The House Committee on Health offers the following substitute to HB 1346:
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 1 of Title 33 of the Official Code of Georgia Annotated, relating to
general provisions relative to insurance, so as to provide for coverage for comprehensive
maternal mental health screening and care; to provide for such screenings at specific points
during and after pregnancy as deemed necessary by a physician or other healthcare provider;
to provide for additional screening; to provide for referral information and resources and
educational materials regarding perinatal mood and anxiety disorders; to provide for a pilot
program; to provide for funding; to provide for rules and regulations; to provide for reports;
to amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated,
relating to medical assistance generally, so as to provide for maternal mental health
screenings for perinatal mood and anxiety disorders; to provide for related matters; to
provide for legislative findings; to provide for a short title; to provide for an effective date
and applicability; to provide for contingent effectiveness upon appropriation of funds; to
repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
The General Assembly finds that:
(1) Georgia has prioritized advancements in access to mental health care and addressing
issues of maternal health and maternal mortality;
(2) The largest demographic of Americans grappling with depression is women of
childbearing age. The mental well-being of women before, during, and after giving birth
is a matter of significant concern for women, their families, their communities, and their
healthcare providers. This issue is of particular interest to the General Assembly in that
it has far-reaching impact on the public health and the welfare of people in this state;
(3) Maternal mental health conditions are among the most common complications of
pregnancy and childbirth;
(4) Statistics from experts in the field show that one in five perinatal women will
experience mood and anxiety disorders at some time during the period spanning from
pregnancy through 12 months after the birth of a child;
(5) Maternal depression, anxiety, and other mood disorders can be debilitating
conditions, but they are treatable if properly diagnosed;
(6) Early identification and treatment of maternal mental health conditions significantly
improves outcomes for mothers and children;
(7) Children born to mothers with untreated depression face a higher likelihood of
encountering developmental challenges and increased utilization of medical and mental
health services throughout their lives;
(8) It is imperative, then, in order to protect and promote public health and welfare, to
ensure the prompt diagnosis and treatment of women experiencing postpartum depression
or other maternal mental health disorders;
(9) The American Medical Association, the American College of Obstetrics and
Gynecology, the American College of Nurse Midwives, and the American Academy of
Pediatrics recommend perinatal mental health screenings at certain intervals for all
pregnant and postpartum women;
(10) Universal maternal mental health screening questionnaires test for the presence of
prenatal or postpartum mood disorders through validated, evidence based tools;
(11) These screening questionnaires are available at little to no cost;
(12) In order to preserve and promote maternal health and strong families, it is
imperative that the State of Georgia provide access to periodic mental health screening
questionnaires for women throughout and after their pregnancies; and
(13) There is a critical need to ensure equitable access to maternal mental health
screening and care across Georgia, particularly in rural and other underserved
communities.
SECTION 2.
This Act shall be known and may be cited as the "Georgia Maternal Mental Health
Improvement Act."
SECTION 3.
Chapter 1 of Title 33 of the Official Code of Georgia Annotated, relating to general
provisions relative to insurance, is amended by adding a new Code section to read as follows:
<ins>"33-1-28.
(a) As used in this Code section, the term:
(1) 'Maternal mental health screening' means the use of an independent, evidence based
screening instrument that is in accordance with nationally recognized clinical practice
guidelines developed by independent organizations or medical professional societies
utilizing a transparent methodology and reporting structure and with a conflict-of-interest
policy. Such guidelines establish standards of care informed by a systematic review of
</ins>
<ins>evidence and an assessment of the benefits and risks of alternative care options and
include recommendations intended to optimize patient care.
(2) 'Medically necessary' has the same meaning as in Code Section 33-1-27.
(3) 'Mental healthcare provider' means any person licensed under Title 43 to provide
prenatal, labor and delivery, or postpartum care, including without limitation physicians,
psychiatrists, psychologists, advanced practice registered nurses, physician assistants,
licensed clinical social workers, and licensed professional counselors and marriage and
family therapists.
(4) 'Telehealth services' means services provided via two-way, real-time interactive
communication between a patient and a mental healthcare provider at a distant site
through telecommunications equipment, which services are compliant with federal Health
Insurance Portability and Accountability Act of 1996 (HIPAA) privacy, security, and
breach notification rules.
(b) Each health benefit policy issued, delivered, or renewed in this state shall provide
coverage for medically necessary:
(1) Maternal mental health screening during the prenatal period and 12 months
postpartum; and
(2) Care and treatment for those screenings positive for maternal mental health
conditions.
(c) All of the services provided in this Code section shall be covered whether provided in
person or through telehealth services.
(d) The provisions of this Code section shall apply to all policies, contracts, and
certificates executed, delivered, issued for delivery, continued, or renewed in this state on
or after January 1, 2027."
</ins>
SECTION 4.
Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to
medical assistance generally, is amended by adding a new Code section to read as follows:
<ins>"49-4-159.5.
(a) Except in cases where the woman refuses the maternal mental health screening, a
pregnant or postpartum woman seeking healthcare from a physician or other healthcare
provider may be screened for perinatal mood and anxiety disorders, as determined
necessary:
(1) At the pregnant woman's first prenatal visit;
(2) When the pregnant woman is between 28 to 32 weeks' gestation;
(3) Between delivery and discharge from the facility where the pregnant woman gives
birth;
(4) At the woman's six-week postpartum obstetrical visit;
(5) If there is a pregnancy loss and at the follow-up obstetric visit after such loss; and
(6) At a pediatric visit occurring when the infant is three months of age or, if there is no
such visit, at the postpartum woman's healthcare visit any time from three months to one
year after pregnancy loss or delivery.
(b) The right to refuse the mental health screening described in subsection (a) of this Code
section shall not exist for a patient determined by the physician or other healthcare provider
to be mentally incompetent.
(c)(1) The maternal mental health screening provided for in subsection (a) of this Code
section may be conducted by the physician or other healthcare provider who is providing
prenatal, obstetric, or postpartum care of the pregnant woman or pediatric care of the
woman's infant, as deemed necessary by such physician or healthcare provider.
Appropriate information and resources addressing perinatal mood or anxiety disorders
shall be provided during such screenings, including referrals, as clinically appropriate,
to licensed mental health professionals, community health workers, home visiting
</ins>
<ins>programs, peer support specialists, social workers, and other community based providers
capable of addressing behavioral health and related social needs. When feasible, such
referrals shall include coordination to ensure timely follow-up care. Each such screening
may utilize questionnaires that conform with nationally recognized clinical practice
guidelines and may be used for the purposes of diagnosis, treatment, appropriate
management, or ongoing monitoring of a woman's mental health, well-being, disease, or
condition as supported by medical and scientific evidence.
(2) Additional maternal mental health screenings, which may be refused, may be
conducted at any other point during the pregnancy or the postpartum period as deemed
necessary by the physician or other healthcare provider. Appropriate referral information
and resources addressing perinatal mood or anxiety disorders may be provided during
such screenings.
(d) A physician or other healthcare provider who provides obstetric or pediatric care may
provide educational materials through electronic or other means on the signs and symptoms
of perinatal mood and anxiety disorders to pregnant and postpartum women under his or
her care, or to mothers of children under his or her care, as deemed necessary by such
physician or healthcare provider.
(e) This Code section shall not preclude any other healthcare provider acting within his or
her scope of practice from screening for maternal mental health conditions or from
providing referral information and resources or educational materials on perinatal mood
and anxiety disorders.
(f) The department shall establish a comprehensive quality metrics program that includes
the following:
(1) Process measures, including but not limited to:
(A) Percentage of eligible patients screened at each required interval;
(B) Time from positive screen to first behavioral health contact;
(C) Completion rates for referrals to behavioral health services; and
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<ins>(D) Utilization rates of telehealth services;
(2) Outcome measures, including but not limited to:
(A) Rates of postpartum depression and anxiety identification;
(B) Emergency department utilization for mental health concerns;
(C) Psychiatric hospitalization rates; and
(D) Duration of treatment engagement;
(3) Equity measures, including but not limited to:
(A) Screening and treatment rates stratified by race, ethnicity, and geographic location;
and
(B) Disparities in access to care and outcomes; and
(4) Patient experience measures, including but not limited to:
(A) Satisfaction with screening process;
(B) Perceived barriers to care; and
(C) Experiences with telehealth services.
(g) Subject to appropriations by the General Assembly or receipt of other funding for such
purpose, the department shall establish a three-year pilot program for remote maternal
mental health screening and monitoring no later than January 1, 2027, that shall:
(1) Prioritize high-risk populations and rural communities;
(2) Include telehealth services;
(3) Integrate with existing maternal health programs including home visiting services;
and
(4) Collect data on program effectiveness and barriers to care.
(h) The department may allocate sufficient funds to support:
(1) Technology infrastructure and support;
(2) Provider training and technical assistance; and
(3) Program evaluation and reporting.
(i) The department shall:
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<ins>(1) Promulgate rules and regulations necessary to implement this Code section;
(2) Establish a process for monitoring compliance; and
(3) Report annually to the Senate Health and Human Services Committee and the House
Committees on Health and Public Health on the implementation progress and outcomes
of the requirements of this Code section.
(j) The annual report provided in subsection (i) of this Code section shall be required from
July 1, 2027, through July 1, 2029.
(k) To implement the provisions of this Code section, the department shall, when
necessary, submit a Medicaid state plan amendment or waiver request to the United States
Department of Health and Human Services."
</ins> SECTION 5.
This Act shall become effective on January 1, 2027, only if prior to such date, funds are
specifically appropriated for the purposes of this Act in an appropriations Act making
specific reference to this Act.
SECTION 6.
All laws and parts of laws in conflict with this Act are repealed.