Bill Would Improve MH Care to Children Under Managed Care

APA and the American Academy of Child and Adolescent Psychiatry (AACAP) applauded new legislation introduced last month in Congress that will ensure that the unique health care needs of children and adolescents are protected within managed care plans.

APA President Herbert S. Sacks, M.D., and AACAP President David Pruitt, M.D., voiced their support for the Children's Health Insurance Accountability Act in a letter last month to Senator Jack Reed (D-R.I.), who sponsored the bill with Senators Edward Kennedy (D-Mass.) and Patty Murray (D-Wash.)

"In particular, we support requirements that protect patients enrolled in managed care from inappropriate limitations on access to medically necessary health care," according to the March 19 letter.

Reed introduced the bill to establish a set of managed care standards that are specific and unique to children to improve areas of access, appeals, accountability, and consumer information, according to a statement from Reed's office.

The legislation mirrors the recent proposal of President Clinton's Advisory Commission on Consumer Protection and Quality in the Health Care Industry that would provide people enrolled in managed care plans greater protections and more control over their health care.

APA and the AACAP support the following principles in Reed's legislation:

• Access to all medically necessary treatment by physicians, especially specialty care providers with training in child and adolescent medicine and psychiatry.


• Access to emergency care services for children.


• Procedures for the provision of services to children with special health care needs.


• Appeals and grievance mechanisms and disclosure of health information.


• Continuous quality improvement and utilization review.


• Studies on children's health needs and outcomes, particularly children's access to mental health services.

"You should know how deeply concerned we are about the inappropriate denial of medically necessary services by health plans," added Sacks and Pruitt in the letter. "We hope this will be addressed by eliminating the ERISA preemption authority to deny patients and their families damages for injuries suffered."

The bill was referred to the Senate Labor and Human Resources Committee, whose members include Reed, Kennedy, and Murray, in anticipation of a comprehensive managed care bill being reviewed by the committee this spring.