Additional Considerations
NC Medicaid setting the reimbursement rate at parity with the OB-GYN rate is feasible in the short term. NC Medicaid adjusts these rates throughout the year. Expanding CNMs scope of practice and licensing CPMs is a medium-term solution as both require legislation. CNM legislation has been introduced in previous sessions and is expected to be introduced in future sessions. Highlighting the support of the North Carolina OB-GYN Society will be helpful in pushing through legislation.
3.2 Screening of Perinatal Mental Health Conditions NC Medicaid should incentivize PHPs to conduct perinatal mental health screenings. Implementation: • NC Medicaid should explicitly include mental health screenings in all three obstetrics bundles. • NC Medicaid should require well-child care providers to conduct postpartum mental health screenings during the infant’s medical visits for the first year postpartum when the birth mother is present. North Carolina Context
More than one in ten women suffer from postpartum depression, and seven in 100 experience depression and/or anxiety during their pregnancy.413 Women with severe forms of depression may commit suicide—a leading cause of maternal mortality.414 Maternal depression is also associated with other risk factors for maternal mortality and morbidity.415 Women of color have a much higher rate of perinatal depression than white women (38 percent v. 13-19 percent).416 Conversely, Black women receive lower levels of treatment for their perinatal mental health condition. Currently, mental health screenings are not included in the obstetrics service packages. The antepartum service package bundle includes antepartum visits, services, counseling, fetal surveillance testing, and genetic testing case management. The postpartum service package bundle includes exams, contraceptive counseling and contraceptives, and vaccinations.417 The global obstetrics package includes the services in the antepartum and postpartum packages, as well as labor and delivery. Starting in 2018, NC Medicaid allowed obstetrics providers to be reimbursed for three emotional/behavioral assessments in the postpartum period, but these assessments 74 Part III. Maternal Health Care Recommendations
