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

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.