August 21, 2019
Many children with attention deficit disorder (ADHD or ADD) who are enrolled in Medicaid do not receive sufficient ADHD treatment, according to a newly released government report.1 The U.S. Department of Health and Human Services Office of Inspector General (OIG) analyzed the claims data for Medicaid-enrolled children who had been newly prescribed ADHD medication or hospitalized for ADHD over a two-year period, and found that more than half a million children did not receive timely follow-up care.
Medicaid treatment quality is evaluated through the Child Core Set, which recommends an initial follow-up visit within 30 days of a new ADHD medication prescription, as well as two additional visits between 31 and 300 days after receiving the prescription.
Of 873,833 children newly prescribed an ADHD medication during the review period, 59% (516,285 children) did not receive follow-up care within 30 days of prescription.
Of the 121,364 children subject to a 300-day analysis, 9% (11,410 children) did not receive any follow-up care within 300 days of being prescribed ADHD medication. 21% (26,081 children) did not receive two follow-up visits between days 31 and 300.
Though behavioral therapy is not included in the Child Core Set, it is an acknowledged component of effective treatment of ADHD in children. Of the children subject to a 300-day analysis, 45% (54,726 children) received no behavioral therapy during the 120 days prior to, and 300 days following, the new prescription. For the purposes OIG’s report, “behavioral therapy” included parent training and group or individual sessions conducted over time, through which parents can learn strategies to help their child manage ADHD behaviors.
After a child is hospitalized for mental illness, the Child Core Set recommends a follow-up visit within two days of hospitalization or no later than 30 days after hospitalization. Of 10,918 children reviewed for the report, 60% (6,560 children) did not receive follow-up care within 7 days of a hospitalization for ADHD. Of 10,521 children reviewed for a 30-day period, 35% (3,694 children) did not receive follow-up care. The number of children reviewed during the longer period is smaller due to hospital readmissions and lapses in Medicaid eligibility for some of the children reviewed in the 7-day period.
OIG reviewed Medicaid claims data from October 1, 2013 through September 30, 2015 from all 50 states and Washington, D.C., for children up to age 21 enrolled in Medicaid who had received a prescription for ADHD medication or a hospital admission with ADHD as the principal diagnosis during the review period. The 300-day analysis was restricted to new ADHD prescriptions between October 1, 2014, and December 4, 2014, to allow sufficient follow-up time.
OIG has recommended that the Centers for Medicare & Medicaid Services (CMS) address these shortcomings by working with partners to develop new strategies, providing technical assistance to states for the implementation of those strategies, and analysis of the effectiveness of these strategies. In a letter dated July 15, 2019, CMS concurred with these recommendations. It is estimated that nearly 5 million children enrolled in Medicaid are impacted by ADHD.
Sources
1 U.S. Department of Health and Human Services Office of Inspector General “Many Medicaid-Enrolled Children Who Were Treated for ADHD Did Not Receive Recommended Followup Care .” Washington, D.C. (August 2019). https://oig.hhs.gov/oei/reports/oei-07-17-00170.pdf