VI. Special Provisions for Youth with Serious and Complex Behavioral Health Needs

An issue emphasized by stakeholders throughout the Tracking Project’s activities is the need for managed care systems to incorporate special services, arrangements, or provisions for children and adolescents with serious and complex behavioral health needs and their families. High-need populations include children and adolescents with serious emotional disorders, children and adolescents involved with the child welfare system, and children and adolescents involved with the juvenile justice system. Many barriers to serving these high-need populations were identified through the impact analyses, including: • Medical necessity and other clinical decision making criteria are rigid or applied too stringently making it difficult for children with serious and complex needs to obtain authorization for services. • MCOs often do not participate in local interagency service planning processes for children with serious and complex needs. • Managed care systems may include unintended financial incentives to underserve consumers with the most serious (and potentially most expensive) service needs. • The tendency within managed care systems to emphasize short-term treatment, which may not be appropriate or sufficient for high utilizer populations with serious disorders. • The lack of understanding of the special legal, logistical, coordination, and treatment needs of children involved in other child-serving systems.