Dear Medical Director:
Given the impetus for health care reform, I am pleased to share a copy of the joint issue
paper Improving Mental Health Services in Primary Care: Reducing Administrative and
Financial Barriers to Access and Collaboration. The American Academy of Pediatrics
(AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP),
collaboratively developed this paper. Our combined organizations, representing over
67,500 pediatricians and child and adolescent psychiatrists, are dedicated to the optimal
health of infants, children, adolescents and young adults.
The paper recommends steps payers can take toward increasing access to mental health
care for children and adolescents through improved support of mental health services in
the primary care and specialty settings and improving coordination of services between
primary care and mental health care systems. The National Business Group on Health
(NBGH) representing over 250 large employers, has endorsed the AAP/AACAP issue
paper.
Pediatric primary care clinicians have unique opportunities to affect the mental health of
children: preventing mental health problems by guiding parents in behavior management;
identifying mental health symptoms as they emerge; intervening early, before symptoms
have evolved into disorders; facilitating referral of children and their family members
when mental health or substance abuse specialty services are needed; collaborating with
child and adolescent psychiatrists in caring for children with severely-impairing mental
health and substance abuse disorders; and coordinating the primary and specialty care of
children with mental health conditions and substance abuse, as they do for children with
other special healthcare needs. Studies have demonstrated that increasing access to outpatient mental health services may reduce mental health and other care costs, including
psychiatric hospitalization rates.1,2 For example, after North Carolina introduced full
coverage parity of mental health and non-mental health conditions into its state health
plan for state employees it saw mental health payments as a percentage of total health
payments decrease.3
The nation-wide shortage of children’s mental health professionals4 contributes to the
urgency of enhancing mental health services in primary care settings. Without
intervention, child and adolescent psychiatric disorders frequently continue into
adulthood, further escalating medical costs, negatively affecting educational attainment
and employment opportunities, and increasing the risk of poverty.5 The NBGH
advocates that mental health care is a basic need of children and adolescents and should
be offered by all employers.6 It is in the best interest of payers, as well as children and
families, to improve the mental health of children and adolescents. AAP and AACAP
agree this can be best accomplished by paying for mental health care in the pediatric
primary care home, paying for effective collaboration between primary care clinicians
and child and adolescent psychiatrists, and eliminating administrative barriers that often
hinder children and adolescents’ access to out-patient mental health services.
Implementation of the AAP/AACAP recommendations will enhance access to cost
effective and clinically sound mental health services for children and adolescents.
Among the recommendations outlined in the enclosed paper are the following:
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Appropriately pay primary care clinicians for the mental health services they provide,
such as mental health and substance abuse screening of children and their
parents/guardians, early intervention (before symptoms have risen to the level of a
diagnosis), treatment planning, care plan oversight, and prolonged services.
Pay primary care clinicians and child and adolescent psychiatrists for non-face-toface elements of their services to children and families, such as telephone services,
online evaluation and management services, interface with school personnel, team
meetings, clinician-clinician consultation, and post-service work consistent with CPT
guidelines.
Assure primary care clinicians’ access to consultation and collaboration with child
and adolescent psychiatrists and with other members of the mental health services
system who have pediatric expertise.
Ensuring that mental health networks contain an adequate number of physicians
qualified to provide mental health services for children and adolescents.
Pay for evidenced based and evidence informed psychosocial interventions,
behavioral treatment, and psychopharmacological therapy.
Implement parity in mental health benefits, including diagnostic parity for
pediatricians and procedural parity for child and adolescent psychiatrists
Support the formation of physician led treatment teams by promoting the use of
incident to billing for mental health professionals employed by child and adolescent
psychiatrists and pediatricians
Adoption of these strategies by payers and health plans will enhance the value of member
benefits coverage and increase access to necessary and effective out-patient mental health
services.
Enclosed please find the issue paper and background paper. For information on these
recommendations, please contact, Louis A. Terranova, MHA, Senior Health Policy
Analyst, AAP Department of Practice at lterranova@aap.org or 847/434-7633 or Kristin
Kroeger, AACAP Director of Clinical Practice, at kkroeger@aacap.org or 202/966-7300,
ext 108.
I look forward to your response for implementing these recommendations.
Sincerely,
David T. Tayloe, Jr, MD, FAAP
President, AAP
Robert Hendren, D.O.
President, AACAP
DTT/lt
Enclosures: – Improving Mental Health Services in Primary Care: Reducing
Administrative and Financial Barriers to Access and Collaboration
– Background - Improving Mental Health Services in Primary Care:
Reducing Administrative and Financial Barriers to Access and
Collaboration
References:
1
Karoly LA, Kilburn R, Cannon JS: Early Childhood Interventions: Proven Results,
Future Promise. Rand (2005) Available at: www.rand.org/pubs/monographs/MG341
2
Institute of Medicine. Preventing Mental, Emotional, and Behavioral Disorders Among
Young People: Progress and Possibilities (2009) Available at:
(http://www.iom.edu/CMS/12552/45572/64120.aspx).
3
Data on the Mental Health Benefit. Prepared by the NC Psychological Association from
data supplied by the NC State Health Plan Office. (April 1999)
4
Simpson GA, Cohen RA, Pastor PN, Reuben CA. U.S. Children 4-17 Years of Age Who
Received Treatment for Emotional or Behavioral Difficulties: Preliminary Data From the
2005 National Health Interview Survey. Atlanta, GA: National Center for Health
Statistics, Centers for Disease Control and Prevention; (2006). Available at:
www.cdc.gov/nchs/products/pubs/pubd/hestats/children2005/children2005.htm.
5
New Freedom Commission on Mental Health. Achieving the Promise: Transforming
Mental Health Care in American: Final Report, Rockville, MD: U.S. Department of
Health and Human Services: 2003. DHHS publication No. SNA-03-3832
6
National Business Group on Health; Consumer-Driven Health Care for Children: An
Employer’s Guide to Developing Child and Adolescent Benefits, Section Two, How to
Design Consumer Driven Health Plans, page 15 Available at:
http://www.businessgrouphealth.org/pdfs/cdhealthcare_children/section2.pdf