California's "Unique Approach" to Screening and Obstetric Provider Support

By the 2020 Mom Advocacy Committee

In one of the latest new articles about AB 2193, in Rewire News, titled "Could a California Bill Be the Key to Addressing Mood Disorders in New Parents?" the writer notes, "The bill takes a somewhat unique approach to this issue, and is one that could become a model for other states."  

What's so unique? (And hasn't necessarily been adequately captured in all news coverage so far.) 
California is interested in not only mandating that obstetric providers (those who deliver babies) screen (like NJ and IL require), but in taking advantage of an existing infrastructure to support them in diagnosis and treatment: 

Using the chassis of the health insurance company:   

  • In California, health insurers are already charged with and held accountable for providing timely access to "in-network" care including addressing treatment shortages in novel ways - that could include provider-to-provider consultation programs (which health insurers aren't proactively marketing to their providers but can and should be).

The California bill provides the framework for the obstetric provider to consult with a psychiatrist who is keeping up with the latest research in treating maternal mental health disorders (like MA). This consultation will be available to the obstetrician after screening to both: 

(1) further assess and assist in diagnosing depression and/or anxiety and ruling out bipolar disorder (which can mimic depression but requires different treatment), and

(2) develop a treatment plan with the patient for depression and/or anxiety which may include prescribing medication(s) safe to use during pregnancy and lactation.

  • Case management programs are developed by health insurers nationally, for various diseases and disorders, like asthma, low back pain, eating disorders and more. Case management programs are designed to identify enrollees with care needs and help them get into the right care at the right time. Services can include technology based support like text messaging and phone coaching for example, checking in to provide help when needed.

Obstetric providers will be now be mandated to screen for maternal mental health disorders and will have a life-line through the insurance company chassis.

What about Reimbursement? 

Regarding lack of reimbursement, Ob/Gyns are reimbursed through a "maternity case rate" which is a flat rate for all medically necessary services once a pregnancy is confirmed and through the final postpartum visit.  Because the Ob/Gyn trade association, the American College of Obstetrics and Gynecology (ACOG) and the U.S. Preventive Services Task Force already recommend screening pregnant and postpartum women, these services would be considered the standard of care and some insurers note would already be covered under that flat rate. Ob/Gyns certainly have the right to renegotiate their rates with insurers. On behalf of its members ACOG could consider issuing a request to California health insurers asking that rates be reconsidered. 

Have ideas?

If you have more questions about AB 2193 and haven't yet read the California Task Force on Maternal Mental Health report, which this bill was based on, read it now, and then share your questions below.   You may also e-mail us at at anytime.  We welcome continued dialogue - it takes a village to raise a child and solve a complex problem.