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State draws scrutiny for decision to keep thousands of children out of health program

Pediatric cardiologist Louis St. Petery battles for standards.
Pediatric cardiologist Louis St. Petery battles for standards.
Published Oct. 11, 2015

Florida lawmakers are starting to ask questions about continuing allegations that state officials are dismantling a health program for thousands of sick and disabled children.

At issue: the new tool used to determine eligibility for the Children's Medical Services program, which manages medical care for about 70,000 low-income kids with serious and chronic conditions. Since the screening tool was introduced in May, about 9,000 children have been dropped from the plan, state records show.

The Florida Department of Health's Chief Operating Officer Jennifer Tschetter has said the changes were necessary to "ensure that only children with chronic and serious health conditions were part of the (program)" in light of concerns about its $826 million budget.

But a group of physicians allege the overhaul has hurt some of the state's most vulnerable kids.

"They dumped them on the regular Medicaid Managed Care program, which is ill-equipped to take care of them," said Dr. Louis St. Petery, a pediatric cardiologist who practices in Tallahassee. "That's unfair to the kids and the families."

A health department workshop on the screening tool is scheduled for Friday in Tallahassee.

Lawmakers are already demanding answers. Last week, Tschetter was called to testify before the Senate Health and Human Services Appropriations Subcommittee.

Sen. Chris Smith, D-Fort Lauderdale, said lawmakers were "starting to hear from constituents and others about kids falling through the cracks."

Sen. Aaron Bean, R-Fernandina Beach, said he had sat down with several parents and physicians, "some of whom were in tears over the changes and how they are coming about."

Tschetter said the kids who had been moved into Medicaid plans were receiving comparable care.

Unlike the old screening tool, which relied on input from clinicians, the new tool is a parent survey. The health department says it is based on a "nationally recognized model," and was developed from a work group that included national experts.

The department began using the survey to screen candidates for the program on May 4. The tool was also used to determine if children who were already in the program would remain eligible.

The changes caught the attention of the program's regional medical directors, more than a dozen of whom sent a letter to Deputy Secretary of Health Celeste Philip saying there had been "a significant decrease in access to care for these vulnerable children."

"We are concerned that Florida CMS no longer provides the high quality care it once did," they wrote.

In June, the families of four children who had been dropped from the program filed a legal challenge, saying the new tool had not gone through the state's formal rule-making procedure.

Though the state argued it was exempt from rule-making — and pointed out that previous tools had not gone through the process — Administrative Law Judge Darren Schwartz sided with the families. He ordered the department to stop using the new screening tool in late September.

But now the state says it won't be able to enroll new children in the Children's Medical Services program until it formally adopts a screening tool. The process will begin with Friday's hearing.

Other changes to CMS may also be under way. The state is considering eliminating a separate rule that requires pediatric cardiac facilities to comply with certain standards, and will hold a hearing on the issue Monday .

The state says the rule "extends beyond the (health) department's statutory authority." But St. Petery called it "the gold standard nationwide," and said Florida had become "very famous for having such an outstanding kids cardiac program for poor kids."

State health officials have tried to assuage concerns by creating a Children's Medical Services advisory panel made up of four physicians, a registered nurse, health care executive and parent. The department also recently announced that CMS had earned full national accreditation from the Accreditation Association for Ambulatory Health Care.

In her Senate appearance last week, Tschetter called the approval of a screening tool a "top priority" for the health department. She conceded that some of the feedback from doctors had been less than favorable — but didn't sound ready to reverse course, either.

"I don't know that we will move completely away from a parent-based model," she said. "There is good literature to support that that is the way to determine what 'serious (medical conditions)' might be."

Senate Health Budget Chairman Rene Garcia, R-Hialeah, said lawmakers would be "keeping a close eye" on the process.

"We're trying to make sure all the kids that need to get covered are covered," he said.

Contact Kathleen McGrory at kmcgrory@tampabay.com or (727) 893-8330. Follow @kmcgrory.

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