MATERNAL MENTAL HEALTH CASE MANAGEMENT PROGRAM
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Defines Sharp Health Plan's maternal mental health case management program for prenatal, postpartum, and interpregnancy members in California, including referral, outreach, and program procedures for providers and members.
Policy revised to comply with SB 1207 to include quality measures for ensuring compliance.
Coverage Criteria — Maternal Mental Health Case Management
Maternal Mental Health Case Management Eligibility and Workflow
Covered when ALL of the following are met
Referrals accepted from providers, members, hospital staff, or other sources
If member not reached after three attempts, an Unable to Contact letter is mailed
Complex case management includes additional assessment, identification of social determinants of health, goal/barrier setting, and ongoing monthly follow-up
No explicit exclusions listed in the policy. The Sharp Health Plan Maternal Mental Health Case Management Program documentation does not identify any specific services, diagnoses, provider types, or member groups that are excluded from the program; referrals are accepted from any source and program guidelines are available to providers on request.
None specified. The policy does not list any services or situations that are considered not medically necessary for the maternal mental health case management program.
Provider Actions — Screening, Referral, Documentation
Referral pathway
No prior authorization is required to refer members to Sharp Health Plan's network behavioral health providers or to the Plan's maternal mental health case management program. Referrals will be accepted from any source, including providers, members, hospital staff, or facility utilization reviewers/case managers.
- Case management referrals may be made by completing the Case Management Referral form on the Sharp Health Plan website or by calling 1-858-499-8300.
Provider action highlight
If a patient has a positive maternal mental health screening, the provider should take action to ensure timely connection to services: direct the mother to a Sharp Health Plan network behavioral health provider or refer to the Plan's case management department. A referral for behavioral health is not required to access behavioral health services.
- Positive screening → direct referral to network behavioral health provider (no behavioral health referral form required).
- Positive screening → refer to case management (Case Management Referral form or phone).
Referral documentation
Providers should document screening results and any referrals made. When referring to case management, include relevant screening findings and member contact information on the Case Management Referral form or in the referral communication so the Plan can efficiently initiate services.
- Include screening outcome and contact details on the Case Management Referral form.
- Program guidelines and criteria are available to providers upon request and should be included or referenced when appropriate.
Screening requirement
Providers who provide prenatal or postpartum care must offer or perform screening for maternal mental health conditions as required by California Health & Safety Code Section 1367.625. Failure to offer or perform required screening may result in noncompliance with state requirements and potential reporting or corrective actions by the Plan.
- California Health & Safety Code 1367.625 requires offering or performing maternal mental health screening to prenatal and postpartum patients.
- Sharp Health Plan monitors quality measures for screening, diagnosis, treatment, and referral as part of regulatory compliance.
Definitions
Background
Maternal mental health conditions occur during pregnancy, the postpartum period, or interpregnancy and include conditions such as postpartum depression. Early identification through screening and timely linkage to behavioral health services or the Plan’s case management supports improved quality and outcomes for mothers by assisting with needs like understanding benefits, making appointments, and connecting to community resources. The Plan’s program is designed to meet California regulatory requirements (Health & Safety Code 1367.625) and to provide outreach and materials to providers to ensure regulatory compliance.
Level of Care — Outpatient Case Management
Case Management and Referral to Behavioral Health
Case Management and Referral to Behavioral Health
Complex case management process described in separate desk top procedure
Referral to network behavioral health provider not required; providers may refer via Case Management Referral form or phone
Visit Limits and Follow-up
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