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108th CONGRESS
  1st Session
                                 S. 450

To amend the Public Health Service Act to provide for research on, and 
  services for individuals with, postpartum depression and psychosis.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 26, 2003

 Mr. Durbin (for himself, Mr. Fitzgerald, and Mrs. Clinton) introduced 
the following bill; which was read twice and referred to the Committee 
               on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to provide for research on, and 
  services for individuals with, postpartum depression and psychosis.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Melanie Stokes Postpartum Depression 
Research and Care Act''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Postpartum depression is a devastating mood disorder 
        which strikes many women during and after pregnancy.
            (2) Postpartum mood changes are common and can be broken 
        into three subgroups: ``baby blues,'' which is an extremely 
        common and the less severe form of postpartum depression; 
        postpartum mood and anxiety disorders, which are more severe 
        than baby blues and can occur during pregnancy and anytime 
        within the first year of the infant's birth; and postpartum 
        psychosis, which is the most extreme form of postpartum 
        depression and can occur during pregnancy and up to twelve 
        months after delivery.
            (3) ``Baby blues'' is characterized by mood swings, 
        feelings of being overwhelmed, tearfulness, irritability, poor 
        sleep, mood changes, and a sense of vulnerability.
            (4) The symptoms of postpartum mood and anxiety disorders 
        are the worsening and the continuation of the baby blues beyond 
        the first days or weeks after delivery.
            (5) The symptoms of postpartum psychosis include losing 
        touch with reality, distorted thinking, delusions, auditory 
        hallucinations, paranoia, hyperactivity, and rapid speech or 
        mania.
            (6) Each year over 400,000 women suffer from postpartum 
        mood changes, with baby blues afflicting up to 80 percent of 
        new mothers; postpartum mood and anxiety disorders impairing 
        around 10-20 percent of new mothers; and postpartum psychosis 
        striking 1 in 1,000 new mothers.
            (7) The causes of postpartum depression are complex and 
        unknown at this time; however, theories include a steep and 
        rapid drop in hormone levels after childbirth; difficulty 
        during labor or pregnancy; a premature birth; a miscarriage; 
        feeling overwhelmed, uncertain, frustrated or anxious about 
        one's new role as a mother; a lack of support from one's 
        spouse, friends or family; marital strife; stressful events in 
        life such as death of a loved one, financial problems, or 
        physical or mental abuse; a family history of depression or 
        mood disorders; a previous history of major depression or 
        anxiety; or a prior postpartum depression.
            (8) Postpartum depression is a treatable disorder if 
        promptly diagnosed by a trained provider and attended to with a 
        personalized regimen of care including social support, therapy, 
        medication, and when necessary hospitalization.
            (9) All too often postpartum depression goes undiagnosed or 
        untreated due to the social stigma surrounding depression and 
        mental illness, the myth of motherhood, the new mother's 
        inability to self-diagnose her condition, the new mother's 
        shame or embarrassment over discussing her depression so near 
        to the birth of her child, the lack of understanding in society 
        and the medical community of the complexity of postpartum 
        depression, and economic pressures placed on hospitals and 
        providers.
            (10) Untreated, postpartum depression can lead to further 
        depression, substance abuse, loss of employment, divorce and 
        further social alienation, self-destructive behavior, or even 
        suicide.
            (11) Untreated, postpartum depression impacts society 
        through its effect on the infant's physical and psychological 
        development, child abuse, neglect or death of the infant or 
        other siblings, and the disruption of the family.

        TITLE I--RESEARCH ON POSTPARTUM DEPRESSION AND PSYCHOSIS

SEC. 101. CONSENSUS RESEARCH CONFERENCE AND PLAN CONCERNING POSTPARTUM 
              DEPRESSION AND PSYCHOSIS.

    Part B of title IV of the Public Health Service Act (42 U.S.C. 284 
et seq.) is amended by adding at the end the following:

``SEC. 409J. CONSENSUS RESEARCH CONFERENCE AND PLAN CONCERNING 
              POSTPARTUM DEPRESSION AND PSYCHOSIS.

    ``(a) Consensus Research Conference and Plan.--
            ``(1) Conference.--The Secretary, acting through the 
        Director of NIH, the Administrator of the Substance Abuse and 
        Mental Health Services Administration, and the heads of other 
        Federal agencies that administer Federal health programs, shall 
        organize a series of national meetings that are designed to 
        develop a research plan for postpartum depression and 
        psychosis.
            ``(2) Plan.--The Secretary, taking into account the 
        findings of the research conference under paragraph (1), shall 
        develop a research plan relating to postpartum depression and 
        psychosis. Such plan shall include--
                    ``(A) basic research concerning the etiology and 
                causes of postpartum depression and psychosis;
                    ``(B) epidemiological studies to address the 
                frequency and natural history of postpartum depression 
                and psychosis and the differences among racial and 
                ethnic groups with respect to such conditions;
                    ``(C) the development of improved diagnostic 
                techniques relating to postpartum depression and 
                psychosis;
                    ``(D) clinical research for the development and 
                evaluation of new treatments for postpartum depression 
                and psychosis, including new biological agents;
                    ``(E) development of information and education 
                programs for health care professionals and the public 
                relating to postpartum depression and psychosis; and
                    ``(F) a plan to disseminate information and 
                education on postpartum depression and psychosis to 
                health care professionals and the public.
            ``(3) Report.--Not later than 2 years after the date of 
        enactment of this section, the Secretary shall prepare and 
        submit to the appropriate committees of Congress a report 
        concerning the research plan under paragraph (2).
    ``(b) Activity Relating to Research Plan.--
            ``(1) In general.--After the development of the research 
        plan under subsection (a)(1), the Secretary, acting through the 
        Director of NIH shall expand and intensify research and related 
        activities of the Institutes relating to postpartum depression 
        and postpartum psychosis in a manner appropriate to carry out 
        such plan, and in particular shall direct research efforts to 
        carry out such plan.
            ``(2) Report.--Not later than 1 year after the development 
        of the research plan under subsection (a)(1), and annually 
        thereafter, the Secretary shall prepare and submit to the 
        appropriate committees of Congress a report on the progress 
        made with respect to such plan and the status of ongoing 
        activities regarding postpartum depression and psychosis at the 
        National Institutes of Health.''.

  TITLE II--DELIVERY OF SERVICES REGARDING POSTPARTUM DEPRESSION AND 
                               PSYCHOSIS

SEC. 201. DELIVERY OF SERVICES REGARDING POSTPARTUM DEPRESSION AND 
              PSYCHOSIS.

    Subpart 3 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb-31 et seq.) is amended--
            (1) by inserting after the subpart heading the following:

                   ``Chapter I--General Provisions'';

        and
            (2) by adding at the end thereof the following:

``Chapter II--Delivery of Services Regarding Postpartum Depression and 
                               Psychosis

``SEC. 520K. ESTABLISHMENT OF PROGRAM OF GRANTS.

    ``(a) In General.--The Secretary shall in accordance with this 
chapter make grants to provide for projects for the establishment, 
operation, and coordination of effective and cost-efficient systems for 
the delivery of essential services to individuals with postpartum 
depression or postpartum psychosis (referred to in this section as a 
`postpartum condition') and their families.
    ``(b) Recipients of Grants.--A grant under subsection (a) may be 
made to an entity only if the entity is a public or nonprofit private 
entity, which may include  a State or local government; a public or 
nonprofit private hospital, community-based organization, hospice, 
ambulatory care facility, community health center, migrant health 
center, or homeless health center; or other appropriate public or 
nonprofit private entity.
    ``(c) Certain Activities.--To the extent practicable and 
appropriate, the Secretary shall ensure that projects under subsection 
(a) provide services for the diagnosis and management of postpartum 
conditions. Activities that the Secretary may authorize for such 
projects may also include the following:
            ``(1) Delivering or enhancing outpatient and home-based 
        health and support services, including case management, 
        screening and comprehensive treatment services for individuals 
        with or at risk for postpartum conditions; and delivering or 
        enhancing support services for their families.
            ``(2) Delivering or enhancing inpatient care management 
        services that ensure the well being of the mother and family 
        and the future development of the infant.
            ``(3) Improving the quality, availability, and organization 
        of health care and support services (including transportation 
        services, attendant care, homemaker services, day or respite 
        care, and providing counseling on financial assistance and 
        insurance) for individuals with postpartum conditions and 
        support services for their families.
    ``(d) Integration With Other Programs.--To the extent practicable 
and appropriate, the Secretary shall integrate the program under this 
title with other grant programs carried out by the Secretary, including 
the program under section 330.

``SEC. 520L. CERTAIN REQUIREMENTS.

    ``A grant may be made under section 520K only if the applicant 
involved makes the following agreements:
            ``(1) Not more than 5 percent of the grant will be used for 
        administration, accounting, reporting, and program oversight 
        functions.
            ``(2) The grant will be used to supplement and not supplant 
        funds from other sources related to the treatment of postpartum 
        conditions.
            ``(3) The applicant will abide by any limitations deemed 
        appropriate by the Secretary on any charges to individuals 
        receiving services pursuant to the grant. As deemed appropriate 
        by the Secretary, such limitations on charges may vary based on 
        the financial circumstances of the individual receiving 
        services.
            ``(4) The grant will not be expended to make payment for 
        services authorized under section 520K(a) to the extent that 
        payment has been made, or can reasonably be expected to be 
        made, with respect to such services--
                    ``(A) under any State compensation program, under 
                an insurance policy, or under any Federal or State 
                health benefits program; or
                    ``(B) by an entity that provides health services on 
                a prepaid basis.
            ``(5) The applicant will, at each site at which the 
        applicant provides services under section 520K(a), post a 
        conspicuous notice informing individuals who receive the 
        services of any Federal policies that apply to the applicant 
        with respect to the imposition of charges on such individuals.

``SEC. 520M. TECHNICAL ASSISTANCE.

    ``The Secretary may provide technical assistance to assist entities 
in complying with the requirements of this chapter in order to make 
such entities eligible to receive grants under section 520K.

``SEC. 520N. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purpose of carrying out this chapter, there are 
authorized to be appropriated such sums as may be necessary for each of 
the fiscal years 2004 through 2006.''.
                                 <all>

Pages: 1

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