Defines maternal depression; requires the provision of maternal depression education, and the provision of a screening and referral plan for the state.
BILL NUMBER:S3137A REVISED MEMO 06/03/2013
TITLE OF BILL: An act to amend the public health law and the insurance law, in relation to developing a maternal depression screening and referral plan for the state, and providing maternal depression education
This bill would define maternal depression; develop guidelines for maternal depression screening and referrals; make available a comprehensive referral list for treatment of maternal depression; and provide public education to promote awareness of and de-stigmatize maternal depression. in addition, legislation is intended to ensure that State residents are informed or the public health services that will help them, understand, identify and treat maternal depression.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 adds a new section 2500-k to the Public Health Law that defines maternal depression and maternal health care provider. This section also authorizes the commissioner to establish maternal depression screening guidelines for the state, including the routine employment et' screening at regular intervals during pregnancy and after childbirth. The commissioner shall identify validated, evidence-based diagnostic tools for maternal health care providers to use to screen patients for maternal depression. Fathers and other family members, as appropriate and consistent with patient confidentiality, shall be included in dialogue about maternal depression in order to help them better understand maternal depression, The commissioner shall develop an appropriate referral mechanism for maternal health care providers to use when the screening results show the need for further evaluation and treatment of maternal depression.
Section 2 adds paragraph (i) to subdivision 1 of section 207 of the Public Health Law to include maternal depression on the list of healthcare and wellness education and outreach programs what may be conducted by the Department of Health.
Section 3 amends Subdivision 1 of section 2603-j of the Public Health law to make leaflets that contain maternity related information available on the Department of Health's website.
Section 4 amends paragraph (b) of subdivision 1 of section 2603-j of the Public Health Law to require the commissioner to review the maternal depression informational leaflets that are distributed to patients before they are discharged from a hospital. The leaflets shall address the various forms of maternal depression and provide resources for treatment of maternal depression. The leaflets shall also be made available in the top six Languages spoken in the state, besides English.
Section 5 amends paragraph (b) of subdivision 1 of section 2803-n of the Public Health Law by adding maternal depression education, screening and referral to hospital care for maternity patients.
Section 6 amends item (ii) of subparagraph (A) of paragraph 10 of subdivision (i) of section 3216 of the Insurance Law by.adding maternal depression education, screening and referral to maternity care coverage.
Section 7 amends subparagraph (B) of paragraph 1 of subsection (c) of section 4303 of the Insurance Law by adding maternal depression education, screening and referral to maternity care coverage.
Section 8 adds a new section 3217-g to the Insurance Law on screening for maternal depression. State and private insurers shall develop a reimbursement structure for maternal depression screening and referral. No insurer shall limit a patient's direct access to maternal depression screening and referral.
Section 9 establishes an effective date.
Maternal depression is broadly defined as a wide range of 'emotional and psychological reactions a woman may experience during pregnancy or after childbirth, These reactions may include, but arc not limited to, feelings of despair or extreme guilt, prolonged sadness, lack of energy, difficulty concentrating, fatigue, extreme changes in appetite, and thoughts of suicide or of harming the baby. These reactions may occur without warning and may happen before, during, or immediately after childbirth, and continue into the infant's first year of life.
Maternal depression may include prenatal depression, the "baby blues," postpartum depression, and postpartum psychosis. Each year, approximately ten to fifteen percent of mothers and twenty-two percent of multi-ethnic inner city, mothers develop postpartum depression; 50-80 percent of new mothers will get "baby blues"; and 0.1-0.2 percent of new mothers develop postpartum psychosis. Postpartum psychosis, the most severe form of maternal depression, usually includes auditory hallucinations and delusions, and in some cases visual hallucinations. Postpartum psychosis has a five percent suicide rate and four percent rate of infanticide, or death of an infant.
Often, the symptoms of maternal depression are not. immediately identified because they closely resemble those generally associated with pregnancy. As a result, maternal depression is sometimes left untreated, and may result in a detrimental impact on the entire family, especially the newborn and other children in the family. Children of mothers with maternal depression are at higher risk for serious developmental, behavioral, and emotional problems. The immediate family is often unaware and/or unsure how to offer support. A mother experiencing depression does not often disclose her condition due to feelings of shame, and the severity of the condition worsens.
Maternal depression is often undetected and untreated by maternal health care providers due to both lack of training in identifying the condition and lack of support booth professionally and financially, as well as concerns about the availability of treatment options and coverage identified with maternal depression.
Early screening and identification of postpartum depression has an 80 to 90 percent success rate and offers long-term health care costs savings. It also helps support healthy child development and addresses issues of early childhood mental health challenges.
Women typically visit their obstetrician and gynecologist during pregnancy and visit the pediatrician for their infant's check-ups more often than they would any other health professional. Therefore, these maternal health care providers are in an ideal position to screen women for maternal depression.
Maternal depression is an epidemic that crosses racial, ethnic, economic boundaries and requires a universal screening to identify patients who need help, It also requires a high-quality network of accessible treatment options to deliver help and public support so that families and babies have a truly healthy start.
PRIOR LEGISLATIVE HISTORY:
To be determined
This act shall take effect on the one hundred eightieth day next succeeding the date on which it shall have become a law; provided, however, that effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date is authorized and directed to be made and completed by the commissioner of health on or before such effective date.
STATE OF NEW YORK ________________________________________________________________________ 3137--A 2013-2014 Regular Sessions IN SENATE January 30, 2013 ___________Introduced by Sen. KRUEGER -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law and the insurance law, in relation to developing a maternal depression screening and referral plan for the state, and providing maternal depression education THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The public health law is amended by adding a new section 2500-k to read as follows: S 2500-K. MATERNAL DEPRESSION. 1. DEFINITIONS. AS USED IN THIS SECTION: (A) "MATERNAL DEPRESSION" MEANS A WIDE RANGE OF EMOTIONAL AND PSYCHO- LOGICAL REACTIONS A WOMAN MAY EXPERIENCE DURING PREGNANCY OR AFTER CHILDBIRTH. THESE REACTIONS MAY INCLUDE, BUT ARE NOT LIMITED TO, FEEL- INGS OF DESPAIR OR EXTREME GUILT, PROLONGED SADNESS, LACK OF ENERGY, DIFFICULTY CONCENTRATING, FATIGUE, EXTREME CHANGES IN APPETITE, AND THOUGHTS OF SUICIDE OR OF HARMING THE BABY. MATERNAL DEPRESSION MAY INCLUDE PRENATAL DEPRESSION, THE "BABY BLUES," POSTPARTUM DEPRESSION, OR POSTPARTUM PSYCHOSIS-THE SEVEREST FORM. (B) "MATERNAL HEALTH CARE PROVIDER" MEANS A PHYSICIAN, MIDWIFE, NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT, OR OTHER HEALTH CARE PRACTITIONER ACTING WITHIN HIS OR HER LAWFUL SCOPE OF PRACTICE, ATTENDING A PREGNANT WOMAN OR A WOMAN UP TO ONE YEAR AFTER CHILDBIRTH, INCLUDING A PRACTI- TIONER ATTENDING THE WOMAN'S CHILD UP TO ONE YEAR AFTER CHILDBIRTH. 2. MATERNAL DEPRESSION SCREENING. (A) THE COMMISSIONER, IN CONSULTA- TION WITH THE COMMISSIONER OF MENTAL HEALTH, SHALL ESTABLISH EVIDENCE-BASED GUIDELINES FOR MATERNAL DEPRESSION SCREENING FOR USE BY MATERNAL HEALTH CARE PROVIDERS AND PEDIATRIC PRIMARY CARE PROVIDERS. IN DEVELOPING GUIDELINES UNDER THIS SECTION, THE COMMISSIONER AND THEEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01525-02-3 S. 3137--A 2
COMMISSIONER OF MENTAL HEALTH SHALL CONSULT APPROPRIATE MATERNAL HEALTH CARE PROVIDERS. SUCH GUIDELINES SHALL INCLUDE, BUT NOT BE LIMITED TO: (I) THE IDENTIFICATION OF SUGGESTED VALIDATED, EVIDENCE-BASED DIAGNOS- TIC TOOLS TO BE USED FOR MATERNAL DEPRESSION SCREENING; (II) THE ROUTINE EMPLOYMENT OF VALIDATED, EVIDENCE-BASED MATERNAL DEPRESSION SCREENING TOOLS AT REGULAR INTERVALS DURING PREGNANCY AND AFTER CHILDBIRTH; AND (III) AN APPROPRIATE REFERRAL MECHANISM FOR PATIENTS WHO REQUIRE FURTHER EVALUATION, SERVICES, OR TREATMENT. (B) MATERNAL DEPRESSION SCREENING AND REFERRAL MAY INCLUDE COMMUNI- CATION WITH THE FATHER OF THE CHILD AND OTHER FAMILY MEMBERS, AS APPRO- PRIATE AND CONSISTENT WITH PATIENT CONFIDENTIALITY. 3. REFERRALS FOR MATERNAL DEPRESSION TREATMENT. THE COMMISSIONER SHALL MAKE AVAILABLE A LIST OF PROVIDERS FOR TREATMENT OF MATERNAL DEPRESSION, INCLUDING SUPPORT GROUPS AND SERVICES PROVIDED BY NOT-FOR-PROFIT ORGAN- IZATIONS. 4. THE COMMISSIONER SHALL MAKE ANY REGULATIONS NECESSARY TO IMPLEMENT THIS SECTION. S 2. Subdivision 1 of section 207 of the public health law is amended by adding a new paragraph (i) to read as follows: (I) MATERNAL DEPRESSION, INCLUDING EDUCATION, SCREENING, REFERRAL SERVICES, AND POSSIBLE OPTIONS FOR TREATMENT. S 3. Subdivision 1 of section 2803-j of the public health law, as amended by chapter 62 of the laws of 1996, is amended to read as follows: 1. The commissioner shall require that every hospital and birth center shall prepare in printed or photocopied form and distribute at the time of pre-booking directly to each prospective maternity patient and, upon request, to the general public an informational leaflet. Such leaflet shall be designed by the commissioner and shall contain brief defi- nitions of maternity related procedures and practices as specified in subdivision two of this section and such other material as deemed appro- priate by the commissioner. Hospitals and birth centers may also elect to distribute additional explanatory material along with the maternity patients informational leaflet. THE COMMISSIONER SHALL MAKE THE INFORMA- TION LEAFLETS AVAILABLE ON THE DEPARTMENT'S WEBSITE. S 4. Subdivision 1-b of section 2803-j of the public health law, as added by chapter 647 of the laws of 1997, is amended to read as follows: 1-b. The informational leaflet shall also include information relating to the physical and mental health of the maternity patient after discharge from the hospital, including, but not limited to, information about MATERNAL AND post-partum depression. THE COMMISSIONER SHALL PERFORM A REVIEW OF INFORMATION ON MATERNAL AND POST-PARTUM DEPRESSION IN INFORMATIONAL LEAFLETS, IN COLLABORATION WITH THE COMMISSIONER OF MENTAL HEALTH, TO EVALUATE THE CONTENTS FOR ADDRESSING ALL FORMS OF MATERNAL AND POST-PARTUM DEPRESSION, AND IDENTIFYING RESOURCES FOR OBTAINING HELP FOR THE PATIENTS AND THEIR FAMILIES. ALL INFORMATION ON MATERNAL AND POST-PARTUM DEPRESSION IN INFORMATIONAL LEAFLETS SHALL BE MADE AVAILABLE TO PATIENTS IN THE TOP SIX LANGUAGES SPOKEN IN THE STATE, OTHER THAN ENGLISH, ACCORDING TO THE LATEST AVAILABLE DATA FROM THE UNITED STATES CENSUS BUREAU. S 5. Paragraph (b) of subdivision 1 of section 2803-n of the public health law, as added by chapter 56 of the laws of 1996, is amended to read as follows: (b) Maternity care shall also include, at minimum, parent education, assistance and training in breast or bottle feeding, EDUCATION ON MATER-S. 3137--A 3
NAL DEPRESSION AND MATERNAL DEPRESSION SCREENING AND REFERRAL, and the performance of any necessary maternal and newborn clinical assessments. Notwithstanding this requirement, nothing in this paragraph is intended to result in the hospital charging any amount for such services in addi- tion to the applicable charge for the maternity inpatient hospital admission. S 6. Item (ii) of subparagraph (A) of paragraph 10 of subdivision (i) of section 3216 of the insurance law, as added by chapter 56 of the laws of 1996, is amended to read as follows: (ii) Maternity care coverage shall also include, at minimum, parent education, assistance and training in breast or bottle feeding, EDUCA- TION ON MATERNAL DEPRESSION AND MATERNAL DEPRESSION SCREENING AND REFER- RAL, and the performance of any necessary maternal and newborn clinical assessments. S 7. Subparagraph (B) of paragraph 1 of subsection (c) of section 4303 of the insurance law, as amended by chapter 661 of the laws of 1997, is amended to read as follows: (B) Maternity care coverage also shall include, at minimum, parent education, assistance and training in breast or bottle feeding, EDUCA- TION ON MATERNAL DEPRESSION AND MATERNAL DEPRESSION SCREENING AND REFER- RAL, and the performance of any necessary maternal and newborn clinical assessments. S 8. The insurance law is amended by adding a new section 3217-g to read as follows: S 3217-G. MATERNAL DEPRESSION SCREENINGS. (A) NO INSURER SUBJECT TO THIS ARTICLE SHALL BY CONTRACT, WRITTEN POLICY OR PROCEDURE LIMIT A PATIENT INSURED'S DIRECT ACCESS TO SCREENING AND REFERRAL FOR MATERNAL DEPRESSION FROM A PROVIDER OF OBSTETRICAL, GYNECOLOGIC, OR PEDIATRIC SERVICES. (B) THE STATE AND PRIVATE INSURERS SHALL ESTABLISH A REIMBURSEMENT STRUCTURE FOR MATERNAL DEPRESSION SCREENING AND REFERRAL, AS OUTLINED IN SECTION TWO THOUSAND FIVE HUNDRED-K OF THE PUBLIC HEALTH LAW. S 9. This act shall take effect on the one hundred eightieth day after it shall have become a law; provided that (a) sections six, seven and eight of this act shall apply to contracts entered into, amended or delivered on or after the first of January after this act becomes a law; and (b) effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date is authorized and directed to be made and completed by the commissioner of health on or before such effective date.