Essential Contractual Language for Medical Necessity in Children

Author:

,Long Thomas F.,Helm Mark,Hudak Mark L.,Racine Andrew D.,Shenkin Budd,Snider Iris Grace,White Patience Haydock,Harbaugh Norman Chip,Droge Molly

Abstract

The previous policy statement from the American Academy of Pediatrics, “Model Language for Medical Necessity in Children,” was published in July 2005. Since that time, there have been new and emerging delivery and payment models. The relationship established between health care providers and health plans should promote arrangements that are beneficial to all who are affected by these contractual arrangements. Pediatricians play an important role in ensuring that the needs of children are addressed in these emerging systems. It is important to recognize that health care plans designed for adults may not meet the needs of children. Language in health care contracts should reflect the health care needs of children and families. Informed pediatricians can make a difference in the care of children and influence the role of primary care physicians in the new paradigms. This policy highlights many of the important elements pediatricians should assess as providers develop a role in emerging care models.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Reference5 articles.

1. Model contractual language for medical necessity for children.;American Academy of Pediatrics Committee on Child Health Financing;Pediatrics,2005

2. Classifying recommendations for clinical practice guidelines.;American Academy of Pediatrics Steering Committee on Quality Improvement and Management;Pediatrics,2004

3. Toward transparent clinical policies.;Shiffman;Pediatrics,2008

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