Clarifying Medicaid Billing Practices Can Help States Prioritize Young Children’s Healthy Emotional Development

Evidence continues to mount that healthy social and emotional development in infants and toddlers underpins a lifetime of healthy physical development. But Medicaid policy and practice solutions to improve infant and early childhood mental health are not always clear, even when the importance of early diagnosis and treatment is well understood. A new report by ZERO TO THREE offers some concrete steps Medicaid agencies can take.

State Medicaid policy can incorporate specialized diagnostic codes, using DC:0–5™: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5), for infant and early childhood mental health and developmental disorders. It offers a clear signal to providers who work with young children that the state will reimburse their work to identify and treat disorders specific to young children.

Developed by an international expert task force including experts at ZERO TO THREE, DC:0-5 provides developmentally specific diagnostic criteria and information about mental health disorders unique to infants and toddlers, such as Excessive Crying Disorder, or Overactivity Disorder of Toddlerhood, as well as other emotional disorders that present differently in young children than in older children and adults.

Because of its specific focus on the developmental needs of young children, a diagnosis using the DC: 0-5 is more accurate and treatment more targeted than when providers try to match infant and toddler symptoms to the standard codes designed to diagnose older children and adults.

Embedding the use of DC: 0-5 in state policy, especially for Medicaid, is a practical way for states to signal that they take the social and emotional development of young children seriously, and that providers should prioritize the emotional development of infants and toddlers equally to their physical health. Diagnosis using the DC: 0-5 can also help providers make the case that treatment of a disorder is medically necessary for purposes of EPSDT in Medicaid, and ensures the child will get the full range of treatment they need. The paper provides a few examples of how states have adopted the criteria.

  • In Arkansas, after the state found high usage of psychotropic drugs for young children and no billing codes for infant mental health therapy, the legislature passed changes to Medicaid to recognize the DC: 0-3R diagnostic codes (an earlier version of the DC: 0-5) so that infants and toddlers could receive more accurate diagnoses and treatment. Like some other states, they also changed the rules to clarify that children can receive treatment with their parents (e.g. parent-child therapy), with the understanding that the child and parent bond is paramount to the healthy emotional development of the child.
  • Minnesota added the DC:0-3R codes to its Medicaid program, and enacted a longer diagnostic period for all ages, so that anyone with a complicated case can be evaluated over three visits at higher reimbursement rates before a diagnosis is made. This also allows providers to observe parent-child interactions on multiple visits.
  • Since 2001 North Carolina has allowed up to 6 visits of a 16-visit cycle to happen without a specific diagnosis code, to allow providers adequate time to fully assess a child’s emotional development before making a formal diagnosis, using the DC: 0-5 as the criteria. (We hope the state’s upcoming transition to managed care maintains this best practice!)

DC:0-5 training is designed for advanced practitioners from the fields of mental health, health, and early intervention who are responsible for assessment and diagnosis. States can also include an overview of DC: 0-5 in workforce training for providers who work with young children, including early childhood educators, family court officials and home visiting providers.

Exposing a broad group of early childhood providers to the DC: 0-5 fosters its use as a common language across sectors – such as health, education, and child welfare—so they can communicate more effectively about specific challenges a child faces and better understand how to help the child together. Advocates can also push higher education programs to include DC: 0-5 into their curriculum so that future professionals have the tools to effectively diagnose and treat infants and toddlers struggling with emotional development.

  • Colorado trained 34 full-time early childhood mental health consultants in the DC: 0-5. They provide consultation to early child care centers on supporting healthy social and emotional development.

Healthy social and emotional development is essential for all other healthy development in young children. When a child has strong caregiver bonds, and can experience a range of emotions and safely and confidently explore their environment, it sets the stage for a lifetime of strong physical development.

Educating providers and state agencies about DC: 0-5 and encouraging them to adopt the criteria can elevate the importance of social and emotional development in young children and take a practical step towards addressing the challenge.

Maggie Clark is a Program Director at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.