Many Medicaid-Enrolled Children Who Were Treated for ADHD Did Not Receive Recommended Followup Care

WHY WE DID THIS STUDY

Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder with symptoms of inattention, hyperactivity, and impulsivity. The Department of Health and Human Services publishes national quality measures that outline timeframes for followup care for children with ADHD. Additionally, professional guidelines from American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry describe the importance of followup care and behavioral therapy for these children. Some children may not receive followup care or behavioral therapy for reasons such as limited access to care or because practitioners may be unaware of the professional recommendations. This study focuses specifically on the extent to which children do not receive followup care and behavioral therapy.

Children with ADHD have higher rates of repeating grade levels, dropping out of school, and receiving hospital care. Childhood ADHD is also associated with negative outcomes in adulthood such as increased rates of other mental health problems, criminal behavior, and increased risk for suicide. The annual societal costs of ADHD are estimated up to $266 billion from loss of productivity, as well as spending in the healthcare, justice, and educational systems.

An estimated 13 percent of Medicaid-enrolled children are impacted by ADHD. Treatment involving behavioral therapy, medication, and followup care can help improve these children's outcomes, long-term prognoses, and quality of life.

OIG conducted this review in response to a congressional request to evaluate pharmaceutical and behavioral therapy treatment of Medicaid-enrolled children with ADHD.

HOW WE DID THIS STUDY

We reviewed Medicaid claims data, fiscal years 2014 and 2015, from all States and the District of Columbia for Medicaid-enrolled children who received ADHD treatment. We examined whether children received: (1) timely followup care with practitioners after being newly prescribed an ADHD medication, (2) timely followup care after ADHD hospitalizations, and (3) behavioral therapy in addition to ADHD medication. We also interviewed professionals to understand the impact ADHD has on children.

WHAT WE FOUND

Over 500,000 Medicaid-enrolled children who were newly prescribed an ADHD medication and over 3,500 children hospitalized with a primary diagnosis of ADHD did not receive followup care within the timeframes outlined in the national quality measures. Additionally, over 54,000 children did not receive any behavioral therapy as recommended by professional guidelines.

WHAT WE RECOMMEND

We recommend that the Centers for Medicare & Medicaid Services (CMS) work toward improving health outcomes by developing strategies to increase the number of children who receive timely followup care for ADHD. Specifically, we recommend that CMS:

• Collaborate: CMS should collaborate with partners to develop strategies for improving rates of followup care for children treated for ADHD.
• Assist: CMS should provide technical assistance to States to implement strategies for improving rates of followup care for children treated for ADHD.
• Analyze: CMS should analyze the effectiveness of strategies for improving rates of followup care for children treated for ADHD.

CMS concurred with all three of our recommendations.