Parity and Access for Child and Adolescent Mental Health Care

Approved by Council, June 2003
To be reviewed

Despite the dramatic advances in scientific knowledge regarding childhood mental illnesses and their treatment over the past 20 years, only a small fraction of children suffering from mental illnesses receive treatment. Our health system fails to provide the most basic mental health services to those children in need. The Surgeon General has declared this a public health crisis1. The AACAP strongly supports the principle that needed mental health treatment services must be available to all children. The AACAP is committed to the elimination of all barriers that prevent children from having access to these services.

Access to care: The lack of availability of mental health professionals for children and adolescents with illnesses is a major barrier. Often parents are given a list of network clinicians attached to their Managed Care Organization (MCO). Specialized professionals and services listed for youth are too often not available, or outdated.

Parity: The AACAP calls for the end of discriminatory insurance policies regarding mental illness, compared with physical illness, that limit access and perpetuate sigma. Discrimination includes contractual limits on psychiatric outpatient visits and inpatient days, higher co-payments/deductibles, and annual and lifetime benefit limits. These limitations create financial burdens and barriers to treatment for patients and families.

The AACAP supports federal and state parity legislation that provide patients and families with access to the full range of appropriate evaluation and treatment services. Treatment must be obtained without financial penalties, hardship or stigma. We recommend:

  • offering and authorizing an adequate assessment and treatment consistent with professionally recognized practice parameters and current standards of care for psychiatric illnesses,
  • maintaining a network of qualified, available and licensed children’s mental health professionals, including sufficient child and adolescent psychiatrists; with strategies to ensure that there are both recruitment and retention of these professionals,
  • supporting the participation of families in the assessment and treatment process, by covering family contact services (i.e. 90846, 901847, 90887 CPT codes),
  • ensuring that funding for communication and collaboration between mental health providers and other caregivers is authorized. When treatment involves other systems of care, a seamless transition of care and funding must occur, (school, juvenile justice, child welfare agency, etc),
  • prohibiting procedures that arbitrarily reduce the time and reimbursement for assessment and treatment for children’s mental health service. If care is denied, appeals must be handled by a board certified child and adolescent psychiatrist (please refer to the AACAP policy statement on utilizations management), and
  • providing parity for all psychiatric and substance abuse disorders of children and adolescents.