Millions of children in California do not receive the preventive health services they are entitled to under federal law. With new data reporting requirements in place, however, California’s administrators and policymakers will be better equipped to develop strategies that increase uptake of these services.
California has not historically reported on infant and toddler access to specific services like developmental screening and well-child visits. Instead, advocates and policymakers have relied on estimates and anecdotes to understand these rates.
A bit of background: The main data set at the federal level on children’s health care quality is the Child Core Set from the Centers for Medicare and Medicaid Services (CMS). Originally created in 2009 to encourage uniform reporting across states, the Child Core Set and the Adult Core Set provide performance data on health quality measures. In 2018, Congress mandated that states report on all Child Core Set measures by 2024. Until then, participation is voluntary.
At the state level, California collects data on children’s health through the Medi-Cal Managed Care Accountability Set (MCAS). The MCAS is a set of performance measures that the Department of Health Care Services (DHCS) selects for Medi-Cal managed care plan annual reporting. On certain measures, DHCS holds plans to a minimum performance level. All measures in the MCAS come from the Adult and Child Core Sets.
California’s reporting on both of these data sets included notable additions in 2020. For the first time, California’s Child Core Set data included the rate of children screened for developmental delays at key intervals (22%), as reported by health plans. When available, 2020 MCAS reporting will also include this measure, though plans will not be held to a minimum performance level on it. This reporting will help policymakers and advocates, who previously relied on estimates from surveys for information about screening. In addition, 2020 MCAS reporting will include the rate of well-child visits in the first 15 months of life, an important measure for understanding how often infants and toddlers are accessing care.
Well-child visits in the first 15 months of life and many other Core Set and MCAS indicators are HEDIS (Healthcare Effectiveness Data and Information Set) measures. HEDIS measures are standardized performance indicators designed by the National Committee for Quality Assurance (NCQA) to measure, report, and compare quality across health plans. The NCAQ is modifying the well-child visit measure recently added in California and starting in 2021 plans will report two rates: children 15 months of age with six or more well-child visits and children 30 months of age with two or more well-child visits in the last 15 months (new). Plans will need to meet minimal performance levels for both rates.
Even though 2020 represents the first year of required reporting on well-child visits in the first 15 months of life, 2020 data comes with some caveats. Because of travel restrictions and quarantines related to the pandemic this year, DHCS is allowing plans to be flexible in their reporting of MCAS measures. In addition, plans will not be held to minimum performance levels or subject to sanctions or corrective action plans for measures requiring chart reviews, such as well-child visits and immunization rates. Given this flexibility, the first year of infant and toddler well-child reporting will likely not be useful--but will certainly be helpful in future years.
The Core Set and MCAS updates will provide more information on infant and toddler well-child visits and developmental screening than has been available in the past. Monitoring these two indicators is crucial given mounting evidence of children’s inadequate health care access and the ongoing negative impact of the pandemic on pediatrics. Better data about children’s health will help policymakers and administrators to focus on problems more precisely, and address them more effectively.
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