CMS Needs To Do More To Improve Medicaid Children’s Utilization of Preventive Screening Services

In a 2010 report entitled Most Medicaid Children in Nine States Are Not Receiving All Required Preventive Screening Services, OEI-05-08-00520, OIG found that children enrolled in Medicaid were not receiving all required Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screenings. In addition, OIG also found that children who received medical screenings were not receiving complete medical screenings. The 2010 OIG report recommended improvements in both areas. This memorandum report describes the steps that CMS has taken since the OIG’s 2010 report to encourage children’s participation in EPSDT screenings and to ensure that providers deliver complete medical screenings.

We found that CMS has taken actions toward encouraging participation in EPSDT screenings and toward encouraging the delivery of all components of medical screenings, but that it has not fully addressed OIG’s recommendations. Further, we found that children’s participation in EPSDT medical screenings remained lower than established goals. Although the national participation ratio improved from 56 percent in 2006 to 63 percent in 2013, both ratios are below the Secretary’s goal of 80 percent participation.

Given the results of our review, OIG considers all four of the recommendations from the 2010 report to remain open. This report contains no new recommendations, but we reiterate the following recommendations from 2010: CMS should (1) require States to report vision and hearing screenings, (2) collaborate with States and providers to develop effective strategies to encourage beneficiary participation in EPSDT screenings, (3) collaborate with States and providers to develop education and incentives for providers to encourage complete medical screenings, and (4) identify and disseminate promising State practices for increasing children’s participation in EPSDT screenings and providers’ delivery of complete medical screenings.

To download the complete report, visit http://oig.hhs.gov/oei/reports/oei-05-13-00690.asp

CMS Efforts to Ensure Children Receive Developmental and Behavioral Screening

The Centers for Medicare and Medicaid (CMS) have several ongoing efforts to support and ensure developmental screening of young children.

Child Core Set Measure: Developmental Screening in the First Three Years of Life
Included in the CMS core set of children’s health care quality measures (Child Core Set) is Developmental Screening in the First Three Years of Life. This measure can be used to track how Medicaid and CHIP programs are performing in evaluating the growth and development of very young children. To help states collect and report data on this measure, CMS hosted a webinar in June 2013: Developmental Screening in the First Three Years of Life: Understanding How to Collect and Use the Child Core Set Measure.

State Reporting on the Developmental Screening Measure
Over the past three years there has been progress in state reporting on the Developmental Screening in the First Three Years of Life measure. The number of state Medicaid programs reporting according to the measure’s specifications increased from two states in Federal Fiscal Year (FFY) 2010 to 11 states in FFY 2012. Twelve states reported in FFY 2013, with seven states reporting the measure for both their Medicaid and CHIP populations. Six additional states indicated that they plan to report the measure in future years. To support states in collecting and reporting this measure, CMS provides technical assistance that can be requested via an email to MACqualityTA@cms.hhs.gov.

Developmental Screening in the CHIPRA Quality Demonstration Grants
In 2010, CMS launched its Children’s Quality Demonstration Grant Program with 10 grantees across 18 states. As part of its grant program, Pennsylvania is working with the Children’s Hospital of Philadelphia to improve the quality of care for children with developmental and behavioral needs in its Medicaid/CHIP programs and to leverage health information technology to maximize early identification of children with developmental and behavioral health concerns. Standardized screening tools were built into the electronic health record system and the system alerts provider staff to age appropriate screens at the time of a patient’s check-in.

The EPSDT Resource Compendium developed by the National Academy for State Health Policy (NASHP) with support from CMS includes state-specific efforts on developmental and behavioral screenings. NASHP’s website also includes a resource center for its Assuring Child Development (ABCD) III initiative, focused on developmental screening. A number of states participating in this initiative have collected and reported on the Child Core measure, Developmental Screening in the First Three Years of Life, described above.

National Baby Facts from Zero To Three, National Center for Infants, Toddlers, and Families

Nationally, almost half (48%) of children under age 3 live in low-income families (with an income less than 200% of the Federal Poverty Level (FPL)), including 25% that live in families in poverty (with an income less than 100% of the FPL). In a majority of states, at least one in four very young children lives in poverty. This fact shows the widespread lack of adequate resources needed for the healthy development of all infants and toddlers. Within the United States, Mississippi has the highest percentage of infants and toddlers living with families in poverty, at 35%.

Twenty-six percent of children under age five are at moderate or high risk for developmental or behavioral delays. Early Head Start (EHS), Child Care and Development Block Grant (CCDBG), and Early Intervention Part C are federal programs that support positive early learning experiences. Less than 4% of eligible infants and toddlers participate in EHS, leaving the majority of eligible infants and toddlers without access to this proven program. EHS plays an important role in children’s success in school, family self-sufficiency, and parental support of their child’s development. Thirty percent of children receiving child care subsidies funded by CCDBG are infants and toddlers. CCDBG, however, is able to serve only one in six eligible children. Three percent of infants and toddlers receive early intervention services under Part C of the Individuals with Disabilities Education Act.  For infants and toddlers with a disability or developmental delay, intervening early can serve as a protective buffer against multiple adverse influences that may hinder their development. Information on each state can be gathered from the 2013 State Baby Facts factsheets at, www.zerotothree.org/policy/statebabyfacts. The factsheets provide state information on infant and toddler health and positive early learning experiences for early childhood professionals and policymakers.