State Softens Stance On Screening For Children's Medical Services

Oct 19, 2015
Originally published on October 19, 2015 8:08 am

Under orders from an administrative law judge, the Department of Health on Friday held a hearing on a controversial new method of determining eligibility for Children's Medical Services -- and offered a compromise that could allow the department to resume enrolling special-needs kids.

"We're looking for common ground," DOH Chief Operating Officer Jennifer Tschetter said.

The compromise would consider medical professionals' opinions as part of the screening process. The department halted that process last month after Judge Darren Schwartz of the Division of Administrative Hearings ordered the department to "immediately cease" using the new screening tool, which relied solely on parents' answers to a five-question survey.

And at a legislative hearing earlier this month, several members of the Senate Health and Human Services Appropriations Subcommittee complained to Tschetter of constituents whose children had lost CMS services.

Since May, when the new screening tool went into effect, roughly 9,000 kids have been dropped from Children's Medical Services, which serves youngsters with "serious and chronic" conditions.

DOH officials say the screened-out kids aren't without their services, but have instead gone into Medicaid managed-care plans.

However, several physicians at the hearing Friday said they believe CMS provides better care to special-needs kids than Medicaid managed-care plans.

The new eligibility tool has drawn criticism from parents, doctors and lawmakers on the grounds that many parents did not understand the questions they were asked during the screening process, yet their children lost services as a result of their answers.

For instance, the Public Interest Law Center at Florida State University's College of Law brought the challenge to the screening process on behalf of several families of children who were denied CMS services.

One of their clients has an aortic valve disorder, said Justin Karp, one of the law students working on the case. Others include a legally blind boy, who has had six eye surgeries since age three, and his sister, who is at risk for a detached retina.

"These are children whose conditions were deemed not to be serious, using that ... screening tool," Karp told the DOH officials at the Friday hearing.

And while DOH has options for parents to request a re-screening for their children, Amy Guinan of Florida Legal Services said few of them were aware of it.

"We are concerned that it wasn't truly communicated to these families," Guinan said.

The administrative challenge to the screening process, filed in June, sought the reinstatement of all children in the CMS network until the department put the new eligibility-screening tool through a standard rule-making process. The hearing Friday is part of that process.

Following the judges' ruling, the department has been on what Tschetter called a "pause" in enrollment, and what her frequent critic, pediatric cardiologist Louis St. Petery, called a "moratorium."

St. Petery and others say the Department of Health should temporarily use its previous screening tool so that kids with HIV and other conditions requiring immediate services will get them.

Tschetter, however, has maintained that the department doesn't have that option, since the previous screening tool also wasn't adopted through formal rule-making procedures.

"We can't just go back," she said Friday.

She also brushed aside suggestions that the department consider an emergency rule or a negotiated rule-making, saying DOH lawyers were all opposed.

But the department had moved to revise the proposed CMS rule before Friday's hearing. When the participants arrived, they received new language allowing physicians to attest to a child's eligibility for the CMS network, along with a list of conditions that would make them eligible.

Physicians are the hearing were still concerned about conditions that were left off the so-called "attestation list," including sickle-cell anemia.

DOH officials agreed to accept written comments until Oct. 30 before moving forward with the rule-making process, which is expected to wrap up by the end of the year.

"We'll be transparent about our decision-making, and be willing to listen to others as they have comments on what our final work product is," Tschetter said. "So not only have we agreed that clinicians should have input. ... We remain open to new ideas, especially when they're about doing the right thing for children with special health-care needs."

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