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Helping Kids with Complex Needs During a Pandemic

With schools closed and health services delayed or canceled, it's a challenge to provide support for children with physical or behavioral health needs. Telehealth is one tool that can help fill the gap.

Children with physical or behavioral health needs typically rely on an intricate, yet patched-together, network of medical and other service providers. Schools are a central part of that network, providing kids with meals, therapies and other crucial services, and, at times, with a safe space away from home. So what happens when, in the midst of an emergency, that stability is taken away?

COVID-19, of course, is one such emergency, and it's forcing state and local educators to answer this question on the fly. As we work during the coronavirus pandemic to support children with complex needs, along with their parents and caregivers, we should leverage what we are learning today to better prepare for future challenges.

While many school administrations have moved students to some version of remote learning, it's much more difficult to move special education and in-school supports such as socio-emotional, physical and occupational therapies to an online or remote format. Thus, school closures and stay-at-home guidance mean the safety net for kids with complex health needs has been severely weakened.

Children also are missing out on afterschool activities, youth sports leagues and interactions with friends and relatives at a time when stay-at-home orders increase kids' proximity to abusers. Critical community members — teachers, coaches, medical providers and other adults — are often the first to identify issues of abuse or neglect. Meanwhile, family courts are shutting down and social work and family visits are suspended, increasing the risk of undetected issues.

Finally, most routine medical, dental and vision visits, tests and procedures have either been delayed or, worse, canceled. Chronic health conditions and complex physical or behavioral health issues may go unmanaged and become exacerbated. Children may miss out on important screenings that under normal circumstances would result in a referral to much-needed services.

While governments and schools may be struggling to immediately provide services and supports to children with complex physical and behavioral needs, opportunities exist to move their systems forward immediately and for the future. Telehealth, in particular, can be a powerful tool, allowing for appointments with medical providers, therapists and other supportive services.

Traditionally, however, telehealth has come with financial and regulatory challenges, including the need to obtain federal approval for a state to provide it (if it's covered under a state's Medicaid waivers), restrictions on the providers who can bill for telehealth services, and limits on the locations in which individuals can receive covered services. However, in the wake of COVID-19, the Centers for Medicare and Medicaid Services (CMS), state Medicaid agencies and many private health insurance companies have announced regulatory changes to address these issues. Federal changes include allowing states to provide telehealth services without submitting a state plan amendment, as long as the services are comparable to those furnished in a face-to-face setting, and expanding the types of providers that can bill for telehealth services.

To address the financial challenges of providing telehealth and other virtual supports to children with needs, thoughtful and novel usage of the CMS Innovation Center's ongoing demonstrations could offer solutions. States could use their Medicaid programs to promote solutions tailored to their communities. CMS, in turn, could evaluate how telehealth and remote patient monitoring can support children with complex needs and how to promote the use of new technologies and long-distance supports across service providers. By addressing this challenge, providers and policymakers could identify innovations that are cost-effective and improve access to services for the most vulnerable children.

As governments look to these and other solutions, evaluating these programs and developing clearinghouses will help identify best practices and the infrastructure needed to support adoption of these technologies. Doing so means we'll have tested resources and approaches that will enable us to better protect vulnerable children — and support parents and caregivers — not just now, but in the future.

Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.

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