New report analyzes full range of care, coordinated services for children and teens under EPSDT

A new analysis by researchers at the George Washington University School of Public Health and Health Services (SPHHS) examines the relationship between health information laws and health system improvements for children and adolescents under Medicaid's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. EPSDT ensures comprehensive coverage of children's health care needs, and its benefits are of particular importance for children and adolescents with physical and mental health conditions that can lead to lifelong disability when not addressed during the developmental years.

The report analyzes a wide range of laws governing health information, such as the HIPAA Privacy Rule, state confidentiality laws, and other laws related to information privacy in schools, child welfare, and day care settings. Funded by the Centers for Medicare & Medicaid Services (CMS) and under subcontract from NORC at the University of Chicago, the analysis is designed to provide an overview of one of the most complex areas of health law while also offering real-world guidance on broadly aligning health care for children and adolescents with the legal principles that govern the collection and disclosure of health information.

"Access to health information by providers and caregivers across medical and educational settings is critical to ensuring children and adolescents receive coordinated, quality health care," said lead author of the report Jane Hyatt Thorpe, JD, an associate professor of health policy at SPHHS. "While various federal and state laws governing health information are often construed as barriers, this analysis breaks down those barriers and highlights opportunities for effective information sharing across care teams and medical and educational settings."

The report notes that without access to patient health information, tests may be unnecessarily repeated, health care and benefits may be delayed or withheld and care may be fragmented or episodic. In the end, such problems may lead to increased health care costs as well as the risk that children and teens with special needs will not get the care they need, the authors note.

"This analysis, the first of its kind, demonstrates that legal principles governing health information are fully consistent with efforts now underway to achieve greater integration between health care for children and adolescents and other critical services such as education and day care and programs offering community-based services to teens," said co-author Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at SPHHS. "With this report as a guide, we hope that the nation's most vulnerable children and teens will be able to get the full range of care and coordinated services they need to develop optimally."

The report and additional resources can be accessed online at Health Information & the Law, a project of the Hirsh Health Law and Policy Program at the SPHHS. The project, which was developed with support from the Robert Wood Johnson Foundation, serves as a practical online resource for federal and state laws on health information.