multiple factors as provided in subparagraph s
c and d of this subsection paragraph.
c. In evaluating the total facility operations, the
Department shall review the actual provision of care
and services to two or mo re inpatients, and t he
effects of that care, to assess whether the care
provided meets the needs of individual patients by wa y
of patient outcomes.
d. The factors that the Department shall consider for
determination of whether an entity meets the
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definition of primarily engaged inc lude, but are not
limited to:
(1) a minimum of four inpatient beds,
(2) the entity’s average daily census (ADC),
(3) the average length of stay (ALOS),
(4) the number of off-site campus outpatient
locations,
(5) the number of provider-based emergency
departments for the entity,
(6) the number of inpatient beds related to the size
of the entity and the s cope of the services
offered,
(7) the volume of outpati ent surgical procedures
compared to the inpatient surgical procedu res, if
surgical services are provid ed,
(8) staffing patterns, and
(9) patterns of ADC by day of the week.
e. Notwithstanding any other provision of this section,
an entity shall be considered primarily engaged in
providing inpatient hospital services to inpatients if
the hospital has had an ADC of at least two (2) and an
ALOS of at least two (2) midnights ove r the past
twelve (12) months. A critical access hospital sh all
be exempt from the ADC and ALOS determination. ADC
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shall be calculated by adding the midnight daily
census for each day of the twelve-month period and
then dividing the total number by days in the year. A
facility that has been operating for less than (12)
months at the time of the survey shall calculate its
ADC based on the number of months the f acility has
been operational, but not less than three (3) months.
If a first survey finds nonco mpliance with the ADC and
ALOS, a second survey may be requir ed by the
Department to demonstrate compliance with state
licensure.
SECTION 3. AMENDATORY 63 O.S. 2021, Section 1-702a, is
amended to read as follows:
Section 1-702a. A. By January 1, 1992, the State Board of
Health shall promulgate and adopt rules for the voluntary licensing
of birthing centers On and after the effective date of this act, the
State Department of Health shall cease licensing birthing centers.
No new license shall be issued, and no curren t license shall be
renewed upon expiration. Provided, however, this subsection shall
not be construed to exempt a hospital that operates a birthing
center from the requirement to obtain a hospital license under
Section 1-702 of this title.
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B. The State Board Commissioner of Health shall promulgate
rules establishing standards for day tre atment programs other than
those operated by community mental health centers.
SECTION 4. AMENDATORY 63 O.S. 2021, Section 3129, is
amended to read as follows:
Section 3129. A. This section shall be known and may be cited
as “Lily’s Law”.
B. As used in this section:
1. “Birthing center” has the same meaning as provided by
Section 1-701 of this title;
2. “Fetal death” means:
a. spontaneous death prior to the complete expulsion or
extraction from its mother of an unborn child,
irrespective of gestational age. The death is
indicated by the fact that, after such expulsion or
extraction, the unborn child does not breathe or show
any other evidence of life such as beating of the
heart, pulsation of the umbilical cord or definite
movement of voluntary muscles,
b. death that occurs as the result of accidental trauma
or a criminal assault on the pregnant female or her
unborn child, irrespective of gestational age, or
c. death that occurs, irrespective of ge stational age,
from the use or prescription of any instrument,
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medicine, drug or any other substance or device to
remove an ectopic pregnancy; and
2. 3. “Stillbirth” shall have the same meaning as prov ided by
subparagraph a of paragraph 1 of this subsection.
C. Every licensed hospital, birthing center, or licensed
medical facility in this state shall maintain a written policy for
the disposition of the remain s of a child from a stillbi rth or fetal
death event at such hospital, birthing center or medical facility.
A parent of the child shall have the right to direct the disposition
of the remains, except that disposition may be made by the hospital,
birthing center or medical facility if no direction is given by a
parent within fourteen ( 14) days following the delivery of the
remains. The policy and the dispositi on shall comply with all
applicable provisions of state and federal law. Upon the delivery
of a child from a stillbirth or a fetal death event, the hospital,
birthing center or medical facility sh all notify at least one (1)
parent of the parents’ right to direct the disposition of the
remains of the child and shall provide at least (1) one parent with
a copy of its policy with respect to disposi tion.
D. Except as otherwise provid ed by law, nothing in this section
shall be interpreted to prohibit any hospi tal, birthing center or
medical facility from providing additional notification and
assistance to the parent of a child delive red as a stillbirth or a
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fetal death event at the hospital, birthing ce nter or medical
facility relating to the disposition of the remains of the child.
SECTION 5. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5029.1 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. As used in this section, “birthing center” has the same
meaning as provided by Section 1 -701 of Title 63 of the Oklahoma
Statutes.
B. The Oklahoma Health Care Auth ority shall seek federal
approval to allow a birthing center that is not licensed by the
state but has been accredited as a freestanding birth center by the
Commission for the Accreditation of Birth Centers to receive
reimbursement under the state Medicaid pr ogram for services
provided.
SECTION 6. This act shall become effective November 1, 2024.
COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES
February 15, 2024 - DO PASS