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What is the ABCD Project?
What are the mission and vision of the project?
What are Colorado’s objectives with this project?
Why is Colorado implementing this project?
Are all screening tools and methods considered equal?
Where has the funding for this work come from?
How do we start?
Can we bill for this work?
Can practices bill for performing standardized developmental screenings at well child visits on a continual basis?
How should a practice handle billing in a situation in which they would like to have a child back who scores in the grey (“watchful wait”) area on the ASQ 3? (i.e. they want to see the child again in one month as opposed to one year). Can they bill 96110 at this second visit and will they be paid by Medicaid for it?
How should a practice bill for an ASQ:SE if a provider feels it should be conducted in conjunction with or as a close follow up to the ASQ?
We have a busy practice and are worried about fitting something new into our well child visits. Is this a difficult change to incorporate?
How does the ABCD project relate to the new guidelines for autism screening?
What is the difference between ASQ 2 and ASQ 3?
What is the difference between the ASQ and the ASQ:SE? Should practices be using both?
Is the ASQ 3 at 18 months good enough to screen for autism?
ABCD stands for Assuring Better Child Health and Development. The project is a national effort to increase the use of standardized developmental screening tools in primary care settings. Identifying developmental problems in children as early as possible is critical! The initiative was introduced in Colorado in 2006.
What are the mission and vision of the project?
The mission of the ABCD project is to “encourage the use of standardized developmental screening tools in health care settings across Colorado to facilitate early identification and referral.”
The vision is that “Colorado’s children will reach maximum developmental potential.”
What are Colorado’s objectives with this project?
The focus of Colorado’s ABCD Project is to:
Why is Colorado implementing this project?
Colorado is implementing this project so that we can identify more children with potential developmental delays earlier. More than 20 years of research have proven that children who receive early intervention are more likely to graduate from high school, hold jobs, and live independently. Under-detection of developmental lags prohibits early intervention. Research shows that providers who use a standardized developmental screening tool will correctly identify more children in need of early intervention services than without the use of such a tool.
The American Academy of Pediatrics Committee on Disabilities estimates that 12% - 16% of all children have disabilities, including speech and language delays, mental retardation, learning disabilities, and emotional/behavioral problems. Only 3 - 5% of these children are detected prior to school entrance. In order to promote early identification of developmental concerns, the American Academy of Pediatrics recommends the use of a valid and standardized screening tool at well child visits in the first few years of life. Current population estimates indicate that there are approximately 278,000 (Colorado Health Information Dataset, 2005) children ages birth to three in Colorado. Using the 12% - 15% estimates mentioned above, the total number of children in Colorado with potential delays is 44,000. Colorado Part C early Childhood Connections 2006 data shows that approximately 6,000 children in Colorado were referred for early intervention services. This means that an estimated 38,000 children in Colorado are potentially missing the opportunity for early intervention during these critical first few years of life.
Key Points from the AAP 2006 Policy Statement:
*Screening can be conducted at 24-month visit instead of 30-month visit.
Are all screening tools and methods considered equal?
No! In a 2001 Policy Statement the American Academy of Pediatrics cited three parental report tools which take just a few minutes to administer and accurately identify children with problems and developmental delays: the Ages and Stages Questionnaires, the PEDs, and the Child Development Inventories. These tools capture parental information about their so children so that doctors, educators, administrators, and specialists can follow-through in an appropriately (Vismara, 2004). Colorado requires the use of the ASQ or the PEDs when screening and surveillance are implemented by pcp’s and providers. The ASQ and the PEDs are validated, standardized developmental screening tools.
Benefits of using the ASQ or the PEDs:
Where has the funding for this work come from?
The initial funding for this work came in 2006 when Colorado received a one-year Technical Assistance grant from the North Carolina ABCD project (one of 4 pilot states) through The Commonwealth Fund. The Commonwealth Fund is a philanthropic foundation established in 1918 to help Americans live healthy and productive lives and to assist specific groups with serious and neglected problems. The ABCD work was so successful in the first four states that an additional fives states were granted funding to begin the work by the Commonwealth Fund. Colorado was included in a third tier of states to receive funding for ABCD. In all, the ABCD project is being implemented in 23 states today! The project has become so large that The Commonwealth Fund has asked the National Association for State Health Care Policy (NASHP) to assist states in the organization and implementation of this work. Grants from the The Colorado Health Foundation and the Kaiser Community Benefits have funded the work on a statewide basis. Local funders include The St. Mary Land and Exploration Company.
Call the ABCD state Technical Assistance Coordinator and let her know you are interested in beginning the work. We will provide you with the appropriate tools and technical assistance to get your practice started. Also, you can look at the tools provided under the TAB on this website.
Yes, Medicaid reimburses $36 for the use of a standardized developmental screening tool. You should use the 96110 billing code. Be sure are using a STANDARDIZED tool to qualify for billing. In our experience, private insurers reimburse at rates between $12 - $16 using the 96110 code. More information about reimbursement, billing and coding can be found here.
Can practices bill for performing standardized developmental screenings at well child visits on a continual basis?
Medicaid will reimburse for the use of a standardized developmental screening tool once per patient, per visit. Many private insurers do as well, although some private insurers allow three screens by the time a child turns three years old following the AAP guideline on standardized developmental screening.
How should a practice handle billing in a situation in which they would like to have a child back who scores in the grey (“watchful wait”) area on the ASQ 3? (i.e. they want to see the child again in one month as opposed to one year). Can they bill 96110 at this second visit and will they be paid by Medicaid for it?
In general, Medicaid prefers that when a pediatrician or health care provider suspects a developmental delay, they make a referral right away. The reason for this is that in Colorado we are trying to discourage a “wait and see” approach. However, since the ASQ 3 includes the “watchful wait” grey area, Medicaid will allow billing using the 96110 code on the secondary visit to occur. Medicaid has already begun auditing practices if there is any indication the code is being over- or misused.
How should a practice bill for an ASQ:SE if a provider feels it should be conducted in conjunction with or as a close follow up to the ASQ?
96110 is the correct billing code to use for both tools. 96110 can only be billed ONCE during a well child visit, so, if a provider feels it is important for the well being of the child to receive both screens at the same visit, they should conduct both screens but can only bill once for the same visit. If a practice has a child back for a secondary visit to conduct the second screen, Medicaid will allow it. Medicaid WILL audit any practice if there is any indication that the code is being over- or misused.
We have a busy practice and are worried about fitting something new into our well child visits. Is this a difficult change to incorporate?
No, most practices have told us that incorporating a standardized developmental screening tool like the ASQ saves times and focuses the visit. They appreciate the technical assistance available to help get their practices started and to address ongoing questions that come up.
How does the ABCD project relate to the new guidelines for autism screening?
The AAP best practice for use of a standardized developmental screening tool at well child visits is at least three times before the child turns three years old. Most practices that we have worked with in Colorado have opted to use the ASQ at every well child visit. This lessens the administrative burden on the front desk and the sensitivity and specificity of the tool go up over time. The AAP recommends that an MCHAT be administered at the 18 and 24 month old well child visits. The MCHAT does not replace the ASQ or vice versa.
ASQ and M-CHAT as screening tools for ASD |
||
DEVELOPMENTAL TASK |
M-CHAT |
ASQ (18 MONTH) |
Interest in other children |
X |
|
Pro-declarative point |
X |
|
Imitation |
X |
X |
Respond to name |
X |
|
Joint attention |
X |
|
Reciprocity |
X |
|
Pretend play |
X |
X |
Point to ask |
X |
X |
Plays with toys properly |
X |
X |
Eye contact |
X |
|
Referencing |
X |
|
Show caregiver something |
X |
|
What is the difference between ASQ 2 and ASQ 3?
ASQ 2 is still a perfectly valid and reliable screening tool to use. It is not necessary to change from ASQ 2 to ASQ 3. However, there are some very nice new features in ASQ 3 including a 2 month and a 9 month questionnaire and a more detailed score sheet. Please refer to the “What’s New in ASQ 3 tool in the Provider Toolkit on this website for full details.
What is the difference between the ASQ and the ASQ:SE? Should practices be using both?
ASQ is a series of questionnaires that look at children’s development. Each questionnaire covers five developmental domains, communication, fine-motor, gross motor, personal social and problem solving. There are six questions regarding each of those domains. The ASQ:SE or Ages and Stages Questionnaire: Social Emotional provides a more in depth look at a child’s social and emotional development specifically. Ideally, practices will use both tools. Some practices screen regularly with the ASQ and rely on the ASQ:SE as a secondary tool to take a closer look when there are specific concerns about the child's social and emotional development.
Is the ASQ 3 at 18 months good enough to screen for autism?
No. The ASQ 3 is a standardized developmental screening tool and is not a primary screening tool for Autism Spectrum Disorders.