A Free Screening Tool Left Out of Medi-Cal Developmental Screening Policy

The first step in early intervention is early detection. Unfortunately, only 26% of California infants and toddlers receive a screening to detect developmental delays. The State has recently made several policy changes to increase this rate. Starting in 2020 a new policy allows Medi-Cal providers to receive an incentive payment for screening infants and toddlers. This is an important policy change that may increase the number of children who receive needed services.

To bill for developmental screening under this new policy, a provider must use a standardized screening tool that meets Centers for Medicare and Medicaid Services (CMS) and AAP criteria. However, the incentive payment policy references old Bright Futures guidance and a list of tools from 2006, instead of revised guidance from 2020. Importantly, it leaves out a newly recommended free developmental screening tool called The Survey of Well-being of Young Children (SWYC).

The SWYC is a relatively new tool. Evidence over the past 10 years has shown it to be as effective at detecting delays as more commonly used tools, like the Ages and Stages Questionnaire (ASQ:3). As a result, AAP has included the SWYC on its list of recommended tools for developmental screening. It also meets CMS criteria for being a reliable tool as outlined in the CMS Child Core Set Technical Manual.

Although providers should use whatever tool is best for their patients and practice, the SWYC has a few distinct advantages. First, it is free to use by both health care professionals and other child providers without licensing fees. Second, the SWYC can easily be integrated into the patient portals of many electronic medical records (EMR) at no additional cost. Third, the SWYC includes a measurement of family risk factors, (e.g., parental depression, conflict, substance abuse, and hunger) which could support a whole-family approach to care, and referrals into dyadic care like family therapy.

The developmental screening incentive payment will be available through the end of 2021 and will continue if there is sufficient General Fund revenue. At this time, it is unclear if providers would receive the supplemental payment if they screened a child using the SYWC. However, given that the cost of tool licensing is one of many barriers clinics face, allowing the use of SYWC is clearly an additional way DHCS could promote developmental screening for California kids.