senate Bill S3137

Amended

Defines maternal depression, requires the provision of maternal depression education, and the provision of a screening and referral plan for the state

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Sponsor

Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 30 / Jan / 2013
    • REFERRED TO HEALTH
  • 29 / May / 2013
    • AMEND (T) AND RECOMMIT TO HEALTH
  • 29 / May / 2013
    • PRINT NUMBER 3137A
  • 10 / Jun / 2013
    • AMEND AND RECOMMIT TO HEALTH
  • 10 / Jun / 2013
    • PRINT NUMBER 3137B
  • 12 / Jun / 2013
    • AMEND AND RECOMMIT TO HEALTH
  • 12 / Jun / 2013
    • PRINT NUMBER 3137C

Summary

Defines maternal depression; requires the provision of maternal depression education, and the provision of a screening and referral plan for the state.

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Bill Details

Versions:
S3137
S3137A
S3137B
S3137C
Legislative Cycle:
2013-2014
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Add §2500-k, amd §§207, 2803-j & 2803-n, Pub Health L; amd §§3216, 3221 & 4303, add §3217-g, Ins L
Versions Introduced in 2011-2012 Legislative Cycle:
S7355

Sponsor Memo

BILL NUMBER:S3137

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 report-
ing; 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 axe 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 obstet-
rical setting and three screenings after birth 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 paragraph (g) of subdivision 1 of section 207 of the Public
Health Law by is amended 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 reimburse-
ment 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, feel-
ings 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 identi-
fied because they closely resemble those generally associated with preg-
nancy. 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 profes-
sionals 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.

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.

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

                                  3137

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 30, 2013
                               ___________

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-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01525-01-3

S. 3137                             2

II (BDI-II), OR THE CENTER FOR EPIDEMIOLOGICAL STUDIES-DEPRESSION  SCALE
(CES-D).
  (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
FOURTEEN.
  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:

S. 3137                             3

  (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;
  (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

S. 3137                             4

TO  HELP  THEM  BETTER  UNDERSTAND  THE  NATURE  AND CAUSES OF PERINATAL
DEPRESSION.
  (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.  Paragraph  (g)  of  subdivision  1 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

S. 3137                             5

(b) of section forty-eight hundred three of this [chapter] ARTICLE,  the
insurer shall permit the insured to continue an ongoing course of treat-
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 after
it shall have become a law; provided, however, that effective immediate-
ly,  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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