MedicaidDocumentationHigh impact
Maternal Mental Health Screening Requirements
L.A. Care Health Plan·CA · OB-GYN, Family Medicine, General Practice +1 more·Medical Policy
Effective date
Jun 17, 2026
We identified it
Jul 1, 2026
Summary
L.A. Care updated its Maternal Mental Health Screening Requirements policy (effective immediately) requiring providers to conduct and document validated depression screenings during pregnancy (first trimester recommended) and within 6 weeks postpartum, with positive results requiring follow-up within 30 days. Billing teams must now use specific LOINC codes and ensure depression follow-up encounters include billable CPT codes for proper claim submission and HEDIS measure reporting.
Action Required
Immediately (effective June 17, 2026): Billing and clinical teams must implement the following: (1) Update encounter forms and EMR templates to require documentation of at least one maternal mental health screening during pregnancy and one screening within 6 weeks postpartum using validated tools (EPDS, PHQ-2, PHQ-9, or PHQ-A); (2) Ensure screening scores and results are documented in patient records with positive screens flagged for 30-day follow-up; (3) Train providers to use the specified LOINC codes (55758-7 for PHQ-2, 44261-6 for PHQ-9, 89204-2 for PHQ-A, 99046-5 for EPDS) when submitting depression screening data to L.A. Care; (4) Verify that all depression follow-up billing is associated with encounters that include at least one billable CPT code to prevent claim denials; (5) Establish referral workflows to Carelon Behavioral Health at (877) 344-2858 for mild-to-moderate findings and Los Angeles County Department of Mental Health at (800) 854-7771 for high-level needs; (6) Add screening requirements for substance use disorder (SUD), Adverse Childhood Experiences (ACEs), and Intimate Partner Violence (IPV) to pregnant and postpartum care protocols; (7) Distribute updated maternal mental health educational materials from L.A. Care (available at https://lacare.icolorconnect.com/login) to members. Failure to comply will result in non-compliance with AB 1936 requirements, potential claim denials, and reduced HEDIS performance metrics (PND-E and PDS-E measures).