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.
