Children living in rural areas who are enrolled in the Medicaid State Plan in Florida are being denied access to necessary health care services due to not possessing the required comprehensive diagnostic evaluations (CDE) required to qualify for such services. The Bay County area, as an example, does not have a diagnosing physician within a 100 mile radius of Panama City, where most residents reside. These CDEs are a prerequisite for accessing other medically necessary services, such as behavior analysis and mental health services. There are several variables preventing children with disabilities from getting the healthcare services they need, such as:

·         lack of providers resulting in excessively long waitlists;

·         low reimbursement rates through Medicaid resulting in high out of pocket costs for low income families; and

·         general lack of provider training on how to conduct CDEs

 

The lack of Medicaid-approved providers (i.e., pediatricians, neurologists, psychologists, psychiatrists) who meet criteria to conduct CDEs has resulted in a major network deficiency. The current CDE providers have waitlists averaging 6-8 months for the initial screening appointment. Potential solutions could be enrolling more providers in the Florida Medicaid program to expand the network. The Agency for Healthcare Administration (AHCA) could engage in dissemination efforts similar to other states to raise awareness of the need and provide training to qualifying providers on the CDE requirements. More eligible providers will allow children to be served in a timely manner.

 

Currently, many physicians enrolled in the Medicaid program have opted out of conducting CDEs expressively due to low reimbursement rates compared to the extensive time it takes to complete a thorough evaluation of a patient using evidence-based and empirically validated tools. Examples of these diagnostic tests include Autism Diagnostic Observation Schedule (ADOS-2), The Childhood Autism Rating Scale – 2nd Edition (CARS2), Communication and Symbolic Behavior Scales (CSBS), and Battelle Developmental Inventory—2nd Edition.  This has resulted in few options for low-income families receiving Medicaid benefits. Currently, the only option in many of these areas is to privately pay for CDEs which can cost thousands of dollars.

 

Many diagnosing physicians provide families with clinical notes as evidence of the specified diagnosis and seem to have resorted to using screening tools to support the diagnosis in place of CDEs. It has become evident that many physicians who are qualified by the State Medicaid program to issue CDEs, do not understand the criteria that is expected to be met.

We propose the following solutions for individuals that are facing these barriers:

·         State hosted workshops/trainings to teach providers how to conduct appropriate and thorough screenings

·         Reimbursement rates suitable to the time, skills, training and intensity required to provide a CDE

·         Acceptance of alternative documentation to demonstrate a diagnosis of autism spectrum disorder or related diagnoses such as an Individualized Education Plan (IEP) or office notes/visit notes from MD until a date at which time a more formal CDE can be obtained

·         Incentive programs for pediatricians, specialists, psychiatrists to enroll as a Medicaid provider in rural areas

 

If you agree that change needs to be made so that all individuals in need of medically necessary services requiring a CDE, such as behavior analysis services, are able to have access to the care they need and deserve, please sign the petition below.