NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9610B
SPONSOR: Gottfried TITLE OF BILL: An act to amend the public health law and the insur-
ance law, in relation to the provision of maternal depression education,
screening guidelines, and referrals for treatment
PURPOSE: This bill would define maternal depression; provide informa-
tion and guidelines on maternal depression screening; provide informa-
tion 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. "Other-
wise 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 screen-
ing 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, approximate-
ly ten to fifteen percent of mothers and twenty-two percent of multieth-
nic inner city mothers develop postpartum depression; 50-B0 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 psycho-
sis have a five percent suicide rate and four percent infanticide rate.
Often, the symptoms of maternal depression are not immediately identi-
fied because they closely resemble those generally associated with preg-
nancy. 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, behav-
ioral, 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 iden-
tified 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 preg-
nancy 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. 2014: A9610-A passed the assembly
FISCAL IMPLICATIONS: To be determined
EFFECTIVE DATE: This act shall take effect on the one hundred eight-
ieth 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.
STATE OF NEW YORK
________________________________________________________________________
9610--B
Cal. No. 870
IN ASSEMBLY
May 12, 2014
___________
Introduced by M. of A. GOTTFRIED, ORTIZ -- read once and referred to the
Committee on Health -- reported and referred to the Committee on Ways
and Means -- passed by Assembly and delivered to the Senate, recalled
from the Senate, vote reconsidered, bill amended, ordered reprinted,
retaining its place on the order of third reading -- repassed by
Assembly and delivered to the Senate, recalled from the Senate, vote
reconsidered, bill amended, ordered reprinted, retaining its place on
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:
1 Section 1. The public health law is amended by adding a new section
2 2500-k to read as follows:
3 § 2500-k. Maternal depression. 1. Definitions. As used in this
4 section:
5 (a) "Maternal depression" means a wide range of emotional and psycho-
6 logical reactions a woman may experience during pregnancy or after
7 childbirth. These reactions may include, but are not limited to, feel-
8 ings of despair or extreme guilt, prolonged sadness, lack of energy,
9 difficulty concentrating, fatigue, extreme changes in appetite, and
10 thoughts of suicide or of harming the baby. Maternal depression may
11 include prenatal depression, the "baby blues," postpartum depression, or
12 postpartum psychosis -- the severest form.
13 (b) "Maternal health care provider" means a physician, midwife, nurse
14 practitioner, or physician assistant, or other health care practitioner
15 acting within his or her lawful scope of practice, attending a pregnant
16 woman or a woman up to one year after childbirth, including a practi-
17 tioner attending the woman's child up to one year after childbirth.
18 2. Maternal depression information. (a) The commissioner, in consulta-
19 tion with the commissioner of mental health, shall make available to
20 maternal health care providers information on maternal depression. The
21 information shall include, but not be limited to:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD14648-11-4
A. 9610--B 2
1 (i) a summary of the current evidence base and professional guidelines
2 for maternal depression screening;
3 (ii) validated, evidence-based tools for maternal depression screen-
4 ing;
5 (iii) information about follow-up support for patients who may require
6 further evaluation, referral, or treatment including, when available,
7 information about specific community resources and entities licensed by
8 the office of mental health; and
9 (iv) information on engaging support for the mother, which may include
10 communicating with the other parent of the child and other family
11 members, as appropriate and consistent with patient confidentiality.
12 (b) The information on maternal depression shall be posted on the
13 department's website. The commissioner shall, in collaboration with the
14 commissioner of mental health, update and review the information on
15 maternal depression, as necessary.
16 3. The commissioner shall make any regulations necessary to implement
17 this section.
18 § 2. Subdivision 1 of section 207 of the public health law is amended
19 by adding a new paragraph (j) to read as follows:
20 (j) Maternal depression, including information about education,
21 screening, referral services, and possible options for treatment.
22 § 3. Subdivision 1 of section 2803-j of the public health law, as
23 amended by chapter 62 of the laws of 1996, is amended to read as
24 follows:
25 1. The commissioner shall require that every hospital and birth center
26 shall prepare in printed or photocopied form and distribute at the time
27 of pre-booking directly to each prospective maternity patient and, upon
28 request, to the general public an informational leaflet. Such leaflet
29 shall be designed by the commissioner and shall contain brief defi-
30 nitions of maternity related procedures and practices as specified in
31 subdivision two of this section and such other material as deemed appro-
32 priate by the commissioner. Hospitals and birth centers may also elect
33 to distribute additional explanatory material along with the maternity
34 patients informational leaflet. The commissioner shall make the informa-
35 tion contained in the leaflet available on the department's website.
36 § 4. Subdivision 1-b of section 2803-j of the public health law, as
37 added by chapter 647 of the laws of 1997, is amended to read as follows:
38 1-b. The informational leaflet shall also include information relating
39 to the physical and mental health of the maternity patient after
40 discharge from the hospital, including, but not limited to, information
41 about [post-partum] maternal depression. The commissioner, in collab-
42 oration with the commissioner of mental health, shall review and update
43 the information on maternal depression contained in the leaflet, as
44 necessary. The informational leaflets shall be made available to
45 patients in the top six languages spoken in the state, other than
46 English, according to the latest available data from the United States
47 Census Bureau.
48 § 5. Paragraph (b) of subdivision 1 of section 2803-n of the public
49 health law, as added by chapter 56 of the laws of 1996, is amended to
50 read as follows:
51 (b) Maternity care shall also include, at minimum, parent education,
52 assistance and training in breast or bottle feeding, education on mater-
53 nal depression, education on maternal depression screening and refer-
54 rals, and the performance of any necessary maternal and newborn clinical
55 assessments. Notwithstanding this requirement, nothing in this para-
56 graph is intended to result in the hospital charging any amount for such
A. 9610--B 3
1 services in addition to the applicable charge for the maternity inpa-
2 tient hospital admission.
3 § 6. The insurance law is amended by adding a new section 3217-g to
4 read as follows:
5 § 3217-g. Maternal depression screenings. To the extent a policy
6 provides coverage for maternal depression screening, no insurer subject
7 to this article shall by contract, written policy or procedure limit a
8 patient insured's direct access to screening and referral for maternal
9 depression, as defined in subdivision one of section twenty-five
10 hundred-k of the public health law, from a provider of obstetrical,
11 gynecologic, or pediatric services of her choice; provided that the
12 patient insured's access to such services, coverage and choice of
13 provider is otherwise subject to the terms and conditions of the policy
14 under which the patient insured is covered.
15 § 7. The insurance law is amended by adding a new section 4306-f to
16 read as follows:
17 § 4306-f. Maternal depression screenings. To the extent a contract
18 provides coverage for maternal depression screening, no corporation
19 subject to this article shall by contract, written policy or procedure
20 limit a patient insured's direct access to screening and referral for
21 maternal depression, as defined in subdivision one of section twenty-
22 five hundred-k of the public health law, from a provider of obstetrical,
23 gynecologic, or pediatric services of her choice; provided that the
24 patient insured's access to such services, coverage and choice of
25 provider is otherwise subject to the terms and conditions of the
26 contract under which the patient insured is covered.
27 § 8. The public health law is amended by adding a new section 4406-f
28 to read as follows:
29 § 4406-f. Maternal depression screenings. To the extent a plan
30 provides coverage for maternal depression screening, no health mainte-
31 nance organization subject to this article shall by contract, written
32 policy or procedure limit a patient enrollee's direct access to screen-
33 ing and referral for maternal depression, as defined in subdivision one
34 of section twenty-five hundred-k of this chapter, from a provider of
35 obstetrical, gynecologic, or pediatric services of her choice; provided
36 that the patient enrollee's access to such services, coverage and choice
37 of provider is otherwise subject to the terms and conditions of the plan
38 under which the patient enrollee is covered.
39 § 9. This act shall take effect on the one hundred eightieth day after
40 it shall have become a law; provided that (a) sections six, seven and
41 eight of this act shall apply to all policies and contracts issued,
42 renewed, modified, altered, amended or delivered on or after the first
43 of January after this act becomes a law; and (b) effective immediately,
44 the addition, amendment and/or repeal of any rule or regulation neces-
45 sary for the implementation of this act on its effective date is author-
46 ized to be made and completed by the commissioner of health on or before
47 such effective date.
