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I have an Oklahoma State Senator willing to propose a bill to allow our state medicaid to reimburse providers to screen for ACEs. Currently the federal match is only $2.77 and ours is not even activated to be used. You may want to check your state. To reimburse more the state legislature would need to set aside money for it like I know CA did. I could use any information either about the specific bill in CA that did it - I'm having trouble finding the language used- or any other state that has done this that we could use as an example. Any help appreciated - looking for specific state bills. Thanks Laura Shamblin, MD 

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Laura Shamblin, M.D. 

George Till, M.D., a pediatrician / legislator in Vermont, introduced Vermont House Bill 762 in 2013, for all Vermont health care providers to screen ALL patients-regardless of age, for 'ACEs'. The bill may have subsequently been edited / re-introduced in later years Hopefully, Vermont's legislative website has subsequent info. I don't know about Medicaid particulars there

David Finkelhor, of Univ. of NH [Crimes Against Children Research Ctr] authored a 'critique'...

Planned Parenthood may have taken a position....I had a discussion with some PP staff at the White River Junction, Vermont office, noting Finkelhor's critique...

'Physicians for a National Health Plan' may have also ... "National Conference of State Legislatures" may have something as well.

I wish someone would have screened my family members for attachment trauma and personality disorders.  That’s where this gets passed from  generation to generation, at least the most severe stuff we see in pediatrics.

I screened in my own informal way with carefully selected patients since 2004. Do you think that in a system with screening as performed by CYW that patients will really open up to these questions? I don’t but I don’t knw for sure.  I do know that I’m not sure that it’s wise asking patients each of these 10 questions in such a detached manner.   

I often find myself wondering why we aren’t trying to figure out which questions are most effective at getting the information that we need in pediatrics to provide the best care and break the cycle of generational transmission.  I wish Dr. Green were still alive. I’d really like to ask for his thoughts. 

When these 10 questions are set up in an Assembly Line fashion, I believe that many patients will not answer these questions honestly.  I don’t blame them.   I don’t believe I would answer honestly anymore. 

I’d like to be clear I am not stating an opinion about whether universal screening should be done or how that should come about. I do feel that if a physician is taking the time to use the screen whether in targeted diagnosis or a well check I feel they should be reimbursed for their time just like they are reimbursed for other things like developmental questionnaires. These things take time and time should be valued. 

I know that you aren’t taking a position about universal screening here Laura. Yes physician time should be valued and compensated.

I don’t believe that there has been the extensive discussion that should be had about whether screening for ACEs is the right thing for pediatricians to do - (I can get a lot of helpful information from the ASQ-SE and it’s a developmental screener that is appropriate for pediatrics)... so though I know you are asking a question that is different than the content of my reply, I know that there are many other doctors out there who check out topics like this on ACEsConnection.  Our colleagues are looking for information that might move their practice and ultimately force all doctors into doing something that might not be as well thought out as our good intentions hope.... so I ask these kinds of questions on all kinds of posts on ACEsConnection and post musings that may be somewhat off topic but have the intention of getting us thinking... I know it might be a little annoying but I know that this is just too important to pediatric care not to discuss.  So I hope you can forgive the indulgence. The intentions are always for the best we can do for our patients. 

You can check out these two articles if you are interested. Or disregard them if not.... The authors may be members of ACEsConnection... I’m actually not sure because I haven’t looked. 

1. Please address correspondence concerning this article to: Kimberly Renk, Ph.D., University of Central Florida, Department of Psychology, P.O. Box 161390, Orlando, Florida, USA, 32816. E-mail: Kimberly.Renk@ucf.edu

2. Address correspondence to: Sheri Madigan, Department of Psychology, University of Calgary, 2500 University Ave., Calgary, AB, T2N 1N4, Canada, Phone: (403) 220-5561; Fax: (403) 282-8249; email: sheri. madigan@ucalgary.ca 

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Tina Cain posted:

I wish someone would have screened my family members for attachment trauma and personality disorders.  That’s where this gets passed from  generation to generation, at least the most severe stuff we see in pediatrics.

I screened in my own informal way with carefully selected patients since 2004. Do you think that in a system with screening as performed by CYW that patients will really open up to these questions? I don’t but I don’t knw for sure.  I do know that I’m not sure that it’s wise asking patients each of these 10 questions in such a detached manner.   

I often find myself wondering why we aren’t trying to figure out which questions are most effective at getting the information that we need in pediatrics to provide the best care and break the cycle of generational transmission.  I wish Dr. Green were still alive. I’d really like to ask for his thoughts. 

When these 10 questions are set up in an Assembly Line fashion, I believe that many patients will not answer these questions honestly.  I don’t blame them.   I don’t believe I would answer honestly anymore. 

I often ask (apart from What happened?)

When did this begin ?  When did it start ?  or  Since when is it like this ?

Laura Shamblin posted:

I have an Oklahoma State Senator willing to propose a bill to allow our state medicaid to reimburse providers to screen for ACEs. Currently the federal match is only $2.77 and ours is not even activated to be used. You may want to check your state. To reimburse more the state legislature would need to set aside money for it like I know CA did. I could use any information either about the specific bill in CA that did it - I'm having trouble finding the language used- or any other state that has done this that we could use as an example. Any help appreciated - looking for specific state bills. Thanks Laura Shamblin, MD 

Laura, the best source of information on screening under the Medicaid program in California is ACEs Aware, led by California’s Surgeon General, Nadine Burke Harris.  Below is the excerpt from the CA Budget for 2019-2020 relating to ACEs screening. 

In a Dec. 4 webinar, Dr. Burke Harris reported that $40.8M has been allocated for ACE screenings of young children and adults receiving Medi-Cal and that the Department of Health Care Services will provide a $29 payment to Medi-Cal providers for trauma screenings for adults and children, beginning January 1, 2020. She also said that there is an allocation of $50M (plus match) over three years for robust provider training and engagement activities to equip Medi-Cal providers to screen for ACEs and respond with trauma-informed care.

In addition, it has been reported that the State of Michigan Department of Health and Human Services (MDHHS) reimburses physicians for ACEs screening of children (21 & younger) under EPSDT (Early and Periodic Screening, Diagnosis and Treatment) as of February of 2017.  Reimbursement rates are low and embedded with other services such as well child exams and it is not clear that many physicians are aware of the policy.   

Also, if you go the legislative route, I can share bills from other states.  Hope this is helpful. 

Excerpt from the California State Budget 2019-2020 (pg. 30)

Released January 10, 2019

http://ebudget.ca.gov/FullBudgetSummary.pdf

EARLY CHILDHOOD HEALTH AND WELLNESS
TRAUMA AND DEVELOPMENTAL SCREENINGS


Research shows that individuals who experienced adverse childhood experiences are at greater risk of heart disease, diabetes, and premature death. Identifying cases of trauma in children and adults and providing treatment can lower long-term health costs and support individual and family wellness and healing.

The Budget includes $30.8 million ongoing federal funds and $23.1 million ongoing Proposition 56 funds for developmental screenings for children in the Medi-Cal program and $27.2 million ongoing federal funds and $13.6 million ongoing Proposition 56 funds for trauma screenings for children and adults in the Medi-Cal program. In addition, the Budget includes $25 million federal funds and $25 million Proposition 56 funds (as part of a total investment of $120 million one-time combined federal and Proposition 56 funds over three years) to train providers on delivering trauma screenings. The increased funding for these programs will be suspended on December 31, 2021. The suspension will be lifted if the administration determines through the 2021 Budget Act process that there is sufficient General Fund revenue to support all suspended programs in the subsequent two fiscal years.

The National Conference of State Legislatures data base includes two bills in CA and two in New York related to ACEs screening.  There is a law in CA that establishes a working group on ACEs screening in the Medicaid program and one in Illinois that related to social/emotional screening, not ACEs per se.  Links to these bills and laws are included in the attached document.  

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