Pathways Recommendation

Ensure that health insurance covers children’s mental health, including: 1) Language allowing use of and payment based on a diagnostic system that reflects the developmental needs of young children (the DC:0-5, rather than the DSM-5) and professional development for practitioners in the use of that system, 2) Language allowing the use of non-specific diagnosis codes for at least six initial visits when a diagnosis is uncertain, or when there are functional issues without a diagnosis, 3) A definition of “medically necessary services” to include prevention, diagnosis and treatment of infant and early childhood mental health concerns and conditions, and 4) A requirement for evidence-based approaches appropriate for infants, toddlers, and their families, such as treating families and young children together and delivering infant and early childhood mental health services in primary care settings and home visits.

Pathways Action Map > Expectation 4: Social-Emotional Health Action 4.10: Address Barriers in Health Insurance Coverage of Infant and Early Childhood Mental Health Services to Ensure Adequate Benefits

Why This Matters

Various aspects of health insurance coverage for young children in North Carolina currently limits their access to mental health services. Specific revisions to language, coding, definitions, and requirements will help to remove barriers, improve service delivery, and ensure that the children who are in most need of mental health services can receive them during their most critical years of development.

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