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Model Maternal Medical and Mental Health Provider Availability Legislation

Mental Health Provider Access

Perinatal Mental Health Certified (PMH-C) Providers

Unlike provider network adequacy of medical providers, where both licensure and specialty are monitored, network adequacy of mental health providers has been limited to licensure (such as LCSW, PhD, etc.). This has meant that licensed providers who specialize in the treatment of maternal mental health conditions–Perinatal Mental Health Certified (PMH-C)* providers–have often been declined when applying to join an insurer/plan’s panel because there have been sufficient numbers of LCSWs in the zip code radius, for example. 

Insurers and health plans shall monitor network adequacy for PMH-Cs, not just licensure type. 

Certified Peer Support Specialists

Given the increasing need for mental health providers, insurers and plans shall also contract with and monitor for network adequacy of certified peer support specialists. As these specialists are not licensed and overseen by a state board, peers shall be contracted through a licensed medical or mental health provider and reported in provider directories as adjunct providers of the contracted licensed provider. Network adequacy of peers shall be monitored using standards for licensed mental health providers, such as LCSWs.

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Network Adequacy Standards 

Typical network adequacy standards include both ratios of providers to insureds/members (the average number of women who give birth) and the geographic distance of providers relative to insurers/members.  

Proposed Interim Network Adequacy Standard

Because there are currently limited numbers of each of these providers* in the state, it is recommended that a standard of 80% or more of such providers be included in the insurer’s/plan’s network until standard ratio and geo distance network adequacy standards are met.

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Novel Approaches for Mental Health Availability 

Given the deepening shortages of mental health professionals in the state and across the U.S., insurers and plans shall also be required to develop a plan regarding the promotion, coverage, and availability monitoring of usage of mental health provider-to-provider mental health psychiatry consultation and FDA-approved digital therapeutics.   

Medical Care Provider Access

Women should have a choice in accessing evidence-based services and providers, including who provides prenatal and postpartum care, who delivers their babies, and where they give birth.  

This is particularly important for Black and Native American mothers, and those who live in rural communities, as these groups have disproportionate levels of maternal deaths and near misses.

Therefore, the state shall be required to offer licensure and oversee through a licensure board, the following providers/facilities:

  1. certified midwives*
  2. doulas* 

-and-

  1. free-standing birth centers*

*Health plans and insurers shall contract with these licensed providers/facilities and report on network availability using standards in place for Ob/Gyns and tertiary facilities, respectively. 

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