Senate Panel Wants Answers From DOH On Children's Health Programs

A Florida Senate panel on Wednesday demanded answers from a state Department of Health official about how many special-needs children have recently lost services as the state transitions to a new Medicaid system --- and why.

Several 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 losing critical health-care services for their children.

They asked DOH Chief Operating Officer Jennifer Tschetter how youngsters are faring in Children's Medical Services, which serves kids with "serious and chronic" conditions, and Early Steps, which serves babies and toddlers with developmental disabilities or delays.

In February, blaming a budget shortfall, the Department of Health cut 13 full-time positions from the Early Steps central program office, which was most of the staff. In June, led by Senate Health and Human Services Appropriations Chairman Rene Garcia, R-Hialeah, and Senate President Andy Gardiner, R-Orlando, lawmakers agreed to pour $13 million into the program.

Now, Tschetter said, the Department of Health "is confident about its ability to stay within its appropriation this year for the Early Steps program."

But lawmakers pressed Tschetter for details about how the program was doing beyond administrative matters like managing contracts and determining eligibility.

"I've enjoyed all the technical information that you have shared, but at the root of all this is the children," Sen. Lizbeth Benacquisto, R-Fort Myers, told Tschetter. "And if at some point in your presentation, you could tell us about outcomes and how the kids are doing, now that they have increased access to the program --- what's working well, what needs some more tweaking --- because we invest this much money through the leadership of the chairman. We do this because these children need assistance, so I'd like to know how they're doing."

Meanwhile, the Children's Medical Services Network remains mired in controversy, stemming from the state's transition to Medicaid managed care last year. Under the new system, state officials hope to whittle the CMS program's rolls down to children with the most serious problems.

Children's health advocates contend that DOH has used a new eligibility-screening tool to deliberately screen kids out of the program and into less-expensive managed-care plans.

Thousands of kids have been screened out of the CMS Network since May, although Tschetter did not know how many.

Pediatric cardiologist Louis St. Petery, a frequent critic of DOH, said the department's presentation to the committee showed that roughly 9,000 children had been screened out of the Children's Medical Services Network --- from an enrollment of 64,089 in mid-May to 55,506 in mid-September.

Meanwhile, no children have been admitted to the CMS Network since Sept. 22, when an administrative law judge ordered the Department of Health to "immediately cease" using the new eligibility-screening tool, since it was not adopted through formal rule-making procedures.

The administrative challenge to the screening process, filed in June, sought the reinstatement of all children in the network until the department put the new eligibility-screening tool through a standard rule-making process, with public comment.

DOH has scheduled a rule-making hearing for Oct. 16, Tschetter said. Meanwhile, though, the department hasn't been using its previous screening tool to enroll children, since that tool wasn't adopted by rule, either.

"So these kids who need services are not getting services?" asked Sen. Eleanor Sobel, D-Hollywood.

"No Medicaid-eligible child goes without services," Tschetter replied. "All of the managed-care plans ... have the same contractual requirements."

Sobel said she'd gotten calls from constituents whose children lost access to occupational therapy and other services when they were switched from the CMS Network to a managed-care plan.

Garcia asked Tschetter for a list of all the children who had been screened out. And Sen. Chris Smith, D-Ft. Lauderdale, asked for a list of all the conditions for which the children had been deemed ineligible.

Sobel also wanted to know why DOH hadn't sought the advice of doctors and nurses in creating the disputed screening tool, which involves a series of questions that parents were asked about their children's medical conditions.

Tschetter said the screening tool had been developed "in consultation with national experts and medical experts."

After the committee meeting, Garcia said he was "somewhat" surprised to learn that the Department of Health had stopped enrolling children in the CMS Network pending the rules challenge.

He noted that all the members of his committee were engaged in the discussion.

"And we're not going to stop until we fix the problem with CMS," he said.

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