To promote awareness and treatment of maternal depression among enrollees, the Illinois Medicaid program has begun to reimburse providers for screening their patients using a standardized screening tool. To pay for this service, the state invoked an existing Medicaid policy that allows providers to conduct risk assessments of children and pregnant women. The initiative has been widely promoted among partner organizations. Physicians who identify women suffering from maternal depression have access to free consultations with experts, information about referral services, and Web resources.
Type of Innovation: State Medicaid Reimbursement and Billing Policy for Maternal Depression Screening
Organization: Task Force comprised of the Illinois Departments of Public Aid (Medicaid), Public Health, Children and Family Services, and Corrections and Conference of Women Legislators in coordination with other state organizations.
Date of Implementation: December 2004
Target Populations: Pregnant and postpartum women enrolled in the Illinois Medicaid program and women whose infants (under age 1) are Medicaid eligible.
The issue: Approximately one of 10 new mothers suffers from maternal depression in the first year after giving birth. In addition to being a debilitating and harmful illness, maternal depression can compromise women's ability to nurture their children. Studies have found that children of depressed women exhibit more problem behaviors and have more difficulty achieving age-appropriate developmental and cognitive milestones. Certain factors, including low socioeconomic status and exposure to stress, place pregnant and postpartum women at greater risk for maternal depression. In spite of its significant impact on the health and well-being of women and children, maternal depression remains under-recognized and under-treated. Fortunately, simple and validated screening tools that can identify women who may be experiencing depression are available. Moreover, prescription medications and psychosocial interventions can effectively treat depression during pregnancy and the postpartum period.
The intervention: On December 1, 2004, the Illinois Medicaid program implemented a policy enabling providers to receive Medicaid reimbursement for maternal depression screening of pregnant women and women with children under age 1. "If you want to improve healthcare overall, starting with the largest health insurer, such as Medicaid, is a good place to start," says Anne Marie Murphy, M.D., Illinois Medicaid director. "Supporting mothers is an important first step in keeping young children healthy and safe. Here in Illinois, where we provide healthcare for over 2 million Illinoisans and over 1.2. million children, we have developed a wide range of initiatives to address mental health and, in particular, perinatal depression, so that every child can have a healthy start in life."
Under existing Medicaid policy that allows providers to conduct risk assessments of children and pregnant women, providers who use an approved depression screening tool can receive Medicaid reimbursement at a rate of $14.60 per screening. The Edinburgh Postnatal Depression Scale, the Beck Depression Inventory, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire are approved by the Illinois Departments of Public Aid (IDPA). Providers interested in using another screening tool must receive written approval from IDPA. The new policy can be used for two different populations: 1) pregnant and postpartum women who are covered by Medicaid and 2) women who are not themselves enrolled in Medicaid, but whose infants (under age 1) are eligible for the program.
For pregnant and postpartum women (up to one year after delivery) who are enrolled in Medicaid, the screening can be billed under the woman's Medicaid number, or Recipient Identification Number (RIN). If the postpartum screening occurs during a well child or acute care visit for a child covered by Medicaid, providers can bill under the infant's RIN. The IDPA worked closely with pediatricians, obstetricians and gynecologists, and family physicians to develop and promote the new policy.
Resources for providers on how to implement the policy and maintain records are available at the Illinois Chapter of the American Academy of Pediatrics (ICAAP) Web site. Both the ICAAP and the Illinois Academy of Family Physicians are participating in the Commonwealth Fund's ABCD II initiative by training providers on maternal depression screening and social/emotional screening of children under age 3. "Addressing the issue of maternal depression and its impact on the healthy development of young children is a critical need; not only is it a women's health issue but a pediatric issue as well," said Dr. Stephen Saunders, president of ICAAP. To help counsel pregnant and postpartum women identified in need of mental health services, providers can access a statewide Perinatal Mental Health Consultation Service to receive free consultation by a team of experts. Information about referral sources is available to providers by calling a statewide toll-free hotline (1-800-573-6121).
Additionally, the IDPA has developed online resources for providers, including information on how to refer patients for appropriate treatment. This new Medicaid policy is one component of a broader statewide initiative to improve maternal and child health outcomes. In addition to the policy, Illinois is pilot-testing training of pediatricians and family physicians on the mental health of children and families, including screening children for social/emotional delays and mothers for maternal depression. Moreover, children who are identified with or at risk of social and emotional delays can receive services through the state's Early Intervention program (Part C of the Individuals with Disabilities Education Act).
Resources: IDPA guidelines and approved screening tools are attached at right.
For more information: Contact the Illinois Department of Public Aid, Bureau of Maternal and Child Health Promotion, at (217) 524-7478 or firstname.lastname@example.org.