SB 626

Introduced by Senators Smallwood-Cuevas and Cervantes
(Coauthor: Senator Valladares)
 An act to amend Sections 1367.625 and 123640 of the Health and Safety Code, and to amend Section 10123.867 of the Insurance Code, relating to perinatal health.
perinatal health
Perinatal health screenings and treatment.
Existing law requires a licensed health care practitioner who provides prenatal, postpartum, or interpregnancy care for a patient to offer to screen or appropriately screen a mother for maternal mental health conditions. For purposes of that requirement, existing law defines “maternal mental health condition” to mean a mental health condition that occurs during pregnancy, the postpartum period, or interpregnancy, as specified.
This bill would limit the definition of “maternal mental health condition” to a mental health condition that occurs during the pregnancy or the postpartum period, as specified. The bill would authorize a licensed health care practitioner to satisfy the above-described requirement for maternal mental health screening by referring the patient or client to another licensed health care practitioner who is authorized to screen, evaluate, diagnose, and treat the patient or client for a
			 maternal mental health condition. The bill would require a licensed health care practitioner who provides prenatal, postpartum, or perinatal care for a patient or client who screens positive for a maternal mental health condition to ensure that the patient or client receives appropriate clinical evaluation, and, if the practitioner diagnoses a patient or client with a maternal mental health condition, offer or provide treatment to the patient
			 or client, consistent with the provider’s scope of practice.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to develop a maternal mental health program designed to promote quality and cost-effective outcomes. Existing law requires the program to, among other things, conduct specified maternal mental health screenings during
			 pregnancy and the postpartum period. Existing law requires the program guidelines and criteria to be provided to relevant medical providers, including all contracting obstetric providers. Existing law encourages health care service plans and health insurers to, among other things, improve screening, treatment, and referral to maternal mental health services. For purposes of these provisions, existing law defines “maternal mental health” to mean a mental health condition that occurs during pregnancy or during the postpartum period, as specified.
This bill would modify the term to “maternal mental health condition” and define it as a mental health condition that occurs during the pregnancy or the postpartum period, as defined by the most recent clinical guidelines adopted by the American College of Obstetricians, as specified. The bill would instead require the above-described maternal mental health program to include
			 maternal mental health screening to be conducted during pregnancy and one or more mental health screenings to be conducted during the postpartum period in accordance with applicable clinical guidelines and the standards of care appropriate to the provider’s scope of practice, as specified. The bill would require program guidelines and criteria to be provided to relevant licensed health care practitioners, as defined, including all contracting obstetric providers. The bill would require a health care service plan or health insurer to provide case management
			 or care coordination for an enrollee or insured who screens positive for a maternal mental health condition in accordance with the plan’s or insurer’s existing case management and care coordination programs. The bill would encourage health care service plans and health insurers to improve treatment, including through the use of outpatient prescription drugs approved for maternal mental health by the United States Food and Drug Administration. Because a willful violation of these provisions by a health care service plan would be a crime, the bill
			 would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
The people of the State of California do enact as follows:
SECTION 1.
Section 1367.625 of the
Health and Safety Code
 is amended to read:
1367.625.
(a) A health care service plan shall do all of the following:
(1) (A) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall include one or more maternal mental health screenings to be conducted during pregnancy and one or more mental health screenings to be conducted during the postpartum period in accordance with applicable clinical guidelines and the standards of care appropriate to the provider’s scope of practice. The program shall be developed consistent with sound clinical principles and processes, and shall include quality measures to encourage screening, diagnosis, treatment, and referral. The program guidelines and criteria shall be provided to relevant licensed health care practitioners, including all contracting obstetric providers. As part of a maternal mental health program, the health care service plan is
						encouraged to improve screening, treatment, including through the use of outpatient prescription drugs approved for maternal mental health by the United States Food and Drug Administration, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate
						enrollees about the program.
(B) (i) The guidelines described in subparagraph (A) shall be guidelines adopted by the American College of Obstetricians and Gynecologists, unless those guidelines do not align with the provider’s scope of practice.
(ii) If the guidelines described in clause (i) do not align with the provider’s scope of practice, the guidelines may include, but are not limited to, guidelines adopted by other recognized professional bodies.
(C) This paragraph does not expand or alter a licensed provider’s existing scope of practice.
(2) (A) Provide case management or care coordination for an enrollee
						who screens positive for a maternal mental health condition in accordance with the plan’s existing case management and care coordination programs.
(B) Case management and care coordination services may include, as appropriate, identification
						of available treatment providers and community supports, appointment scheduling, behavioral health navigation, medication access assistance when prescribed, regular patient engagement or followup, and communication with the referring obstetric and behavioral health providers.
(C) Case management and care coordination may be provided by the health care service plan, or by a delegated provider if case management or care coordination, as defined in subparagraph (B), is already provided for pursuant to the contract between the plan and delegated provider as of December 31, 2026, or in accordance with Section 1375.7.
(D) This paragraph does not limit a plan’s flexibility in care delivery models, if an enrollee receives timely and appropriate followup care consistent with the standard of care and the plan’s quality improvement requirements.
(E) This paragraph does not create a new benefit.
(3) Incorporate maternal mental health screening, referral, care coordination, and followup activities into its existing quality improvement and population health management programs, and maintain documentation demonstrating compliance that is available to regulators upon request.
(b) For the purposes of this section:
(1) “Case management” means a health care process in which a health care professional, acting within their scope of practice, assists a patient by developing and implementing
						a coordinated plan of care that integrates the medical and psychosocial support services the patient needs to achieve optimal outcomes.
(2) “Contracting obstetric provider” means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, and who is contracted with the enrollee’s health care service plan to provide services under the enrollee’s plan contract.
(3) “Health care practitioner” means a physician and surgeon, naturopathic doctor, nurse practitioner, physician assistant, nurse midwife, or a midwife licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code or an initiative act referred to in that division and who is acting within their scope of practice.
(4) “Health care service plan” includes Medi-Cal managed care plans that contract with the
						State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code. The State Department of Health Care Services shall seek any federal approvals it deems necessary to implement this section. This section applies to Medi-Cal managed care plan contracts only to the extent that the State Department of Health Care Services obtains any necessary federal approvals, and federal financial participation under the Medi-Cal program is available and not otherwise jeopardized.
(5) “Maternal mental health condition” means a mental health condition, including postpartum or perinatal depression, that occurs during the pregnancy or
						the postpartum period,
						as defined by the most recent clinical guidelines adopted by the American College of Obstetricians and Gynecologists on the screening and diagnosis of mental health conditions during pregnancy and postpartum, regardless of the pregnancy outcome and inclusive of gender-diverse birthing people.
(c) This section does not apply to specialized health care service plans, except specialized behavioral health-only plans offering professional mental health services.
(d) Notwithstanding subdivision (a), a Medi-Cal managed care plan shall continue to comply with any quality measures required or adopted by the State Department of Health Care Services. Quality measures included in a Medi-Cal managed care plan’s maternal mental health program shall not be inconsistent with quality measures required or adopted by the State Department of Health Care Services.
(e) This section shall not be construed to limit access to additional treatment options for maternal mental health.
SEC. 2.
Section 123640 of the
Health and Safety Code
 is amended to read:
123640.
(a) A licensed health care practitioner who provides prenatal, postpartum, or perinatal care for a patient or client shall ensure that the patient or client is offered screening or is appropriately screened for maternal mental health conditions consistent with Section
						1367.625 of the Health and Safety Code, Section 10123.867 of the Insurance Code, and applicable standards of care.
(b) If a patient or client screens positive for a maternal mental health condition, the licensed health care practitioner shall, consistent with the practitioner’s scope of practice, ensure that the patient or client is offered or receives a clinical evaluation. If the practitioner diagnoses the patient or client with a maternal mental health condition, the practitioner shall offer or provide treatment to the patient or client.
(c) A licensed health care practitioner may satisfy the requirements of
						subdivisions (a) and (b)
						by referring the patient or client to another licensed health care practitioner who is authorized to screen, evaluate, diagnose, and treat the patient or client for a maternal mental health condition.
(d) This section shall not apply to a licensed health care practitioner when providing emergency services or care, as defined in Section 1317.1.
(e) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal
						mental health conditions.
(f) For purposes of this section, the following definitions apply:
(1) “Health care practitioner” means a physician and surgeon, naturopathic doctor, nurse practitioner, physician assistant, nurse midwife, or a midwife licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code or an initiative act referred to in that division and who is acting within their scope of practice.
(2) “Maternal mental health condition” means a mental health
						condition, including postpartum or perinatal depression, that occurs during the pregnancy or the postpartum period, as defined by the most recent clinical guidelines adopted by the American College of Obstetricians and Gynecologists on the screening and diagnosis of mental health conditions during pregnancy and postpartum, regardless of the pregnancy outcome and inclusive of gender-diverse birthing people.
SEC. 3.
Section 10123.867 of the
Insurance Code
 is amended to read:
10123.867.
(a) A health insurer shall do all of the following:
 (1) (A) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall include one or more maternal mental health screenings to be conducted during pregnancy and one or more mental health screenings to be conducted during the postpartum period in accordance with applicable clinical guidelines and the standards of care appropriate to the provider’s scope of practice. The program shall be developed consistent with sound clinical principles and processes, and shall include quality measures to encourage screening, diagnosis, treatment, and referral. The program guidelines and criteria shall be provided to relevant licensed health care practitioners, including all contracting obstetric providers. As part of the maternal mental health program, a health insurer is encouraged to improve
						screening, treatment, including through the use of outpatient prescription drugs approved for maternal mental health by the United States Food and Drug Administration, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate insureds about the program.
(B) (i) The guidelines described in subparagraph (A) shall be guidelines adopted by the American College of Obstetricians and Gynecologists, unless those guidelines do not align with the provider’s scope of practice.
(ii) If the guidelines described in clause (i) do not align with the provider’s scope of practice, the guidelines may include, but are not limited to, guidelines adopted by other recognized professional bodies.
(C) This paragraph does not expand or alter a licensed provider’s existing scope of practice.
(2) (A) Provide
						case management or care coordination for an insured
						who screens positive for a maternal mental health condition in accordance with the insurer’s existing case management and care coordination programs.
(B) Case management and care coordination services may include, as appropriate, identification of available treatment providers and community supports, appointment scheduling, behavioral health navigation, medication access assistance when prescribed, regular patient engagement or followup, and communication with the referring obstetric and behavioral health providers.
(C) Case management and care coordination may be provided by the health insurer, or by a delegated provider if case management or care coordination, as defined in subparagraph (B), is already provided for pursuant to the contract between the insurer and delegated provider as of December 31, 2026, or in accordance with Section 10133.65.
(D) This paragraph does not limit an insurer’s flexibility in care delivery models, if an insured receives timely and appropriate followup care consistent with the standard of care and the insurer’s quality improvement requirements.
(E) This paragraph does not create a new benefit.
(3) Incorporate maternal mental health screening, referral, care coordination, and followup activities into its existing quality improvement and population health management programs, and maintain documentation demonstrating compliance that is available to regulators upon request.
(b) For the purposes of this section:
(1) “Case management” means a health care process in which a health care professional, acting within their scope of practice, assists a patient by developing and implementing a coordinated plan of care that integrates the medical and psychosocial support services the patient needs to achieve optimal outcomes.
(2) “Contracting obstetric provider” means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, and who is
						contracted with the insured’s health insurer to provide services under the insured’s health insurance policy.
(3) “Health care practitioner” means a physician and surgeon, naturopathic doctor, nurse practitioner, physician assistant, nurse midwife, or a midwife licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code or an initiative act referred to in that division and who is acting within their scope of practice.
(4) “Maternal mental health condition” means a mental health
						condition, including postpartum or perinatal depression, that occurs during the pregnancy or the postpartum period, as defined by the most recent clinical guidelines adopted by the American College of Obstetricians and Gynecologists on the screening and diagnosis of mental health conditions during pregnancy and postpartum, regardless of the pregnancy outcome and inclusive of gender-diverse birthing people.
(c) This section does not apply to Medicare supplement policies or to specialized health insurers, except behavioral health-only insurers that provide coverage for professional mental health services.
(d) This section shall not be construed to limit access to additional treatment options for maternal mental health.
SEC. 4.
No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.