1367.625.
(a) A health care service plan shall do all of the following:
(1) (A) Develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall include one or more maternal mental health screenings to be conducted during pregnancy and one or more mental health screenings to be conducted during the postpartum period in accordance with applicable clinical guidelines and the standards of care appropriate to the provider’s scope of practice. The program shall be developed consistent with sound clinical principles and processes, and shall include quality measures to encourage screening, diagnosis, treatment, and referral. The program guidelines and criteria shall be provided to relevant licensed health care practitioners, including all contracting obstetric providers. As part of a maternal mental health program, the health care service plan is encouraged to improve screening, treatment, including through the use of outpatient prescription drugs approved for maternal mental health by the United States Food and Drug Administration, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate enrollees about the program.
(B) (i) The guidelines described in subparagraph (A) shall be guidelines adopted by the American College of Obstetricians and Gynecologists, unless those guidelines do not align with the provider’s scope of practice.
(ii) If the guidelines described in clause (i) do not align with the provider’s scope of practice, the guidelines may include, but are not limited to, guidelines adopted by other recognized professional bodies.
(C) This paragraph does not expand or alter a licensed provider’s existing scope of practice.
(2) (A) Provide case management or care coordination for an enrollee who screens positive for a maternal mental health condition in accordance with the plan’s existing case management and care coordination programs.
(B) Case management and care coordination services may include, as appropriate, identification of available treatment providers and community supports, appointment scheduling, behavioral health navigation, medication access assistance when prescribed, regular patient engagement or followup, and communication with the referring obstetric and behavioral health providers.
(C) Case management and care coordination may be provided by the health care service plan, or by a delegated provider if case management or care coordination, as defined in subparagraph (B), is already provided for pursuant to the contract between the plan and delegated provider as of December 31, 2026, or in accordance with Section 1375.7.
(D) This paragraph does not limit a plan’s flexibility in care delivery models, if an enrollee receives timely and appropriate followup care consistent with the standard of care and the plan’s quality improvement requirements.
(E) This paragraph does not create a new benefit.
(3) Incorporate maternal mental health screening, referral, care coordination, and followup activities into its existing quality improvement and population health management programs, and maintain documentation demonstrating compliance that is available to regulators upon request.
(b) For the purposes of this section:
(1) “Case management” means a health care process in which a health care professional, acting within their scope of practice, assists a patient by developing and implementing a coordinated plan of care that integrates the medical and psychosocial support services the patient needs to achieve optimal outcomes.
(2) “Contracting obstetric provider” means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, and who is contracted with the enrollee’s health care service plan to provide services under the enrollee’s plan contract.
(3) “Health care practitioner” means a physician and surgeon, naturopathic doctor, nurse practitioner, physician assistant, nurse midwife, or a midwife licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code or an initiative act referred to in that division and who is acting within their scope of practice.
(4) “Health care service plan” includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code. The State Department of Health Care Services shall seek any federal approvals it deems necessary to implement this section. This section applies to Medi-Cal managed care plan contracts only to the extent that the State Department of Health Care Services obtains any necessary federal approvals, and federal financial participation under the Medi-Cal program is available and not otherwise jeopardized.
(5) “Maternal mental health condition” means a mental health condition, including postpartum or perinatal depression, that occurs during the pregnancy or the postpartum period, as defined by the most recent clinical guidelines adopted by the American College of Obstetricians and Gynecologists on the screening and diagnosis of mental health conditions during pregnancy and postpartum, regardless of the pregnancy outcome and inclusive of gender-diverse birthing people.
(c) This section does not apply to specialized health care service plans, except specialized behavioral health-only plans offering professional mental health services.
(d) Notwithstanding subdivision (a), a Medi-Cal managed care plan shall continue to comply with any quality measures required or adopted by the State Department of Health Care Services. Quality measures included in a Medi-Cal managed care plan’s maternal mental health program shall not be inconsistent with quality measures required or adopted by the State Department of Health Care Services.
(e) This section shall not be construed to limit access to additional treatment options for maternal mental health.