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.
In 2010, a report from the Office of Inspector General (OIG) was released detailing findings of children enrolled in Medicaid who were not receiving all required Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screenings, nor were they receiving complete medical screening. Based on four recommendations from OIG, the Centers for Medicare and Medicaid Services (CMS) has taken steps towards encouraging children's participation in these screenings and ensuring proper medical screenings.
Through interviews with the CMS staff, representatives of workgroups relating to EPSDT issues, and reviewing States' reports on EPSDT participation, CMS found that since 2010, action has been taken to address the recommendations laid out by OIG, but they have not fully addressed each problem area. While children's participation in EPSDT screenings have increased from 56 percent in 2006 to 63 percent in 2013, these are still below the Secretary's 80 percent participation goal. Based on these findings, OIG believes all four of the same 2010 recommendations from the report need to stay open.
The Centers for Medicare and Medicaid (CMS) have several ongoing efforts to support and ensure developmental screening of young children.
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.
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.
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.
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.
The Help Me Grow National Center recently created a document that outlined main core components and structural requirements for the Help Me Grow System. The Help Me Grow system is a way that connects children at-risk for developmental and behavioral problems with services they need. It builds on simple pre-existing resources and solutions that are effective for children and their families. Through ongoing analysis and data, barriers of information system can be identified.
The Help Me Grow system is divided into four core components and three structure requirements that easily outline the aspects of the system. The four core components include, child health care provider outreach, community outreach, centralized telephone access, and data collection. Child health care providers are included in this list since they are the ones who identify children at risk for developmental delay and work with families to analyze children's developmental status. Community outreach encourages the outside community to form participation in the Help Me Grow system and markets these services. It also allows easier accessibility to information and resource to ensure that all information is up-to-date. Centralized telephone access connects children and families to services and care coordination centers. This service provides a direct access point to information and identifying needs of families and care providers. Lastly, data collection allows people to understand all aspects of the Help Me Grow through analysis of information and identification of gaps and barriers.
The three structural requirements are organizing entity, statewide expansion, and continuous quality improvement. The organizing entity allows for administrative and fiscal oversight and helps identify partners into leadership that will help guide Help Me Grow. Statewide expansion requires states to have a statewide vision of Help Me Grow in order to facilitate its success. The third structural requirement, continuous quality improvement, analyzes successes and limitations in these programs as more information is understood through this system.
To learn more about the Help Me Grow system and these core components and structural requirements visit www.helpmegrownational.org. Detailed information for each outlined point is also provided.
A new report was released by the Association of Maternal and Child Health Program on "State Strategies and Initiatives to Improve Developmental and Autism Screening, and Early Identification System." This report discusses the various screening activities that occur throughout the US and territories to identify children with autism spectrum disorder and other developmental disabilities.
The outcomes of this report identified common strategies and areas of improvement for state systems. It is AMCHP's hope to eventually be able to provide program suggestions to states so that they may be able to improve in the early identification screening efforts.