Bill S7234B-2013

Relates to the provision of maternal depression education, screening guidelines, and referrals for treatment

Relates to the provision of maternal depression education, screening guidelines, and referrals for treatment.

Details

Actions

  • Aug 4, 2014: SIGNED CHAP.199
  • Jul 31, 2014: DELIVERED TO GOVERNOR
  • Jun 19, 2014: returned to senate
  • Jun 19, 2014: passed assembly
  • Jun 19, 2014: ordered to third reading cal.870
  • Jun 19, 2014: substituted for a9610b
  • Jun 19, 2014: referred to ways and means
  • Jun 19, 2014: DELIVERED TO ASSEMBLY
  • Jun 19, 2014: PASSED SENATE
  • Jun 16, 2014: AMENDED ON THIRD READING 7234B
  • Jun 9, 2014: ADVANCED TO THIRD READING
  • Jun 9, 2014: AMENDED 7234A
  • Jun 3, 2014: 2ND REPORT CAL.
  • Jun 2, 2014: 1ST REPORT CAL.1089
  • May 20, 2014: REPORTED AND COMMITTED TO FINANCE
  • May 7, 2014: REFERRED TO HEALTH

Votes

Memo

BILL NUMBER:S7234B

TITLE OF BILL: An act to amend the public health law and the insurance law, in relation to the provision of maternal depression education, screening guidelines, and referrals for treatment

PURPOSE: This bill would define maternal depression; provide information and guidelines on maternal depression screening; provide information on follow-up support and referrals; 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 of 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 provide information on maternal depression to maternal health care providers. The information shall include a summary of the current evidence base and professional guidelines for maternal depression screening. The information shall also include validated, evidence-based tools for providers to use to screen patients for maternal depression. The other parent of the child and other family members, as consistent with patient confidentiality, may be included in dialogue about maternal depression in order to help them better understand maternal depression. The commissioner shall also provide information on follow-up support for patients when the screening results show the need for further evaluation, referral, or treatment of maternal depression. This shall also include information on available community resources and entities licensed by the office of mental health, such as treatment providers, support groups and not-for-profit organizations.

Section 2 adds paragraph (j) to subdivision 1 of section 207 of the Public Health Law to include maternal depression on the list of health care and wellness education and outreach programs that may be conducted by the Department of Health.

Section 3 amends subdivision 1 of section 2803-j of the Public Health Law to make the information contained in maternity related leaflets available on the Department of Health's website.

Section 4 amends paragraph (b) of subdivision 1 of section 2803-j of the Public Health Law to require the commissioner to review and update the information contained in the leaflets that are distributed to maternity patients before they are discharged from a hospital. 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, and education on maternal depression screening and referrals to hospital care for maternity patients.

Section 6 adds a new section 3217-g to the Insurance Law on screening for maternal depression. No insurer shall limit a patient's direct

access to maternal depression screening and referral, provided that the patient's access to such services, coverage and choice of provider is otherwise subject to the terms and conditions of the policy. "Otherwise subject to" means that the terms and conditions apply to the extent that they are not inconsistent with this provision. This is a procedural provision, not a benefit mandate, and clarifies that health insurers shall not require a referral from a primary care practitioner for this service.

Section 7 adds a new section 4306-f to the Insurance Law on screening for maternal depression. No corporation shall limit a patient's direct access to maternal depression screening and referral provided that the patient's access to such services, coverage and choice of provider is otherwise subject to the terms and conditions of the contract. "Otherwise subject to" means that the terms and conditions apply to the extent that they are not inconsistent with this provision. This is a procedural provision, not a benefit mandate, and clarifies that health insurers shall not require a referral from a primary care practitioner for this service.

Section 8 adds a new section 4406-f to the Public Health Law on screening for maternal depression. No health maintenance organization shall limit an enrollee's direct access to maternal depression screening and referral provided that the patient's access to such services, coverage and choice of provider is otherwise subject to the terms and conditions of the plan. "Otherwise subject to" means that the terms and conditions apply to the extent that they are not inconsistent with this provision. This is a procedural provision, not a benefit mandate, and clarifies that health insurers shall not require a referral from a primary care practitioner for this service.

Section 9 establishes an effective date.

JUSTIFICATION: 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 are 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 multiethnic 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. Women whose maternal depression is severe enough to be considered postpartum psychosis have a five percent suicide rate and four percent infanticide rate.

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 both 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, and economic boundaries and requires increased education and 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: 2013: S3137C/A7667B - PBH - Vetoed by the Governor - veto 269. 2012: S7355.

FISCAL IMPLICATIONS: To be determined

EFFECTIVE DATE: 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 to be made and completed by the commissioner of health on or before such effective date.


Text

STATE OF NEW YORK ________________________________________________________________________ 7234--B Cal. No. 1089 IN SENATE May 7, 2014 ___________
Introduced by Sens. KRUEGER, CARLUCCI, MONTGOMERY, PARKER, PERKINS, SERRANO, TKACZYK -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- reported favorably from said committee and committed to the Committee on Finance -- reported favorably from said committee, ordered to first and second report, amended on second report, ordered to a third reading, and to be reprinted as amended, retaining its place in the order of third read- ing -- again amended and ordered reprinted, retaining its place in the order of third reading AN ACT to amend the public health law and the insurance law, in relation to the provision of maternal depression education, screening guide- lines, and referrals for treatment 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 INFORMATION. (A) THE COMMISSIONER, IN CONSULTA- TION WITH THE COMMISSIONER OF MENTAL HEALTH, SHALL MAKE AVAILABLE TO
MATERNAL HEALTH CARE PROVIDERS INFORMATION ON MATERNAL DEPRESSION. THE INFORMATION SHALL INCLUDE, BUT NOT BE LIMITED TO: (I) A SUMMARY OF THE CURRENT EVIDENCE BASE AND PROFESSIONAL GUIDELINES FOR MATERNAL DEPRESSION SCREENING; (II) VALIDATED, EVIDENCE-BASED TOOLS FOR MATERNAL DEPRESSION SCREEN- ING; (III) INFORMATION ABOUT FOLLOW-UP SUPPORT FOR PATIENTS WHO MAY REQUIRE FURTHER EVALUATION, REFERRAL, OR TREATMENT INCLUDING, WHEN AVAILABLE, INFORMATION ABOUT SPECIFIC COMMUNITY RESOURCES AND ENTITIES LICENSED BY THE OFFICE OF MENTAL HEALTH; AND (IV) INFORMATION ON ENGAGING SUPPORT FOR THE MOTHER, WHICH MAY INCLUDE COMMUNICATING WITH THE OTHER PARENT OF THE CHILD AND OTHER FAMILY MEMBERS, AS APPROPRIATE AND CONSISTENT WITH PATIENT CONFIDENTIALITY. (B) THE INFORMATION ON MATERNAL DEPRESSION SHALL BE POSTED ON THE DEPARTMENT'S WEBSITE. THE COMMISSIONER SHALL, IN COLLABORATION WITH THE COMMISSIONER OF MENTAL HEALTH, UPDATE AND REVIEW THE INFORMATION ON MATERNAL DEPRESSION, AS NECESSARY. 3. 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 (j) to read as follows: (J) MATERNAL DEPRESSION, INCLUDING INFORMATION ABOUT 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 CONTAINED IN THE LEAFLET 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 [post-partum] MATERNAL depression. THE COMMISSIONER, IN COLLAB- ORATION WITH THE COMMISSIONER OF MENTAL HEALTH, SHALL REVIEW AND UPDATE THE INFORMATION ON MATERNAL DEPRESSION CONTAINED IN THE LEAFLET, AS NECESSARY. THE 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- NAL DEPRESSION, EDUCATION ON MATERNAL DEPRESSION SCREENING AND REFER- RALS, and the performance of any necessary maternal and newborn clinical
assessments. Notwithstanding this requirement, nothing in this para- graph is intended to result in the hospital charging any amount for such services in addition to the applicable charge for the maternity inpa- tient hospital admission. S 6. The insurance law is amended by adding a new section 3217-g to read as follows: S 3217-G. MATERNAL DEPRESSION SCREENINGS. TO THE EXTENT A POLICY PROVIDES COVERAGE FOR MATERNAL DEPRESSION SCREENING, 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, AS DEFINED IN SUBDIVISION ONE OF SECTION TWENTY-FIVE HUNDRED-K OF THE PUBLIC HEALTH LAW, FROM A PROVIDER OF OBSTETRICAL, GYNECOLOGIC, OR PEDIATRIC SERVICES OF HER CHOICE; PROVIDED THAT THE PATIENT INSURED'S ACCESS TO SUCH SERVICES, COVERAGE AND CHOICE OF PROVIDER IS OTHERWISE SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY UNDER WHICH THE PATIENT INSURED IS COVERED. S 7. The insurance law is amended by adding a new section 4306-f to read as follows: S 4306-F. MATERNAL DEPRESSION SCREENINGS. TO THE EXTENT A CONTRACT PROVIDES COVERAGE FOR MATERNAL DEPRESSION SCREENING, NO CORPORATION 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, AS DEFINED IN SUBDIVISION ONE OF SECTION TWENTY-FIVE HUNDRED-K OF THE PUBLIC HEALTH LAW, FROM A PROVIDER OF OBSTETRICAL, GYNECOLOGIC, OR PEDIATRIC SERVICES OF HER CHOICE; PROVIDED THAT THE PATIENT INSURED'S ACCESS TO SUCH SERVICES, COVERAGE AND CHOICE OF PROVIDER IS OTHERWISE SUBJECT TO THE TERMS AND CONDITIONS OF THE CONTRACT UNDER WHICH THE PATIENT INSURED IS COVERED. S 8. The public health law is amended by adding a new section 4406-f to read as follows: S 4406-F. MATERNAL DEPRESSION SCREENINGS. TO THE EXTENT A PLAN PROVIDES COVERAGE FOR MATERNAL DEPRESSION SCREENING, NO HEALTH MAINTE- NANCE ORGANIZATION SUBJECT TO THIS ARTICLE SHALL BY CONTRACT, WRITTEN POLICY OR PROCEDURE LIMIT A PATIENT ENROLLEE'S DIRECT ACCESS TO SCREEN- ING AND REFERRAL FOR MATERNAL DEPRESSION, AS DEFINED IN SUBDIVISION ONE OF SECTION TWENTY-FIVE HUNDRED-K OF THIS CHAPTER, FROM A PROVIDER OF OBSTETRICAL, GYNECOLOGIC, OR PEDIATRIC SERVICES OF HER CHOICE; PROVIDED THAT THE PATIENT ENROLLEE'S ACCESS TO SUCH SERVICES, COVERAGE AND CHOICE OF PROVIDER IS OTHERWISE SUBJECT TO THE TERMS AND CONDITIONS OF THE PLAN UNDER WHICH THE PATIENT ENROLLEE IS COVERED. 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 all policies and contracts issued, renewed, modified, altered, 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 neces- sary for the implementation of this act on its effective date is author- ized to be made and completed by the commissioner of health on or before such effective date.

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