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| 1 | + | CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 626Introduced by Senator Smallwood-CuevasFebruary 20, 2025 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 maternal health. LEGISLATIVE COUNSEL'S DIGESTSB 626, as introduced, Smallwood-Cuevas. Maternal 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.This bill would require a licensed health care practitioner who provides perinatal care for a patient to screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists.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, as specified.This bill would require a health care service plan or health insurer to provide case management and care coordination for an enrollee or insured during the perinatal period. The bill would require a plan or insurers to annually report the utilization and outcomes of case management services to the appropriate department and to post that reported information to its internet website. The bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026, to provide coverage for at least one medication and one digital therapeutic for maternal mental health, as specified. 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe 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 develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of a maternal mental health program the health care service plan is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate enrollees about the program.(2) Provide case management and care coordination for an enrollee during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the plans internet website.(b) A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 enrollees health care service plan to provide services under the enrollees plan contract.(2) 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.(2)(3) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health care service plans, except specialized behavioral health-only plans offering professional mental health services.(d)For purposes of this section, 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.(e) 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 plans maternal mental health program shall not be inconsistent with quality measures required or adopted by the State Department of Health Care Services.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 interpregnancy care for a patient shall ensure that the mother is offered screening or is appropriately screened for maternal mental health conditions.(b) A licensed health care practitioner who provides perinatal care for a patient shall screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists.(b)(c) This section shall not apply to a licensed health care practitioner when providing emergency services or care, as defined in Section 1317.1.(c)(d) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal mental health conditions.(d)(e) 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 that occurs during pregnancy, the postpartum period, or interpregnancy and includes, but is not limited to, postpartum depression.SEC. 3. Section 10123.867 of the Insurance Code is amended to read:10123.867. (a) A health insurer shall develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of the maternal mental health program, a health insurer is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate insureds about the program.(2) Provide case management and care coordination for an insured during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the insurers internet website.(b) A health insurance policy issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 insureds health insurer to provide services under the insureds health insurance policy.(2) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health insurers, except behavioral health-only insurers that provide coverage for professional mental health services.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. | |
| 2 | 2 | ||
| 3 | - | ||
| 3 | + | CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 626Introduced by Senator Smallwood-CuevasFebruary 20, 2025 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 maternal health. LEGISLATIVE COUNSEL'S DIGESTSB 626, as introduced, Smallwood-Cuevas. Maternal 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.This bill would require a licensed health care practitioner who provides perinatal care for a patient to screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists.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, as specified.This bill would require a health care service plan or health insurer to provide case management and care coordination for an enrollee or insured during the perinatal period. The bill would require a plan or insurers to annually report the utilization and outcomes of case management services to the appropriate department and to post that reported information to its internet website. The bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026, to provide coverage for at least one medication and one digital therapeutic for maternal mental health, as specified. 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES | |
| 4 | 4 | ||
| 5 | - | Amended IN Senate March 24, 2025 | |
| 6 | 5 | ||
| 7 | - | Amended IN Senate March 24, 2025 | |
| 6 | + | ||
| 7 | + | ||
| 8 | 8 | ||
| 9 | 9 | CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION | |
| 10 | 10 | ||
| 11 | 11 | Senate Bill | |
| 12 | 12 | ||
| 13 | 13 | No. 626 | |
| 14 | 14 | ||
| 15 | 15 | Introduced by Senator Smallwood-CuevasFebruary 20, 2025 | |
| 16 | 16 | ||
| 17 | 17 | Introduced by Senator Smallwood-Cuevas | |
| 18 | 18 | February 20, 2025 | |
| 19 | 19 | ||
| 20 | - | 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 maternal | |
| 20 | + | 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 maternal health. | |
| 21 | 21 | ||
| 22 | 22 | LEGISLATIVE COUNSEL'S DIGEST | |
| 23 | 23 | ||
| 24 | 24 | ## LEGISLATIVE COUNSEL'S DIGEST | |
| 25 | 25 | ||
| 26 | - | SB 626, as | |
| 26 | + | SB 626, as introduced, Smallwood-Cuevas. Maternal health screenings and treatment. | |
| 27 | 27 | ||
| 28 | - | 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. | |
| 28 | + | 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.This bill would require a licensed health care practitioner who provides perinatal care for a patient to screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists.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, as specified.This bill would require a health care service plan or health insurer to provide case management and care coordination for an enrollee or insured during the perinatal period. The bill would require a plan or insurers to annually report the utilization and outcomes of case management services to the appropriate department and to post that reported information to its internet website. The bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026, to provide coverage for at least one medication and one digital therapeutic for maternal mental health, as specified. 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. | |
| 29 | 29 | ||
| 30 | - | 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. | |
| 30 | + | 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. | |
| 31 | 31 | ||
| 32 | - | This | |
| 32 | + | This bill would require a licensed health care practitioner who provides perinatal care for a patient to screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists. | |
| 33 | 33 | ||
| 34 | - | 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, as specified. | |
| 34 | + | 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, as specified. | |
| 35 | 35 | ||
| 36 | - | This | |
| 36 | + | This bill would require a health care service plan or health insurer to provide case management and care coordination for an enrollee or insured during the perinatal period. The bill would require a plan or insurers to annually report the utilization and outcomes of case management services to the appropriate department and to post that reported information to its internet website. The bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026, to provide coverage for at least one medication and one digital therapeutic for maternal mental health, as specified. 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. | |
| 37 | 37 | ||
| 38 | 38 | 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. | |
| 39 | 39 | ||
| 40 | 40 | This bill would provide that no reimbursement is required by this act for a specified reason. | |
| 41 | 41 | ||
| 42 | 42 | ## Digest Key | |
| 43 | 43 | ||
| 44 | 44 | ## Bill Text | |
| 45 | 45 | ||
| 46 | - | 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) Develop a maternal | |
| 46 | + | 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 develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of a maternal mental health program the health care service plan is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate enrollees about the program.(2) Provide case management and care coordination for an enrollee during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the plans internet website.(b) A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 enrollees health care service plan to provide services under the enrollees plan contract.(2) 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.(2)(3) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health care service plans, except specialized behavioral health-only plans offering professional mental health services.(d)For purposes of this section, 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.(e) 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 plans maternal mental health program shall not be inconsistent with quality measures required or adopted by the State Department of Health Care Services.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 interpregnancy care for a patient shall ensure that the mother is offered screening or is appropriately screened for maternal mental health conditions.(b) A licensed health care practitioner who provides perinatal care for a patient shall screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists.(b)(c) This section shall not apply to a licensed health care practitioner when providing emergency services or care, as defined in Section 1317.1.(c)(d) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal mental health conditions.(d)(e) 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 that occurs during pregnancy, the postpartum period, or interpregnancy and includes, but is not limited to, postpartum depression.SEC. 3. Section 10123.867 of the Insurance Code is amended to read:10123.867. (a) A health insurer shall develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of the maternal mental health program, a health insurer is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate insureds about the program.(2) Provide case management and care coordination for an insured during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the insurers internet website.(b) A health insurance policy issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 insureds health insurer to provide services under the insureds health insurance policy.(2) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health insurers, except behavioral health-only insurers that provide coverage for professional mental health services.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. | |
| 47 | 47 | ||
| 48 | 48 | The people of the State of California do enact as follows: | |
| 49 | 49 | ||
| 50 | 50 | ## The people of the State of California do enact as follows: | |
| 51 | 51 | ||
| 52 | - | 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) Develop a maternal | |
| 52 | + | SECTION 1. Section 1367.625 of the Health and Safety Code is amended to read:1367.625. (a) A health care service plan shall develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of a maternal mental health program the health care service plan is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate enrollees about the program.(2) Provide case management and care coordination for an enrollee during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the plans internet website.(b) A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 enrollees health care service plan to provide services under the enrollees plan contract.(2) 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.(2)(3) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health care service plans, except specialized behavioral health-only plans offering professional mental health services.(d)For purposes of this section, 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.(e) 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 plans maternal mental health program shall not be inconsistent with quality measures required or adopted by the State Department of Health Care Services. | |
| 53 | 53 | ||
| 54 | 54 | SECTION 1. Section 1367.625 of the Health and Safety Code is amended to read: | |
| 55 | 55 | ||
| 56 | 56 | ### SECTION 1. | |
| 57 | 57 | ||
| 58 | - | 1367.625. (a) A health care service plan shall do all of the following:(1) Develop a maternal | |
| 58 | + | 1367.625. (a) A health care service plan shall develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of a maternal mental health program the health care service plan is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate enrollees about the program.(2) Provide case management and care coordination for an enrollee during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the plans internet website.(b) A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 enrollees health care service plan to provide services under the enrollees plan contract.(2) 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.(2)(3) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health care service plans, except specialized behavioral health-only plans offering professional mental health services.(d)For purposes of this section, 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.(e) 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 plans maternal mental health program shall not be inconsistent with quality measures required or adopted by the State Department of Health Care Services. | |
| 59 | 59 | ||
| 60 | - | 1367.625. (a) A health care service plan shall do all of the following:(1) Develop a maternal | |
| 60 | + | 1367.625. (a) A health care service plan shall develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of a maternal mental health program the health care service plan is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate enrollees about the program.(2) Provide case management and care coordination for an enrollee during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the plans internet website.(b) A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 enrollees health care service plan to provide services under the enrollees plan contract.(2) 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.(2)(3) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health care service plans, except specialized behavioral health-only plans offering professional mental health services.(d)For purposes of this section, 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.(e) 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 plans maternal mental health program shall not be inconsistent with quality measures required or adopted by the State Department of Health Care Services. | |
| 61 | 61 | ||
| 62 | - | 1367.625. (a) A health care service plan shall do all of the following:(1) Develop a maternal | |
| 62 | + | 1367.625. (a) A health care service plan shall develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of a maternal mental health program the health care service plan is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate enrollees about the program.(2) Provide case management and care coordination for an enrollee during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the plans internet website.(b) A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 enrollees health care service plan to provide services under the enrollees plan contract.(2) 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.(2)(3) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health care service plans, except specialized behavioral health-only plans offering professional mental health services.(d)For purposes of this section, 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.(e) 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 plans maternal mental health program shall not be inconsistent with quality measures required or adopted by the State Department of Health Care Services. | |
| 63 | 63 | ||
| 64 | 64 | ||
| 65 | 65 | ||
| 66 | - | 1367.625. (a) A health care service plan shall do all of the following: | |
| 66 | + | 1367.625. (a) A health care service plan shall develop do all of the following: | |
| 67 | 67 | ||
| 68 | - | (1) Develop a maternal | |
| 68 | + | (1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of a maternal mental health program the health care service plan is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate enrollees about the program. | |
| 69 | 69 | ||
| 70 | 70 | (2) Provide case management and care coordination for an enrollee during the perinatal period. | |
| 71 | 71 | ||
| 72 | 72 | (3) Annually report to the department on the utilization and outcomes of case management services. | |
| 73 | 73 | ||
| 74 | 74 | (4) Publicly post the information reported pursuant to paragraph (3) on the plans internet website. | |
| 75 | 75 | ||
| 76 | - | (b) A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal perinatal mental health and for at least one FDA-approved digital therapeutic for maternal perinatal mental health. | |
| 76 | + | (b) A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health. | |
| 77 | + | ||
| 78 | + | (b) | |
| 79 | + | ||
| 80 | + | ||
| 77 | 81 | ||
| 78 | 82 | (c) For the purposes of this section: | |
| 79 | 83 | ||
| 80 | 84 | (1) 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 enrollees health care service plan to provide services under the enrollees plan contract. | |
| 81 | 85 | ||
| 82 | 86 | (2) 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. | |
| 83 | 87 | ||
| 84 | - | (3) Maternal Perinatal mental health means a mental health condition that occurs during pregnancy or during the postpartum period pregnancy, the postpartum period, or the perinatal period and includes, but is not limited to, postpartum or perinatal depression. | |
| 88 | + | (2) | |
| 89 | + | ||
| 90 | + | ||
| 91 | + | ||
| 92 | + | (3) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression. | |
| 93 | + | ||
| 94 | + | (c) | |
| 95 | + | ||
| 96 | + | ||
| 85 | 97 | ||
| 86 | 98 | (d) This section does not apply to specialized health care service plans, except specialized behavioral health-only plans offering professional mental health services. | |
| 87 | 99 | ||
| 88 | - | ( | |
| 100 | + | (d)For purposes of this section, 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. | |
| 89 | 101 | ||
| 90 | - | (f) This section shall not be construed to limit access to additional treatment options for perinatal mental health. | |
| 91 | 102 | ||
| 92 | - | 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, perinatal, or interpregnancy care for a patient shall ensure that the mother is offered screening or is appropriately screened for maternal perinatal mental health conditions.(b) A licensed health care practitioner who provides perinatal care for a patient shall screen, diagnose, and treat the patient for a maternal perinatal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists.(c) This section shall not apply to a licensed health care practitioner when providing emergency services or care, as defined in Section 1317.1.(d) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal perinatal mental health conditions.(e) 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 Perinatal mental health condition means a mental health condition that occurs during pregnancy, the postpartum period, the perinatal period, or interpregnancy and includes, but is not limited to, postpartum or perinatal depression. | |
| 103 | + | ||
| 104 | + | (e) 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 plans maternal mental health program shall not be inconsistent with quality measures required or adopted by the State Department of Health Care Services. | |
| 105 | + | ||
| 106 | + | 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 interpregnancy care for a patient shall ensure that the mother is offered screening or is appropriately screened for maternal mental health conditions.(b) A licensed health care practitioner who provides perinatal care for a patient shall screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists.(b)(c) This section shall not apply to a licensed health care practitioner when providing emergency services or care, as defined in Section 1317.1.(c)(d) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal mental health conditions.(d)(e) 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 that occurs during pregnancy, the postpartum period, or interpregnancy and includes, but is not limited to, postpartum depression. | |
| 93 | 107 | ||
| 94 | 108 | SEC. 2. Section 123640 of the Health and Safety Code is amended to read: | |
| 95 | 109 | ||
| 96 | 110 | ### SEC. 2. | |
| 97 | 111 | ||
| 98 | - | 123640. (a) A licensed health care practitioner who provides prenatal, postpartum | |
| 112 | + | 123640. (a) A licensed health care practitioner who provides prenatal, postpartum, or interpregnancy care for a patient shall ensure that the mother is offered screening or is appropriately screened for maternal mental health conditions.(b) A licensed health care practitioner who provides perinatal care for a patient shall screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists.(b)(c) This section shall not apply to a licensed health care practitioner when providing emergency services or care, as defined in Section 1317.1.(c)(d) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal mental health conditions.(d)(e) 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 that occurs during pregnancy, the postpartum period, or interpregnancy and includes, but is not limited to, postpartum depression. | |
| 99 | 113 | ||
| 100 | - | 123640. (a) A licensed health care practitioner who provides prenatal, postpartum | |
| 114 | + | 123640. (a) A licensed health care practitioner who provides prenatal, postpartum, or interpregnancy care for a patient shall ensure that the mother is offered screening or is appropriately screened for maternal mental health conditions.(b) A licensed health care practitioner who provides perinatal care for a patient shall screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists.(b)(c) This section shall not apply to a licensed health care practitioner when providing emergency services or care, as defined in Section 1317.1.(c)(d) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal mental health conditions.(d)(e) 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 that occurs during pregnancy, the postpartum period, or interpregnancy and includes, but is not limited to, postpartum depression. | |
| 101 | 115 | ||
| 102 | - | 123640. (a) A licensed health care practitioner who provides prenatal, postpartum | |
| 116 | + | 123640. (a) A licensed health care practitioner who provides prenatal, postpartum, or interpregnancy care for a patient shall ensure that the mother is offered screening or is appropriately screened for maternal mental health conditions.(b) A licensed health care practitioner who provides perinatal care for a patient shall screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists.(b)(c) This section shall not apply to a licensed health care practitioner when providing emergency services or care, as defined in Section 1317.1.(c)(d) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal mental health conditions.(d)(e) 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 that occurs during pregnancy, the postpartum period, or interpregnancy and includes, but is not limited to, postpartum depression. | |
| 103 | 117 | ||
| 104 | 118 | ||
| 105 | 119 | ||
| 106 | - | 123640. (a) A licensed health care practitioner who provides prenatal, postpartum | |
| 120 | + | 123640. (a) A licensed health care practitioner who provides prenatal, postpartum, or interpregnancy care for a patient shall ensure that the mother is offered screening or is appropriately screened for maternal mental health conditions. | |
| 107 | 121 | ||
| 108 | - | (b) A licensed health care practitioner who provides perinatal care for a patient shall screen, diagnose, and treat the patient for a maternal perinatal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists. | |
| 122 | + | (b) A licensed health care practitioner who provides perinatal care for a patient shall screen, diagnose, and treat the patient for a maternal mental health condition according to the clinical guidelines from the American College of Obstetricians and Gynecologists. | |
| 123 | + | ||
| 124 | + | (b) | |
| 125 | + | ||
| 126 | + | ||
| 109 | 127 | ||
| 110 | 128 | (c) This section shall not apply to a licensed health care practitioner when providing emergency services or care, as defined in Section 1317.1. | |
| 111 | 129 | ||
| 112 | - | (d) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal perinatal mental health conditions. | |
| 130 | + | (c) | |
| 131 | + | ||
| 132 | + | ||
| 133 | + | ||
| 134 | + | (d) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal mental health conditions. | |
| 135 | + | ||
| 136 | + | (d) | |
| 137 | + | ||
| 138 | + | ||
| 113 | 139 | ||
| 114 | 140 | (e) For purposes of this section, the following definitions apply: | |
| 115 | 141 | ||
| 116 | 142 | (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. | |
| 117 | 143 | ||
| 118 | - | (2) Maternal | |
| 144 | + | (2) Maternal mental health condition means a mental health condition that occurs during pregnancy, the postpartum period, or interpregnancy and includes, but is not limited to, postpartum depression. | |
| 119 | 145 | ||
| 120 | - | 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: | |
| 146 | + | SEC. 3. Section 10123.867 of the Insurance Code is amended to read:10123.867. (a) A health insurer shall develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of the maternal mental health program, a health insurer is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate insureds about the program.(2) Provide case management and care coordination for an insured during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the insurers internet website.(b) A health insurance policy issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 insureds health insurer to provide services under the insureds health insurance policy.(2) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health insurers, except behavioral health-only insurers that provide coverage for professional mental health services. | |
| 121 | 147 | ||
| 122 | 148 | SEC. 3. Section 10123.867 of the Insurance Code is amended to read: | |
| 123 | 149 | ||
| 124 | 150 | ### SEC. 3. | |
| 125 | 151 | ||
| 126 | - | 10123.867. (a) A health insurer shall do all of the following: | |
| 152 | + | 10123.867. (a) A health insurer shall develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of the maternal mental health program, a health insurer is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate insureds about the program.(2) Provide case management and care coordination for an insured during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the insurers internet website.(b) A health insurance policy issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 insureds health insurer to provide services under the insureds health insurance policy.(2) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health insurers, except behavioral health-only insurers that provide coverage for professional mental health services. | |
| 127 | 153 | ||
| 128 | - | 10123.867. (a) A health insurer shall do all of the following: | |
| 154 | + | 10123.867. (a) A health insurer shall develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of the maternal mental health program, a health insurer is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate insureds about the program.(2) Provide case management and care coordination for an insured during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the insurers internet website.(b) A health insurance policy issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 insureds health insurer to provide services under the insureds health insurance policy.(2) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health insurers, except behavioral health-only insurers that provide coverage for professional mental health services. | |
| 129 | 155 | ||
| 130 | - | 10123.867. (a) A health insurer shall do all of the following: | |
| 156 | + | 10123.867. (a) A health insurer shall develop do all of the following:(1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of the maternal mental health program, a health insurer is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate insureds about the program.(2) Provide case management and care coordination for an insured during the perinatal period.(3) Annually report to the department on the utilization and outcomes of case management services.(4) Publicly post the information reported pursuant to paragraph (3) on the insurers internet website.(b) A health insurance policy issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health.(b)(c) For the purposes of this section:(1) 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 insureds health insurer to provide services under the insureds health insurance policy.(2) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c)(d) This section does not apply to specialized health insurers, except behavioral health-only insurers that provide coverage for professional mental health services. | |
| 131 | 157 | ||
| 132 | 158 | ||
| 133 | 159 | ||
| 134 | - | 10123.867. (a) A health insurer shall do all of the following: | |
| 160 | + | 10123.867. (a) A health insurer shall develop do all of the following: | |
| 135 | 161 | ||
| 136 | - | ||
| 162 | + | (1) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional postpartum screenings, if determined to be medically necessary and clinically appropriate in the judgment of the treating provider. 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 medical providers, including all contracting obstetric providers. As part of the maternal mental health program, a health insurer is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate insureds about the program. | |
| 137 | 163 | ||
| 138 | 164 | (2) Provide case management and care coordination for an insured during the perinatal period. | |
| 139 | 165 | ||
| 140 | 166 | (3) Annually report to the department on the utilization and outcomes of case management services. | |
| 141 | 167 | ||
| 142 | 168 | (4) Publicly post the information reported pursuant to paragraph (3) on the insurers internet website. | |
| 143 | 169 | ||
| 144 | - | (b) A health insurance policy issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal perinatal mental health and for at least one FDA-approved digital therapeutic for maternal perinatal mental health. | |
| 170 | + | (b) A health insurance policy issued, amended, or renewed on or after January 1, 2026, shall provide coverage for at least one medication approved by the United States Food and Drug Administration (FDA) for maternal mental health and for at least one FDA-approved digital therapeutic for maternal mental health. | |
| 171 | + | ||
| 172 | + | (b) | |
| 173 | + | ||
| 174 | + | ||
| 145 | 175 | ||
| 146 | 176 | (c) For the purposes of this section: | |
| 147 | 177 | ||
| 148 | 178 | (1) 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 insureds health insurer to provide services under the insureds health insurance policy. | |
| 149 | 179 | ||
| 150 | - | (2) Maternal Perinatal mental health means a mental health condition that occurs during pregnancy or during the postpartum period pregnancy, the postpartum period, or the perinatal period and includes, but is not limited to, postpartum or perinatal depression. | |
| 180 | + | (2) Maternal mental health means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression. | |
| 181 | + | ||
| 182 | + | (c) | |
| 183 | + | ||
| 184 | + | ||
| 151 | 185 | ||
| 152 | 186 | (d) This section does not apply to specialized health insurers, except behavioral health-only insurers that provide coverage for professional mental health services. | |
| 153 | - | ||
| 154 | - | (e) This section shall not be construed to limit access to additional treatment options for perinatal mental health. | |
| 155 | 187 | ||
| 156 | 188 | SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. | |
| 157 | 189 | ||
| 158 | 190 | SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. | |
| 159 | 191 | ||
| 160 | 192 | SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. | |
| 161 | 193 | ||
| 162 | 194 | ### SEC. 4. |