The Chapter Action Kit was developed to support AAP Chapters in addressing and improving children's mental health in primary care. Review the information below for strategies on maximizing benefits and financing to improve mental health services.
Working with your AAP Chapter Pediatric Council, initiate discussions with benefits managers in large businesses and companies (purchasers) to educate them about the benefits of comprehensive coverage of mental health services for the children of their employees. Pediatric Councils meet regularly with managed care organization representatives to discuss issues of quality care, inadequate communications between clinicians, system issues, and barriers to mental health care (eg, behavioral health care carve-outs).
Although fees cannot be discussed during these meetings, it is acceptable to discuss policies that impede collaboration (see the Strategies to Collaborating with Mental Health Professionals); lack of payment to pediatricians for their treatment of mental health disorders; provider panels that are insufficient, inaccessible, and/or lacking in pediatric expertise; the clinical problems that result from poor communication and siloed (carved out) behavioral health plans; cumbersome administrative and authorization requirements that discourage access to mental health and substance abuse services; and limited mental health benefits. Forty chapters have established these councils and the AAP has developed several resources for chapters and members for chapters and pediatric councils.
Policy Statement: Scope of Health Care Benefits for Children From Birth Through Age 26
AAP Chapter Pediatric Council Shared Resources
Hassle Factor Form: Concerns With Payers
Pediatric Mental Health Coverage Letter
Advocate for insurer compliance with mental health parity and for mental health parity to apply to Medicaid and CHIP. The Departments of Health and Human Services, Labor, and Treasury issued the final rule implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). Under MHPAEA, if a group health plan includes medical/surgical benefits and mental health/substance use disorder (MH/SUD) benefits, the financial requirements (eg, deductibles and co-pays) and treatment limitations (eg, number of visits or days of coverage) that apply to MH/SUD benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits. It is effective plan years on or after July 2014. The final rule specifies that intermediate levels of care (eg, intensive outpatient, partial hospitalization, residential treatment) are included in the parity requirement as are specific forms of non-quantitative treatments limitations including payment rates and provider networks.
On April 6, 2015, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule to implement the MHPAEA for Medicaid and the Children's Health Insurance Program (CHIP). The proposed rule would apply MHPAEA requirements to Medicaid managed care, CHIP, and Medicaid alternative benefit programs, ensuring that mental health services are provided to everyone at parity with medical and surgical services. Medicaid fee-for-service (FFS) plans are not included in the proposed rule, but the rule encourages states to apply mental health parity requirements in their FFS programs. The Academy has commented on the proposed rule; once the rule is finalized, states will have 18 months to bring their Medicaid and CHIP programs into compliance.
Recommend full implementation of Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program to ensure eligible children receive the mental health and developmental screens and services they need.
Collaboratively with the partners listed above, develop an advocacy agenda to address gaps in needed private programs and funding and to assure adequate payment of all providers of services to children with mental health problems.
American Academy of Pediatrics