Children’s Health Program To Resume Enrollment Next Month
December 31, 2015
Under fire in the media and the state Senate, the Florida Department of Health took another step toward accepting children into a program that serves kids with “chronic and serious” medical conditions.
After a hearing on a proposed rule to determine which youngsters will be eligible for the Children’s Medical Services Network, Department of Health officials said they were on track to reopen the program to new enrollees next month.
“We could be again screening in early January,” said Jennifer Tschetter, the department’s chief operating officer.
The Department of Health has faced criticism after 9,000 special-needs kids were dropped from Children’s Medical Services between May and September. Critics blamed the use of a controversial screening tool to determine whether the children were eligible for services. The issue has drawn heavy attention this week because of investigative reporting by the Miami Herald.
An administrative law judge ruled in September that the Department of Health could not use the screening tool without adopting it through a formal rule-making process. Since then, new enrollments in Children’s Medical Services have been on hold pending the rule-making process now under way.
The hearing was aimed at adopting a screening tool that would address some of the criticism.
“We are delighted that they are moving forward with a process that will allow children to be screened and have access to the services at (the Children’s Medical Services Network), and we are delighted that they are moving very quickly with that,” said Laura Brennaman, policy and research director for the advocacy group Florida CHAIN.
The department also has agreed to revisit the proposed rule three months after it goes into effect.
Department of Health officials say the current screening tool was based on the legislative intent behind a 2012 law that changed Children’s Medical Services from a fee-for-service plan, based on a child’s needs, to a specialty managed-care plan that involves the department providing care coordination.
The screening tool, which has been in effect since May, relies solely on parents’ responses to a five-question survey. Pediatricians and lawmakers have criticized the approach on the grounds that many parents did not understand the questions they were being asked, yet their children lost vital services as a result of their answers.
Senate President Andy Gardiner, R-Orlando, and some senators have watched the process warily.
In October, members of the Senate Health and Human Services Appropriations Subcommittee said they’d had calls from constituents — “in tears,” in the words of Sen. Aaron Bean, R-Fernandina Beach — over their special-needs kids being dropped from Children’s Medical Services.
Gardiner told The News Service of Florida that he might consider legislative changes to the program, depending on the options available to families whose children need the specialized care.
“Is it being communicated to them that there are other options where services are not reduced?” Gardiner asked. “If people are being told they’re no longer eligible for services, what are they being offered? Is it just, ‘Hey, we’re no longer serving you’ — or is it, ‘Here’s the other program that we’re recommending you move into?’ That’s what we’re trying to figure out.”
Department of Health officials say the kids who left the program obtained services through other managed-care plans “with the same level of service agreement as the CMS Plan, or other Medicaid programs” — but critics have contended that other managed-care plans can’t provide the same quality of service that Children’s Medical Services does.
“So much of it is communication, but there may be some policy decisions, too, that we need to look at,” Gardiner said.
Agency officials say the proposed rule would ensure that all Medicaid-eligible children with special health care needs are given the option to enroll in the Children’s Medical Services Network. It’s a dual approach to eligibility screening that would consider medical professionals’ opinions as well as parents’ responses to a five-question survey.
Additionally, the department has worked with the Children’s Medical Services regional medical directors to create a revised list of diagnosed conditions that would allow physicians to attest to children’s eligibility for the program.
For instance, Tschetter said, sickle cell anemia and certain cardiac conditions have been added to the list of diagnoses that would qualify a child for Children’s Medical Services.
Pediatricians and advocates like Brennaman still have qualms about the list of diagnoses in the proposed rule, but are banking on the department’s agreement to reopen the process down the line.
“We’re delighted that they’ve already agreed to revisit the rule in three months — and that will happen while children are being allowed to enter the system,” Brennaman said. “So we can take a more deliberate approach at that time to ensure that the final rule comes out right for all of Florida’s children.”
Meanwhile, with CMS enrollment temporarily closed, the state Agency for Health Care Administration has been accepting the sickest children into managed-care plans. Additionally, new enrollments for October, November and December include kids who were screened and found eligible prior to the judge’s ruling in September, were then screened by AHCA and ultimately chose Children’s Medical Services for their care.
Gov. Rick Scott, who has recently made a mission of fighting “price-gouging” at Florida hospitals, said that services for fragile children have not been disrupted.
“There will be absolutely no interruption in service,” he told reporters. “What AHCA has been doing, I think, is good for those that need service in our state. But I can tell you there will be absolutely no interruption in service.”
by Margie Menzel, The News Service of Florida