Require the use of diagnostic classification systems
Recommendation
The Centers for Medicare and Medicaid (CMS) should require Medicaid and the Children’s Health Insurance Program (CHIP) to use the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R or DC:0-5) for diagnosis payment and utilization review purposes.[1]
Background/summary
Individuals with intellectual and developmental disabilities (IDD) are at an increased risk for developing other mental health or substance use disorders (MH/SUDs).[2] IDD usually develops or presents in early childhood, and early diagnosis and intervention can lead to better outcomes.[3] To aid in early diagnosis, in 1994, Zero to Three developed a guide known as the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3), which was most recently updated in 2021 (DC:0-5).[4] With over 42 million children receiving coverage from Medicaid and CHIP, a recent survey asked states if their policies required or recommended the use of DC:0-5 or DC:0-3R.[5] However, only seven states require the use of the diagnostic classification, and only eight states recommend its use.[5] The use of age-specific diagnostic systems should be required for payment and utilization review purposes to improve access to needed care.[1]
citations
1. Zero to Three. Planting Seeds in Fertile Ground: Actions Every Policymaker Should Take to Advance Infant and Early Childhood Mental Health. Last Updated 2016.
2. Kennedy Forum. Navigating The New Frontier of Mental Health and Addiction: A Guide for the 115th Congress. Last Accessed July 27, 2023.
3. Zisman-Ilani, Yaara. “The Mental Health Crisis of Individuals With Intellectual and Developmental Disabilities.” Last Updated March 1, 2022.
4. Zero to Three. DC:0–5™ Manual and Training. Psychiatry Online. Last Accessed July 27, 2023.
5. Smith, Sheila, Maribel R. Granja, Elisabeth Wright Burak, Kay Johnson, and Daniel Ferguson. “Medicaid Policies to Help Young Children Access Infant-Early Childhood Mental Health Services: Results from a 50-State Survey.” National Center for Children in Poverty. Last Updated June 2023.