My Testimony in Favor of Tracking How Often Prenatal Depression Screening Occurs

By Joy Burkhard, MBA, Executive Director

On Tuesday, February 6, I provided the following testimony in support of state Medicaid agencies measuring how often screening and follow-up are occurring for depression in pregnancy. This testimony was provided to the CMS Medicaid Core Set working group, which evaluates measures for consideration as mandatory for state Medicaid agencies to report.

This work is made possible through a capacity grant from a philanthropic foundation. 

The purpose of the Child and Adult Core Sets is to measure the overall national quality of care for beneficiaries, monitor performance at the state level, and improve the quality of health care. State reporting of these measure sets has historically been voluntary; however, state reporting of the Child Core Set and the behavioral health measures on the Adult Core Set will become mandatory in the Federal Fiscal Year (FFY) 2024. 

Following are my remarks:

“My name is Joy Burkhard, and I am the founder and executive director of the Policy Center for Maternal Mental Health. On behalf of a network of 10,000 providers, patients, health system leaders, and others, I appreciate the opportunity to have nominated this measure and the workgroup’s consideration of this important measure.

I also want to be sure workgroup members know that I spent nearly 24 years at a health plan and, for many of those years, led our health plan’s quality management accreditation program. So, I have a deep appreciation of the challenges that come with HEDIS data collection and reporting. 

As many of the workgroup members may be aware, maternal mental health disorders such as depression and anxiety are well recognized as the leading complications of birth, and according to the CDC, suicide and overdose are the leading causes of pregnancy-related death in the U.S.

What many people don’t understand is that the new onset of maternal mental health disorders happens as frequently in pregnancy as in the postpartum period, and some studies suggest onset is more frequent in pregnancy. Maternal stress, anxiety, and depression are also well recognized as a leading cause of preterm birth and low birth weight deliveries, something patients, providers, and payors are all deeply concerned with.

Further research supports that untreated depression in pregnancy can carry over to the postpartum period, and those with untreated prenatal depression are also at higher risk of suicide. 

It’s important to detect challenges not only in the postpartum period but also in pregnancy for the health and well-being of mothers, babies, and children.  The Alliance for Innovation on Maternal Health, an initiative funded by HRSA and led by the American College of Obstetricians and Gynecologists, re-released its recommendation in 2023 to screen in pregnancy and the postpartum period in the form of a primary “bundle” that states should focus on implementing to improve maternal health. The recommendation moved into the “primary” category, prioritizing it for states because it aligned with the new HEDIS measures. 

Regarding potential measure collection concerns, particularly in states that reimburse through a global maternity rate, there are two pathways for states to consider: 

  • Collection through plan-level case management programs, which is a data source allowed with ECDS measures. Many plans have preexisting case management programs to support reduction in preterm birth and are already offering screening 
  • Work toward publishing guidance regarding reimbursement for screening on a fee-for-service basis. Some states are exploring this or have already implemented it, including CA, AZ, and CO, to name a few.

Finally, at a time when many women in this country are no longer offered a choice whether to have a baby, the time is now for state Medicaid agencies and their plan partners to prioritize maternal depression screening, starting in pregnancy so expecting mothers have the greatest opportunity to receive early intervention, treatment, and follow-up care.

Thank you.”

There was a robust discussion about the measure, including the feasibility of reporting by states. Eighty-five percent of workgroup members voted to recommend CMS add the measure to the Core Set. A significant milestone for the maternal mental health community! 

Last year, during the workgroup conversation, the workgroup re-emphasized the importance of measuring screening for postpartum depression, recommending CMS add the postpartum HEDIS measure to the core set. 

Now, CMS will be reviewing Core Set measure recommendations made both last year and this year by the workgroup. CMS will release the new Core Set measures (which will be tracked by states in 2025 and reported in 2026) by April of this year. 

Learn more about the HEDIS maternal depression measures

Read my Core Set Meaure nomination for the HEDIS prenatal depression HEDIS screening and follow-up, here