Inaugural Maternal Mental Health State Report Cards (2023)

Indicators and Weighting 

3 Domains

1. Providers and Programs 

2. Screening Requirements and Reimbursement

3. Insurance Coverage and Payment

Weighting: 

• In most cases, states are awarded 3 points if they meet an indicator. 

• In some cases, states are awarded fewer points for meeting an indicator. These indicators (ie Medicaid expansion) are not considered state efforts specific to maternal mental health, but are considered state efforts that can support maternal mental health.

Domain 1: Providers and Programs

1. PMH-C provider to Patient Ratio (5 for every 1000 births) 
   (3 points for states that meet the ratio)

   • Item: State has at least 5 Perinatal Mental Health Certified (PMH-C) providers for every 1,000 births. (PMH-C providers in this measure exclude prescribers such as psychiatrists and psychiatric nurse practitioners. These PMH-C providers are included in Measure #2 below.)

   • Dataset: Postpartum Support International PMH-C Listing

2. Maternal Mental Health Prescriber-to-Patient Ratio (1 for every 5000 births)  
   (3 points for states that meet the ratio)

   • Item: State has at least 1 mental health prescriber with specialized perinatal training for every 5,000 births. (These prescribers include psychiatrists, psychiatric nurse practitioners, advanced practice nurse practitioners, and some CNMs and FNPs with PMH-C training or other “specialized perinatal training”.)

   • Dataset: Postpartum Support International Directory

   • Note: The main source of prescriber data for this measure is the Postpartum Support International Directory. Perinatal prescribers must request to be added to this list. Since not all perinatal prescribers will request to be part of this list, this measure is considered less reliable for 2023. 

3. State has Inpatient Perinatal Mental Health Treatment Program 
   (1 point per program, capped at 3 points per state)

   • Item: State has an inpatient MMH program(s)

   • Dataset: Postpartum Support International list of inpatient programs

   • Note: There are only 3 inpatient units in the U.S.

4. State has Outpatient Intensive or Partial Hospitalization Programs
   (1 point per program, capped at 3 points per state)

   • Item: State has an outpatient MMH program(s)

   • Dataset: Postpartum Support International list of outpatient programs 

   • Note there are only 26 outpatient programs in the U.S.

5. State has Maternal Mental Health Task Force or Commission 
   (3 points)

   • Item: State has formed a Task Force or Commission to issue a strategic plan on maternal mental health

   • Dataset: The Policy Center for MMH Legislative Tracker

6. Community-Based Organizations (CBOs) Providing Direct Maternal Mental Health Services 
   (If state meets ratio of 1 CBO per 50,000 births, state receives 1 point per CBO, capped at 3 points per state)

   • Item: State has at least 1 CBO providing MMH services per 50,000 births

   • Dataset: Policy Center for Maternal Mental Health CBO Listing

   • Note: This measure is preliminary, with somewhat low-reliability. Additional CBOs can be submitted to the Policy Center for Maternal Mental Health’s Nonprofit Nation website.

   Domain 2: Screening Requirements and Reimbursement  

7. State requires OB-GYNs to screen for maternal mental health disorders 
   (3 points)

   • Item: State mandates that OB-GYNs screen for maternal mental health disorders in pregnancy and the postpartum period

   • Dataset: The Policy Center for MMH Legislative Tracker

8. State Medicaid Agency reimburses screening during pregnancy by an OB provider, as well as postpartum mental health screening by an OB provider or pediatrician
   (3 points)

   • Item: State reimburses for screening in pregnancy and postpartum 

   • Dataset: Policy Center Medicaid Screening Reimbursement Analysis of the Commonwealth Fund’s Care Delivery Transformation, Integrating Mental Health for Pregnancy data set.

9. State Medicaid requires managed care organizations to collect the “prenatal depression screening & follow-up” HEDIS measure
   (2 points if measure collected, 3 points if measure used for payment)

   • Item: State requires collection of HEDIS PND-E measure

   • Dataset: NASHP State Use of Behavioral Health Performance Measures in MMC

10. State Medicaid requires managed care organizations to collect the “postpartum depression screening & follow-up” HEDIS measure
    (2 points if measure collected, 3 points if measure used for payment)

    • Item: State requires collection of HEDIS PDS-E measure

    • Dataset: NASHP State Use of Behavioral Health Performance Measures in MMC

11. Private Insurance Billing for Prenatal MMH Screening
    (Points provided based on the percentage of patients whose provider bills private insurance for prenatal MMH screening: 1-3% = .5 point, 3%-15% = 1 point, 15% or higher = 3 points)

    • Item: % those who are privately insured and pregnant whose provider billed for mental health screening (any provider) 

    • Dataset: Analysis of FAIR Health NPIC® (National Private Insurance Claims) Database. (Disclaimer: FAIR Health, Inc. is not responsible for the research or opinions expressed in this publication.)

    • Note: States with any reported OB screening rates receive 1 extra point

12. Private Insurance Billing for Postpartum Screening
    (Points provided based on the percentage of patients whose provider bills private insurance for postpartum MMH screening: 1-3% = .5 point, 3%-15% = 1 point, 15% or higher = 3 points)

    • Item: % persons who are privately insured and in the postpartum period whose provider billed for mental health screening (any provider)

    • Dataset: Analysis of FAIR Health NPIC® (National Private Insurance Claims) Database. (Disclaimer: FAIR Health, Inc. is not responsible for the research or opinions expressed in this publication.)

    • Note: States with any reported OB screening receive 1 extra point

    Domain 3: Insurance Coverage and Treatment Payment

13. Medicaid Expansion
    (1 point)

    • Item: State has adopted Medicaid expansion

    • Dataset: Kaiser Family Foundation Medicaid Expansion Tracker

14. Postpartum Medicaid Extension
    (2 points)

    • Item: State implemented or is planning to implement postpartum coverage for Medicaid beneficiaries to 12 months postpartum

    • Dataset: Kaiser Family Foundation Postpartum Medicaid Extension Tracker

15. State requires health plans to develop a maternal mental health quality management program
    (3 points)

    • Item: State mandates that health all plans develop a maternal mental health quality management program 

    • Dataset: The Policy Center for MMH Legislative Tracker

16. Private Insurance Billing for Prenatal Treatment
    (Points provided based on the percentage of patients whose provider bills private insurance for prenatal mental health treatment: 1-3% = .5 point, 3%-15% = 1 point, 15% or higher = 3 points)

    • Item: % persons who are privately insured and pregnant whose provider billed for mental health treatment (any provider)

    • Dataset: Analysis of FAIR Health NPIC® (National Private Insurance Claims) Database. (Disclaimer: FAIR Health, Inc. is not responsible for the research or opinions expressed in this publication.)

17. Private Insurance for Postpartum Treatment
    (Points provided based on the percentage of patients whose provider bills private insurance for postpartum mental health treatment: 1-3% = .5 point, 3%-15% = 1 point, 15% or higher = 3 points)

    • Item: % persons who are privately insured in the postpartum period whose provider billed for mental health treatment (any provider)

    • Dataset: Analysis of FAIR Health NPIC® (National Private Insurance Claims) Database. (Disclaimer: FAIR Health, Inc. is not responsible for the research or opinions expressed in this publication.)

Future Potential Domains and Measures

It is important to note that the 2023 state report cards are considered preliminary. There are many data points that the Policy Center knows to be relevant to maternal mental health and hoped to include in the report cards, but either: 1) the measure isn’t being tracked, or 2) the measure is being tracked but the data isn’t yet available.

Among the measures and data that are available, the Policy Center included the measures that we believe to be the most important to maternal mental health. It is the Policy Center’s hope to keep incorporating new measures into the report cards as data becomes available.

For example, potential future measures include:

1. HEDIS Perinatal Depression Screening and Follow-up

   • State-level data by Medicaid and commercial segments have not yet been released by NCQA to the Policy Center

2. State efforts to support CBOs providing Maternal Mental Health Services

3. State efforts to cover of maternal supports such as doulas, peer supports, and community health workers

4. State efforts to require provider implicit bias training

Researchers, Request Data Sets

For more information regarding data sets please email info@policycentermmh.org.