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Report (OEI-05-13-00690)

11-12-2014
CMS Needs To Do More To Improve Medicaid Children's Utilization of Preventive Screening Services

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Summary

WHY WE DID THIS STUDY

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. CMS concurred, or partially concurred, with the recommendations. 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.

HOW WE DID THIS STUDY

We conducted structured interviews with the CMS staff responsible for EPSDT and four representatives from a national workgroup that CMS created to address EPSDT issues. We also reviewed documents provided by CMS or workgroup representatives, including informational bulletins, strategy guides, Web seminars, and workgroup reports. In addition, we reviewed States' reports on EPSDT participation from 2006-2013, as well as the national aggregate reports for those same years.

WHAT WE FOUND

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.

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