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.
Resources/Tools:
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.
Resources/Tools:
CMS Letter on Application of Mental Health Parity to Medicaid, Medicaid Managed Care, and CHIP
Hassle Factor Form: Concerns With Payers -
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.
Resources/Tools:
EPSDT - A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents
-
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.
Resources/Tools:
Payment Strategies Targeting Payers
Return on Investment in Systems of Care for Children With Behavioral Health Challenges
Business Case
Example:New York – Health Insurance Coverage for Maternal Depression Screening
-
Identify sources of federal and state funds applicable to the mental health needs of children and youth and work with the state department that oversees mental health, substance abuse and developmental disabilities services; the state Medicaid agency; the state education agency to integrate these streams in support of evidence-based programs and services to treat mental illness in children and youth.
Partner with organizations such as the National Alliance on Mental Illness, the Federation for Families, and state mental health association(s); and professional associations of mental health providers (including the state chapter of the American Academy of Child and Adolescent Psychiatrists) in these efforts. Recommend blending or braiding of state programmatic funds to provide more services and eliminate duplication of services.
Blended funding is funding from multiple funding sources combined into a single "pot" of dollars. Braided funding is funding from multiple sources, separately tracked and reported for administrative purposes. Given federal rules and regulations for use of funds, braided funding is often seen as a more attractive and simpler strategy for state agencies to use in enhancing mental health and developmental services.
Last Updated
06/12/2021
Source
American Academy of Pediatrics