Ohio § 3923.64

§ 3923.64.

(A) Notwithstanding section 3901.71 of the Revised Code , each public employee benefit plan established or modified in this state that provides

maternity benefits shall provide coverage of inpatient care and follow-up care for

a mother and her newborn as follows: (1) The plan shall cover a minimum of forty-eight hours of inpatient care following a

normal vaginal delivery and a minimum of ninety-six hours of inpatient care following

a cesarean delivery.  Services covered as inpatient care shall include medical, educational, and any other

services that are consistent with the inpatient care recommended in the protocols

and guidelines developed by national organizations that represent pediatric, obstetric,

and nursing professionals. (2) The plan shall cover a physician-directed source of follow-up care or a source of

follow-up care directed by an advanced practice registered nurse.  Services covered as follow-up care shall include physical assessment of the mother

and newborn, parent education, assistance and training in breast or bottle feeding,

assessment of the home support system, performance of any medically necessary and

appropriate clinical tests, and any other services that are consistent with the follow-up

care recommended in the protocols and guidelines developed by national organizations

that represent pediatric, obstetric, and nursing professionals.  The coverage shall apply to services provided in a medical setting or through home

health care visits.  The coverage shall apply to a home health care visit only if the health care professional

who conducts the visit is knowledgeable and experienced in maternity and newborn care. When a decision is made in accordance with division (B) of this section to discharge

a mother or newborn prior to the expiration of the applicable number of hours of inpatient

care required to be covered, the coverage of follow-up care shall apply to all follow-up

care that is provided within seventy-two hours after discharge.  When a mother or newborn receives at least the number of hours of inpatient care

required to be covered, the coverage of follow-up care shall apply to follow-up care

that is determined to be medically necessary by the health care professionals responsible

for discharging the mother or newborn. (B) Any decision to shorten the length of inpatient stay to less than that specified

under division (A)(1) of this section shall be made by the physician attending the

mother or newborn, except that if a certified nurse-midwife is attending the mother

in collaboration with a physician, the decision may be made by the certified nurse-midwife.  Decisions regarding early discharge shall be made only after conferring with the

mother or a person responsible for the mother or newborn.  For purposes of this division, a person responsible for the mother or newborn may

include a parent, guardian, or any other person with authority to make medical decisions

for the mother or newborn. (C)(1) No public employer who offers an employee benefit plan may do either of the following: (a) Terminate the participation of a health care professional or health care facility

as a provider under the plan solely for making recommendations for inpatient or follow-up

care for a particular mother or newborn that are consistent with the care required

to be covered by this section; (b) Establish or offer monetary or other financial incentives for the purpose of encouraging

a person to decline the inpatient or follow-up care required to be covered by this

section. (2) Whoever violates division (C)(1)(a) or (b) of this section has engaged in an unfair

and deceptive act or practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code . (D) This section does not do any of the following: (1) Require a plan to cover inpatient or follow-up care that is not received in accordance

with the plan's terms pertaining to the health care professionals and facilities from

which an individual is authorized to receive health care services; (2) Require a mother or newborn to stay in a hospital or other inpatient setting for

a fixed period of time following delivery; (3) Require a child to be delivered in a hospital or other inpatient setting; (4) Authorize a certified nurse-midwife to practice beyond the authority to practice

nurse-midwifery in accordance with Chapter 4723. of the Revised Code; (5) Establish minimum standards of medical diagnosis, care, or treatment for inpatient

or follow-up care for a mother or newborn.  A deviation from the care required to be covered under this section shall not, solely

on the basis of this section, give rise to a medical claim or derivative medical claim,

as those terms are defined in section 2305.113 of the Revised Code .