NY State Senate Bill 2011-S7355

Senate Bill S7355

2011-2012 Legislative Session

Defines perinatal depression, requires the provision of perinatal depression education, and the provision of a screening and data reporting plan for the state

download bill text pdf

Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 02, 2012	referred to health

2011-S7355 (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §2502-a, amd §207, Pub Health L; amd §§4303, 3217-c, 3216 & 4804, Ins L
Versions Introduced in 2013-2014 Legislative Session:: S3137

2011-S7355 (ACTIVE) - Summary

Defines perinatal depression, requires the provision of perinatal depression education, and the provision of a screening and data reporting plan for the state.

2011-S7355 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S7355

TITLE OF BILL:

An act
to amend the public health law and the insurance law, in relation
to defining perinatal
depression, requiring the provision of perinatal depression education,
and requiring the provision
of a screening and data reporting plan for the state

PURPOSE OR GENERAL IDEA OF BILL:

This bill would define perinatal depression; develop standards for
perinatal screening and data reporting; ensure that training on
perinatal depression screening is available to maternal health
professionals; provide public education to promote awareness and
de-stigmatization of perinatal 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
perinatal depression.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 adds a new section 2502-a to the Public Health Law defining
perinatal depression and maternal health professional and establishes

standards for data reporting on perinatal screening.
The bill will ensure that maternal health providers are educated about
perinatal depression and trained on screening mothers to administer
appropriate diagnostic tools, and manage maternal and perinatal
depression. All qualified health professionals shall screen pregnant
mothers using standardized tools which shall consist of three
screenings in an obstetrical setting and three screenings after bit1h
in a pediatric setting. The commissioner shall recommend and provide
appropriate standardized, validated diagnostic tools for all
perinatal screening. Fathers and other family members shall, as
appropriate be included in the education and treatment process for
perinatal depression.

Section 2 amends section 207 subdivision (g) of the Public Health Law
by adding perinatal depression to the list of healthcare and wellness
outreach education that must be done by the Department of Health.

Section 3 amends section 4303 subsection (c) subparagraph (B) of the
Insurance Law by adding the reporting of perinatal depression signs
to be covered by maternity care coverage.

Section 4 amends section 3217-c subsection (a) of the Insurance Law
by adding perinatal depression to the conditions that cannot be
limited by coverage.

Section 5 amends section 3216 item (ii) of subparagraph (A) of
paragraph 10 of subsection (i) of the Insurance Law by adding
perinatal depression to maternity care coverage.


Section 6 amends section 4804 paragraph 1 of subsection (e) and
subsection (f) the Insurance Law by continuing ongoing treatment for
perinatal depression for 90 days should the insurer leave the network
of providers.

Section 7 requires state and private insurers to establish a
reimbursement structure for perinatal screenings or follow provisions
in section 2530 of the Public Health Law.

Section 8 establishes an effective date.

JUSTIFICATION:

Perinatal depression is broadly defined as a wide range of emotional
and psychological reactions a mother may experience after childbirth.
These reactions may include, but are not limited to, feelings of
despair, prolonged sadness, extreme guilt, thoughts of suicide, lack
of energy, difficulty concentrating, fatigue, extreme changes in
appetite, and thoughts of suicide and/or of harming the baby. In some
cases these reactions-which can occur without warning-happen before,
during, and immediately after childbirth, and continue into the
infant's first year of life.

Depression associated with childbirth is commonly categorized under
three types: the "baby blues", postpartum depression, and postpartum
psychosis. Postpartum psychosis, the most severe form of perinatal
depression, usually includes auditory hallucinations and delusions,
and in some cases visual hallucinations.

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 has a five percent suicide rate and
four percent rate of infanticide, or death of an infant.

Often, the symptoms of perinatal depression are not immediately
identified because they closely resemble those generally associated
with pregnancy. As a result, perinatal depression is sometimes left
untreated, and ultimately may result in detrimental impact to the
entire family.
The family is affected in the following ways: children of mothers with
perinatal 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; and a mother experiencing
depression does not often disclose her condition due to feelings of
shame, and so the severity of the condition worsens.

Perinatal depression is often undetected and untreated by health
professionals due to both lack of training in identifying the
condition, as well as safety concerns about treating pregnant women.
Early screening and identification of perinatal depression has an 80
to 90 percent success rate and offers long-term health care costs
savings.

LEGISLATIVE HISTORY:


New bill.

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

2011-S7355 (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  7355

                            I N  S E N A T E

                               May 2, 2012
                               ___________

Introduced  by  Sen. KRUEGER -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law and the insurance law, in relation
  to defining perinatal depression, requiring the provision of perinatal
  depression education, and requiring the provision of a  screening  and
  data reporting plan for the state

  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
2502-a to read as follows:
  S  2502-A.  PERINATAL  DEPRESSION.  1.  DEFINITIONS.  AS  USED IN THIS
SECTION:
  (A) PERINATAL DEPRESSION MEANS A WIDE RANGE OF EMOTIONAL  AND  PSYCHO-
LOGICAL  REACTIONS  A  MOTHER  MAY  EXPERIENCE  AFTER  CHILDBIRTH. THESE
REACTIONS MAY INCLUDE, BUT ARE NOT  LIMITED  TO,  FEELINGS  OF  DESPAIR,
PROLONGED  SADNESS,  EXTREME GUILT, THOUGHTS OF SUICIDE, LACK OF ENERGY,
DIFFICULTY CONCENTRATING, FATIGUE,  EXTREME  CHANGES  IN  APPETITE,  AND
THOUGHTS  OF SUICIDE AND/OR OF HARMING THE BABY. PERINATAL DEPRESSION IS
COMMONLY CHARACTERIZED AS (1) "BABY BLUES"-THE MILDEST FORM;  (2)  POST-
PARTUM  DEPRESSION;  OR  (3) POSTPARTUM PSYCHOSIS-THE SEVEREST FORM. THE
CHARACTERIZATION CORRESPONDS TO THE VARYING DEGREE TO WHICH  THE  MOTHER
EXPERIENCES SYMPTOMS.
  (B)  "MATERNAL  HEALTH  PROFESSIONAL"  MEANS  A PHYSICIAN, MIDWIFE, OR
OTHER AUTHORIZED PRACTITIONER ATTENDING A PREGNANT WOMAN.
  2. DATA REPORTING FOR PERINATAL DEPRESSION. (A) THE  DEPARTMENT  SHALL
DEVELOP  STANDARDS FOR EFFECTIVE SCREENING OF PERINATAL DEPRESSION USING
RECOGNIZED CLINICAL STANDARDS AND  EVIDENCE-BASED  PRACTICES.  EFFECTIVE
STANDARDIZED,  VALIDATED  DIAGNOSTIC TOOLS USED FOR PERINATAL DEPRESSION
SCREENING MAY INCLUDE THE EDINBURGH POSTNATAL DEPRESSION  SCALE  (EPDS),
THE  POSTPARTUM DEPRESSION SCREEN (PPDS), THE BECK DEPRESSION INVENTORY-
II (BDI-II), OR THE CENTER FOR EPIDEMIOLOGICAL STUDIES-DEPRESSION  SCALE
(CES-D).

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15669-01-2

S. 7355                             2

  (B)  THE  DEPARTMENT  SHALL  MAKE  RECOMMENDATIONS  TO HEALTH PLAN AND
HEALTH CARE PROVIDERS ON DATA REPORTING OF PERINATAL DEPRESSION  SCREEN-
ING.
  (C)  THE DEPARTMENT SHALL ISSUE REGULATIONS THAT REQUIRE PROVIDERS AND
CARRIERS TO REPORT DATA ON THE SCREENING FOR PERINATAL  DEPRESSION,  THE
DIAGNOSED  CASES  OF PERINATAL DEPRESSION, AND RECOMMENDED OR PRESCRIBED
TREATMENT OPTIONS OR REFERRALS  MADE,  TO  THE  DEPARTMENT'S  BUREAU  OF
MATERNAL AND CHILD HEALTH.
  (D)  FOLLOWING THE RECEIPT OF THE SCREENING DATA, THE BUREAU OF MATER-
NAL AND CHILD HEALTH SHALL ISSUE AN ANNUAL SUMMARY OF ACTIVITIES RELATED
TO SCREENING FOR PERINATAL DEPRESSION,  INCLUDING  BEST  PRACTICES;  THE
SCREENING  TOOLS  USED  OR IN CASES WHERE A VALIDATED TOOL WAS NOT USED,
REPORT  IF  ANY  QUESTIONNAIRE  OR  DISCUSSION  TO   INDICATE   POSSIBLE
DEPRESSION  HAD BEEN OFFERED; THE NUMBERS OF DIAGNOSED AND TREATED CASES
OF PERINATAL DEPRESSION REPORTED BY PROVIDERS AND CARRIERS; AND  RESULTS
OF ANY PRESCRIBED TREATMENT, INCLUDING THE OUTCOMES OF ANY REFERRALS FOR
FURTHER  TREATMENT.  THE  BUREAU OF MATERNAL AND CHILD HEALTH SHALL FILE
THE SUMMARY ANNUALLY WITH THE COMMISSIONER AND WITH THE  CLERKS  OF  THE
SENATE AND THE ASSEMBLY NO LATER THAN JUNE THIRTIETH; PROVIDED, HOWEVER,
THAT  THE FIRST REPORT IS DUE NO LATER THAN JUNE THIRTIETH, TWO THOUSAND
THIRTEEN.
  3. PERINATAL DEPRESSION PUBLIC EDUCATION. (A) THE  COMMISSIONER  SHALL
MAKE  PERINATAL  DEPRESSION INFORMATION LEAFLETS AVAILABLE ON THE HEALTH
DEPARTMENT'S WEBSITE, ACCESSIBLE TO EVERY MATERNAL  HEALTH  PROFESSIONAL
AND  MATERNAL HEALTH CARE FACILITY, AS DESCRIBED IN SECTION TWENTY-EIGHT
HUNDRED THREE-J OF THIS  CHAPTER.  THE  COMMISSIONER  SHALL  PERFORM  AN
INITIAL  REVIEW OF SUCH PERINATAL DEPRESSION INFORMATIONAL MATERIALS, IN
COLLABORATION WITH THE STATE BOARD OF MEDICINE AND STATE BOARD OF MENTAL
HEALTH PRACTITIONERS, TO EVALUATE THE CONTENTS FOR ADDRESSING ALL  FORMS
OF  PERINATAL  DEPRESSION,  AND IDENTIFYING RESOURCES FOR OBTAINING HELP
FOR THE INDIVIDUALS AND FAMILIES. ALL PERINATAL  DEPRESSION  INFORMATION
OUTLINED  IN  THIS  SECTION  SHALL  BE PROVIDED IN THE TOP SIX LANGUAGES
OTHER THAN ENGLISH SPOKEN IN THE STATE ACCORDING TO THE LATEST AVAILABLE
DATA FROM THE U.S.   BUREAU OF CENSUS, AND SHALL  ADOPT  ANY  RULES  AND
REGULATIONS  NECESSARY  TO  ENSURE  THAT SUCH PATIENTS, AND THEIR HEALTH
INFORMATION, IS TREATED IN ACCORDANCE WITH THE PROVISIONS OF SUCH STATE-
MENT, INCLUDING THOSE  RULES  ASSOCIATED  WITH  THE  HEALTH  INFORMATION
PORTABILITY AND ACCOUNTABILITY ACT. ALL MATERNAL HEALTH FACILITIES SHALL
BE  REQUIRED  TO PROVIDE THE PERINATAL DEPRESSION INFORMATIONAL LEAFLETS
TO THEIR PROFESSIONAL STAFF AND PATIENTS.
  (B) THE COMMISSIONER SHALL BE  AUTHORIZED  TO  GRANT  AWARDS  FOR  THE
SUPPORT  OF  ADDITIONAL  APPROVED  PERINATAL  DEPRESSION EDUCATION GRANT
PROGRAMS IN ACCORDANCE WITH SECTION TWENTY-FIVE  HUNDRED  TWENTY-TWO  OF
THIS ARTICLE.
  4.  PERINATAL  DEPRESSION  TRAINING FOR MATERNAL HEALTH PROFESSIONALS.
(A) THE COMMISSIONER  SHALL  DEVELOP  TUTORIAL  TRAINING  MATERIALS,  IN
COLLABORATION  WITH  THE  STATE  BOARD  OF  MEDICINE, THE STATE BOARD OF
MENTAL HEALTH PRACTITIONERS, AND THE STATE BOARD OF NURSING. THE DEPART-
MENT SHALL PROVIDE TRAINING ON PERINATAL  DEPRESSION  SCREENING  ON  ITS
WEBSITE.  THE  TRAINING  SHALL  BE  AVAILABLE  TO  EVERY MATERNAL HEALTH
PROFESSIONAL AND MATERNAL HEALTH CARE FACILITY.
  (B) A TRAINED MATERNAL HEALTH PROFESSIONAL SHALL BE  ABLE  TO  DO  THE
FOLLOWING:
  (1)  IDENTIFY  AND ADMINISTER APPROPRIATE DEPRESSION DIAGNOSTIC TOOLS,
SUCH AS THE EDINBURGH POSTNATAL DEPRESSION SCALE,  TO  ASSESS  PERINATAL
DEPRESSION, WHICH SHALL BE PROVIDED BY THE DEPARTMENT ONLINE;

S. 7355                             3

  (2)  APPROPRIATELY  MANAGE MATERNAL RESPONSES, INCLUDING PERINATAL AND
MATERNAL DEPRESSION; AND
  (3)  UNDERSTAND  HOW  TO  INTEGRATE  SCREENINGS  INTO  ALL VISITS IN A
ROUTINE MANNER.
  (C) THE COMMISSIONER SHALL PERFORM AN INITIAL REVIEW OF  THE  TUTORIAL
MATERIALS DESCRIBED IN PARAGRAPH (A) OF THIS SUBDIVISION, IN CONJUNCTION
WITH THE STATE BOARD OF MEDICINE, THE STATE BOARD OF MENTAL HEALTH PRAC-
TITIONERS,  AND THE STATE BOARD OF NURSING, TO EVALUATE THE CONTENTS FOR
TRAINING MATERNAL HEALTH PROFESSIONALS TO APPROPRIATELY SCREEN FOR PERI-
NATAL DEPRESSION. ALL TRAINING MATERIALS SHALL BE AVAILABLE FOR MATERNAL
HEALTH FACILITIES TO VIEW AND/OR DOWNLOAD FOR TUTORIAL  SESSIONS.  AFTER
SUCH TUTORIALS, MATERNAL HEALTH PROFESSIONALS SHALL COMPLETE A QUESTION-
NAIRE   TESTING   THEIR  ABILITY  TO  SCREEN  MOTHERS;  UPON  SUCCESSFUL
COMPLETION, THEY SHALL SIGN A SCREENING AUTHORIZATION LETTER PROVIDED BY
THEIR HEALTH FACILITY.
  5. SCREENING  FOR  PERINATAL  DEPRESSION.  (A)  ALL  QUALIFIED  HEALTH
PROFESSIONALS  SHALL  SCREEN  PREGNANT MOTHERS FOR PERINATAL DEPRESSION;
USING EFFECTIVE STANDARDIZED, VALIDATED DIAGNOSTIC TOOLS USED FOR  PERI-
NATAL  DEPRESSION  SCREENING  SUCH AS THE EDINBURGH POSTNATAL DEPRESSION
SCALE  (EPDS),  THE  POSTPARTUM  DEPRESSION  SCREEN  (PPDS),  THE   BECK
DEPRESSION  INVENTORY-II  (BDI-II),  OR  THE  CENTER FOR EPIDEMIOLOGICAL
STUDIES-DEPRESSION SCALE (CES-D); OR EVEN WHERE SUCH SCREENING TOOLS MAY
NOT BE USED, THEY SHALL OFFER A BASIC QUESTIONNAIRE OR BRIEF  DISCUSSION
TO INDICATE POSSIBLE DEPRESSION.  THIS SHALL CONSIST OF THREE SCREENINGS
IN  AN  OBSTETRICAL  SETTING, INCLUDING: (1) ONE IN THE FIRST TRIMESTER,
INCLUDING RISK ASSESSMENT BASED ON HISTORY OF PRIOR DEPRESSION; (2)  ONE
IN  THE THIRD TRIMESTER; AND (3) ONE AT THE SIX-WEEK POSTPARTUM VISIT OR
WITHIN THE FIRST MONTH OF LIFE.  FURTHER, AFTER BIRTH,  AT  LEAST  THREE
ADDITIONAL  REQUIRED SCREENINGS IN A PEDIATRIC SETTING SHALL OCCUR; THIS
INCLUDES A RISK ASSESSMENT BASED ON HISTORY  OF  PRIOR  DEPRESSION,  AND
THREE  SCREENINGS  AT ROUTINE WELL-CHILD VISITS DURING THE CHILD'S FIRST
YEAR. ALL HEALTH CARE PROFESSIONALS SHALL ADHERE TO  MANDATED  CONFIDEN-
TIALITY  REQUIREMENTS WHEN ACCESSING, DISCUSSING, REPORTING OR TRANSMIT-
TING THE RESULTS OF DEPRESSION SCREENS WHEN AVAILABLE IN A  CHILD'S  AND
MOTHER'S MEDICAL RECORD.
  (B)  IF A MOTHER SWITCHES OBSTETRICIANS OR NURSE MIDWIVES DURING PREG-
NANCY THE NEW PROVIDER SHALL PERFORM A SCREENING AND RISK ASSESSMENT  AT
THE  FIRST APPOINTMENT, AS WELL AS THE REMAINING SCREENINGS, AS OUTLINED
IN THIS SECTION. IF A WOMAN SWITCHES HER CHILDREN'S PEDIATRICIAN  DURING
THE FIRST YEAR OF THE CHILD'S LIFE, THE NEW PEDIATRICIAN SHALL PERFORM A
SCREENING AND RISK ASSESSMENT AT THE FIRST APPOINTMENT, AS WELL AS AT AS
MANY  OF  THE  REMAINING  SCREENINGS  AS  POSSIBLE,  AS OUTLINED IN THIS
SECTION.
  (C) THE COMMISSIONER, IN CONJUNCTION WITH THE STATE BOARD OF MEDICINE,
THE STATE BOARD OF MENTAL HEALTH PRACTITIONERS, AND THE STATE  BOARD  OF
NURSING, SHALL RECOMMEND AND PROVIDE THE APPROPRIATE STANDARDIZED, VALI-
DATED  DIAGNOSTIC TOOLS USED FOR ALL PERINATAL DEPRESSION SCREENING SUCH
AS THE EDINBURGH  POSTNATAL  DEPRESSION  SCALE  (EPDS),  THE  POSTPARTUM
DEPRESSION  SCREEN (PPDS), THE BECK DEPRESSION INVENTORY-II (BDI-II), OR
THE CENTER FOR EPIDEMIOLOGICAL STUDIES-DEPRESSION SCALE (CES-D).
  (D) PHYSICIANS AND OTHER LICENSED HEALTH CARE WORKERS PROVIDING PRENA-
TAL AND POSTNATAL CARE TO WOMEN SHALL INCLUDE FATHERS AND  OTHER  FAMILY
MEMBERS,  AS  APPROPRIATE, IN BOTH THE EDUCATION AND TREATMENT PROCESSES
TO HELP THEM BETTER  UNDERSTAND  THE  NATURE  AND  CAUSES  OF  PERINATAL
DEPRESSION.

S. 7355                             4

  (E) THE COMMISSIONER SHALL ENHANCE EXISTING REFERRAL LISTS FOR PROVID-
ERS;  A  LIST OF SERVICE PROVIDERS FOR INDIVIDUAL COUNSELING; AND A LIST
OF SUPPORT  GROUPS  AROUND  THE  STATE,  INCLUDING  ADEQUATE  ACCESSIBLE
SERVICES  OPERATED  BY  LOCAL NOT-FOR-PROFITS. SUCH ADDITIONAL REFERRALS
SHALL  BE  DISCUSSED  BETWEEN  THE  PROVIDERS AND THE MOTHERS, INCLUDING
FATHERS AND OTHER FAMILY MEMBERS, WHEN APPROPRIATE.
  S 2. Subdivision (g) of section 207  of  the  public  health  law,  as
amended  by  section 16 of part A of chapter 109 of the laws of 2010 and
as relettered by chapter 331 of the laws of 2010, is amended to read  as
follows:
  (g)  Improving  birth outcomes, including the importance of preconcep-
tional  care,  early  prenatal  care,  INCLUDING  PERINATAL  DEPRESSION,
considerations of health risks during pregnancy, considerations of bene-
fits  and risks of labor and delivery options including, but not limited
to, vaginal and cesarean section delivery, elective or  repeat  cesarean
sections, and appropriate use of drugs during delivery.
  S 3. 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, REPORT-
ING SIGNS OF PERINATAL DEPRESSION, and the performance of any  necessary
maternal and newborn clinical assessments.
  S 4. Subsection (a) of section 3217-c of the insurance law, as amended
by chapter 219 of the laws of 2011, is amended to read as follows:
  (a)  No  insurer  subject  to  this article shall by contract, written
policy or procedure limit a female insured's direct  access  to  primary
and  preventive  obstetric  and  gynecologic  services, including annual
examinations, care resulting from such annual examinations,  and  treat-
ment  of acute gynecologic conditions, from a qualified provider of such
services of her choice from within the plan or for any care related to a
pregnancy, INCLUDING PERINATAL DEPRESSION, provided that: (1) such qual-
ified provider discusses such  services  and  treatment  plan  with  the
insured's  primary care practitioner in accordance with the requirements
of the insurer; and (2) such qualified provider agrees to adhere to  the
insurer's  policies  and procedures, including any applicable procedures
regarding referrals and obtaining prior authorization for services other
than obstetric and  gynecologic  services  rendered  by  such  qualified
provider,  and  agrees  to provide services pursuant to a treatment plan
(if any) approved by the insurer.
  S 5. Item (ii) of subparagraph (A) of paragraph 10 of  subsection  (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,  PERINA-
TAL  DEPRESSION,  and  the  performance  of  any  necessary maternal and
newborn clinical assessments.
  S 6. Paragraph 1 of subsection (e) and subsection (f) of section  4804
of  the  insurance law, as added by chapter 705 of the laws of 1996, are
amended to read as follows:
  (1) If an insured's health care provider leaves the insurer's  in-net-
work  benefits  portion  of  its network of providers for a managed care
product for reasons other than those for which the provider would not be
eligible to receive a hearing pursuant to paragraph  one  of  subsection
(b)  of section forty-eight hundred three of this [chapter] ARTICLE, the
insurer shall permit the insured to continue an ongoing course of treat-

S. 7355                             5

ment with the insured's current health care provider  during  a  transi-
tional  period  of  (i) up to ninety days from the date of notice to the
insured of the provider's disaffiliation from the insurer's network;  or
(ii) if the insured has entered the second trimester of pregnancy at the
time  of  the  provider's disaffiliation, for a transitional period that
includes the provision of  post-partum  care  directly  related  to  the
delivery, INCLUDING FOR PERINATAL DEPRESSION.
  (f) If a new insured whose health care provider is not a member of the
insurer's in-network benefits portion of the provider network enrolls in
the  managed  care  product,  the  insurer  shall  permit the insured to
continue an ongoing course  of  treatment  with  the  insured's  current
health  care  provider  during a transitional period of up to sixty days
from the effective date of enrollment, if: (1) the insured has  a  life-
threatening disease or condition or a degenerative and disabling disease
or  condition  or  (2)  the  insured has entered the second trimester of
pregnancy at the time of enrollment,  in  which  case  the  transitional
period  shall include the provision of post-partum care directly related
to the delivery INCLUDING FOR PERINATAL DEPRESSION. If an insured elects
to continue to receive care from such health care provider  pursuant  to
this  paragraph,  such  care  shall be authorized by the insurer for the
transitional period only if the health  care  provider  agrees:  (A)  to
accept reimbursement from the insurer at rates established by the insur-
er  as  payment  in full, which rates shall be no more than the level of
reimbursement applicable to  similar  providers  within  the  in-network
benefits  portion  of  the  insurer's  network for such services; (B) to
adhere to the insurer's quality assurance  requirements  and  agrees  to
provide  to  the  insurer  necessary medical information related to such
care; and (C) to otherwise adhere to the insurer's policies  and  proce-
dures  including,  but not limited to procedures regarding referrals and
obtaining pre-authorization and a treatment plan approved by the  insur-
er.  In no event shall this subsection be construed to require an insur-
er to provide coverage for benefits not otherwise covered or to diminish
or  impair  pre-existing  condition  limitations  contained  within  the
insured's contract.
  S 7. The state and private insurers shall  establish  a  reimbursement
structure for perinatal depression screenings or where applicable follow
provisions pursuant to section 2530 of the public health law.
  S  8. 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.

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