HOUSE DOCKET, NO. 4141 FILED ON: 3/20/2009
HOUSE . . . . . . . . . . . . . . . No. 3897
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The Commonwealth of Massachusetts
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In the Year Two Thousand Nine
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An Act providing coverage for treatment of post-partum depression..
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. Chapter 17 of the General Laws is hereby amended by adding the following section:-
Section 18. The department of public health shall administer training around the commonwealth on screening tools, managing maternal responses, and maternal depression generally, building on previous agency trainings. Said department shall develop a curriculum to expand opportunities for additional training, including web-based training materials. The trainings will strongly encourage obstetricians, nurse midwives, and pediatricians to incorporate screenings into every visit in a routine manner.
SECTION 2. Chapter 175 of the General Laws is hereby amended by inserting after section 47I the following section:-
Section 47J. Any individual policy of accident and sickness insurance issued pursuant to section l08, and any group blanket policy of accident and sickness insurance issued pursuant to section ll0, except policies providing supplemental coverage to Medicare or to other government programs, delivered, issued or renewed by agreement within or without the commonwealth shall provide coverage for screening for post-partum depression, consistent with rules, regulations and criteria established by the department of public health pursuant to section 218 of chapter 111. Said screening process in multiple settings will increase the likelihood of detection of post-partum depression and reduce the stigma associated with it. These screenings shall consist of 3 screenings in an obstetrical setting, including: (a) one in the first trimester, including risk assessment based on history of prior depression; (b) 1 in the third trimester; and (c) 1 at the 6-week post-partum visit. At least 4 required screenings in a pediatric setting, including (i)one in the first month of life, including risk assessment based on history of prior depression; and (ii) three additional screenings at routine well-child visits during the child’s first year. If a woman switches her children’s pediatrician during the first year of her child’s life, the new pediatrician is required to perform a screen and risk assessment at the first appointment, as well as at as many of the remaining required screens as possible. If a woman switches obstetricians or nurse midwives during pregnancy the new provider is required to perform a screen and risk assessment at the first appointment, as well as the remaining required screens. Because both parents have access to children’s medical records, pediatricians should consider safety and confidentiality when indicating the results of depression screens on those records. All providers must use a validated instrument for screens, to be determined by the department. The commonwealth and private insurers shall establish a reimbursement structure for screenings, and are strongly encouraged to use existing billing codes.
SECTION 3. Section ll0 of said chapter 175, as so appearing, is hereby amended by adding the following subdivision:-
(Q) Any individual policy of insurance described in subdivisions (A), (C) or (D), which is delivered or issued for delivery within or without the commonwealth and which covers residents of the commonwealth and any employees health and welfare fund which is promulgated or renewed to any persons or group of persons in the commonwealth shall provide benefits for screening for post-partum depression. Said screening process in multiple settings will increase the likelihood of detection of post-partum depression and reduce the stigma associated with it. These screenings shall consist of 3 screenings in an obstetrical setting, including: (a) one in the first trimester, including risk assessment based on history of prior depression; (b) 1 in the third trimester; and (c) 1 at the 6-week post-partum visit. At least 4 required screenings in a pediatric setting, including (i)one in the first month of life, including risk assessment based on history of prior depression; and (ii) three additional screenings at routine well-child visits during the child’s first year. If a woman switches her children’s pediatrician during the first year of her child’s life, the new pediatrician is required to perform a screen and risk assessment at the first appointment, as well as at as many of the remaining required screens as possible. If a woman switches obstetricians or nurse midwives during pregnancy the new provider is required to perform a screen and risk assessment at the first appointment, as well as the remaining required screens. Because both parents have access to children’s medical records, pediatricians should consider safety and confidentiality when indicating the results of depression screens on those records. All providers must use a validated instrument for screens, to be determined by the department. The commonwealth and private insurers shall establish a reimbursement structure for screenings, and are strongly encouraged to use existing billing codes.
SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after section 8AA the following section:-
Section 8BB. Any contract, except contracts providing supplemental coverage to Medicare or other governmental programs, between a subscriber and the corporation under an individual group hospital service plan which shall be delivered, issued or renewed in the commonwealth shall provide, as a basis benefit to all individual subscribers and members within the commonwealth and to all group members having a principle place of employment within the commonwealth for expense for the screening for post-partum depression, consistent with rules, regulations and criteria established by the department of public health pursuant to section 218 of chapter 111. Said screening process in multiple settings will increase the likelihood of detection of post-partum depression and reduce the stigma associated with it. These screenings shall consist of 3 screenings in an obstetrical setting, including: (a) one in the first trimester, including risk assessment based on history of prior depression; (b) 1 in the third trimester; and (c) 1 at the 6-week post-partum visit. At least 4 required screenings in a pediatric setting, including (i)one in the first month of life, including risk assessment based on history of prior depression; and (ii) three additional screenings at routine well-child visits during the child’s first year. If a woman switches her children’s pediatrician during the first year of her child’s life, the new pediatrician is required to perform a screen and risk assessment at the first appointment, as well as at as many of the remaining required screens as possible. If a woman switches obstetricians or nurse midwives during pregnancy the new provider is required to perform a screen and risk assessment at the first appointment, as well as the remaining required screens. Because both parents have access to children’s medical records, pediatricians should consider safety and confidentiality when indicating the results of depression screens on those records. All providers must use a validated instrument for screens, to be determined by the department. The commonwealth and private insurers shall establish a reimbursement structure for screenings, and are strongly encouraged to use existing billing codes.
SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after section 4BB the following section:-
Section 4CC. Any subscription certificate under an individual or group medical service agreement, except certificates which provide supplemental coverage to Medicare or other governmental programs which shall be delivered or issued or renewed in the commonwealth shall provide as benefits to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth for expense of screening for post-partum depression, consistent with rules, regulations and criteria established by the department of public health pursuant to section 218 of chapter 111. Said screening process in multiple settings will increase the likelihood of detection of post-partum depression and reduce the stigma associated with it. These screenings shall consist of 3 screenings in an obstetrical setting, including: (a) one in the first trimester, including risk assessment based on history of prior depression; (b) 1 in the third trimester; and (c) 1 at the 6-week post-partum visit. At least 4 required screenings in a pediatric setting, including (i)one in the first month of life, including risk assessment based on history of prior depression; and (ii) three additional screenings at routine well-child visits during the child’s first year. If a woman switches her children’s pediatrician during the first year of her child’s life, the new pediatrician is required to perform a screen and risk assessment at the first appointment, as well as at as many of the remaining required screens as possible. If a woman switches obstetricians or nurse midwives during pregnancy the new provider is required to perform a screen and risk assessment at the first appointment, as well as the remaining required screens. Because both parents have access to children’s medical records, pediatricians should consider safety and confidentiality when indicating the results of depression screens on those records. All providers must use a validated instrument for screens, to be determined by the department. The commonwealth and private insurers shall establish a reimbursement structure for screenings, and are strongly encouraged to use existing billing codes.
SECTION 6. Section 4 of chapter 176G of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by adding the following sentence:- Such health maintenance contract shall also provide coverage for screening for post-partum depression as set forth in section 47I of chapter 175.
SECTION 7. The department of public health shall establish a multi-disciplinary task force to promote collaborative communication and continuity of care. Said task force shall include representatives from the department, the department of mental health, the department of early education and care, the department of children and families, MassHealth, and the children’s behavioral health initiative, grass roots groups, professional groups and national organizations addressing maternal and infant mental health. It will also include one Obstetrician, one Pediatrician, one Psychiatrist, one Child and Adolescent Psychiatrist, and one mother who has survived post-partum depression. Said task force shall facilitate the compilation of 2 referral lists for providers; a list of service providers for individual counseling; and a list of support groups around the commonwealth, including groups run by nonprofits; and investigate opportunities to link the referral lists with existing resources, such as parental stress hotlines. This task force shall also investigate opportunities to establish a day treatment program in the commonwealth for women suffering from severe post-partum depression with the capacity for women to bring their infants. The taskforce shall investigate opportunities to promote education about post-partum depression as part of medical school curriculum and continuing medical education.
SECTION 8. The early intervention partnership program shall be expanded from 9 to 13 communities statewide as determined by the department of public health.
SECTION 9. The department of public health shall be required to develop, market and distribute culturally-sensitive, multi-lingual public awareness and education materials on maternal depression, including making it available in birth hospitals and pediatricians’ office to build on their work in the Maternal and Infant Maternal Health Project, and in consultation with community leaders. The department will investigate partnering with graduate communications programs to establish effective social marketing strategies.