Policy

Overview

The TeenScreen National Center operates an active federal and state policy effort to encourage the adoption of promising approaches to the early identification of mental illness by working closely with government and advocates, supporting demonstration projects, and collaborating with expert panels. The TeenScreen National Center serves as a resource for members of Congress and their staff, state legislators, federal agencies, state health and Medicaid commissioners, and state suicide prevention offices. Read about a 2010 Capitol Hill Briefing led by the TeenScreen National Center.

Science to Service

Since the mid-1990s, Columbia University has been at the forefront of new research on the effectiveness of mental health screening. In 2009, the strength of the evidence was recognized by an Institute of Medicine Report calling for the early identification and prevention of mental illness in youth. Soon after, the U.S. Preventive Services Task Force (USPSTF) recommended annual screening for depression for all adolescents ages 12 to 18 when systems are in place to ensure accurate diagnosis and follow-up. The TeenScreen National Center is working with policymakers, administrators and health plans to develop best practices to implement these recommendations and guidelines.
Read more.

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008

Signed into law in 2008, MHPAEA provides federal parity protections to ensure that mental health and substance use disorder benefits offered by employer health plans are on par with medical and surgical benefits. View the legislation. These protections build on the 1996 federal parity law, which prohibited discriminatory annual and lifetime benefit limits for employers’ plans offering mental health coverage.

Once MHPAEA was signed into law by President George W. Bush, the Departments of Treasury, Labor and Health and Human Services were tasked with issuing regulatory guidance to implement the law. Interim final regulations that clarify how the parity protections apply were issued on February 2, 2010 and are available here. These regulations provide strong consumer protections; parity is now required for both quantitative (e.g., copays, deductibles, visit limits) and non-quantitative (e.g., gatekeeper requirements, medical management) treatment limitations. For example, limitations on the number of outpatient mental health visits are prohibited, unless there are similar limitations on the number of outpatient medical/surgical visits.

The MHPAEA protections passed in 2008 applied only to employee health plans covering 51 or more employees. The Patient Protection and Affordable Care Act of 2010, often referred to as the Affordable Care Act (ACA), expanded MPHAEA’s parity protections to new types of plans. Consequently, parity protections will extend to individual and small group plans offered in the Exchange - a new marketplace for insurance created by the ACA, as well as to adult Medicaid managed care plans and coverage offered through the Children’s Health Insurance Program (CHIP). Read more details.

In order to ensure effective parity protections, consumers must understand and help monitor implementation of the law. Analysis of state-level mental health parity protections in New York found that many consumers and even health plan employees are unaware of the state benefit protections. See the full report here. Monitoring implementation of the federal law will be equally important. For resources to help you understand and monitor how federal mental health parity protections apply in your own health plan, visit: http://www.mentalhealthparitywatch.org/Understanding%20the%20Law/Pages/UnderstandingtheLaw.aspx (Parity Implementation Coalition site).

Health Care Reform

The federal health care reform bills that were signed into law in 2010 will expand access to care; provide new consumer protections for privately purchased health care; and spur innovation in health care payment, quality and delivery practices. The law also will extend mental health parity protections to new groups of covered individuals, and it will directly affect mental health screening by mandating access to certain preventive services at no cost. Read more.

Preventive Services Covered under the Affordable Care Act – New resources on www.heathcare.gov explain the importance of preventive care and list the recommended preventive services to be offered without cost-sharing under the health care reform law.

Medicaid

The annual well-child checkup covered by Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit requires that an adolescent mental health assessment be offered during the visit. Evidence suggests that few states require mental health checkups as a regular part of the covered well-child visit. The TeenScreen National Center offers policy options at the Federal level to improve state practice. Read more.

Massachusetts as a Case Study: Among U.S. states, Massachusetts has some of the most comprehensive requirements for the inclusion of mental health screenings in EPSDT primary care visits. Other states can use this experience as a model for expanded mental health screenings through EPSDT. See fact sheet.

Rosie D. and Mental Health Screening – For an in-depth description of Massachusetts’ effort to implement mental health screening at well-child visits in their Medicaid program, please read Rosie D. and Mental Health Screening: A Case Study of Providing Mental Health Screening at the Medicaid EPSDT Visit. Summaries of key insights learned from the Massachusetts experience are available for both policymakers and health plan leadership. See our Brief for PolicyMakers and Brief for Program and Plan Directors.

Quality

As the experience in the Medicaid program demonstrates, defining mental health screening as a covered benefit is not always sufficient to ensure that it is provided in clinical practice. Quality measures, such as those proposed by the Children’s Health Insurance Program Reauthorization (CHIPRA) legislation, can help to improve both recognition of the need to provide this service and the rate at which it is offered. Read more.

Fact Sheets

Fact sheets are available on a variety of policy-related topics in our Policy Digital Library.

Federal and State Suicide Prevention Programs

The TeenScreen National Center informed the design of the nation’s first national suicide prevention legislation, the Garrett Lee Smith Memorial Act. Local TeenScreen sites are helping to implement federal suicide prevention efforts. At the state level, 44 states have suicide prevention plans in place that mention screening as a key method of early identification and prevention. Nine of these states specifically endorse the use of local TeenScreen programs in: New York, Florida, Iowa, Nebraska, New Mexico, Oregon, Vermont, Delaware and Montana.

TeenScreen and the Garrett Lee Smith Memorial Act. Read more.
State Suicide Prevention Programs. Read more.

Policy Partners

Seven of the nation’s leading mental health organizations, and more than 20 professional groups, endorse mental health checkups for every young American. Read more.

Policy Events

Use the links below to read about policy related events led by the TeenScreen National Center:

What You Can Do

Health providers, policymakers, school professionals, parents and other members of the community can support mental health checkups for youth. Opportunities to educate lawmakers and members of the community to build support, as well as resources to start screening in your community are available. Read more.