Beyond the Water's Edge: Charting the Course of Managed Care for People with Disabilities - Conference Resource Book. Families' Out-of-Pocket Expenses When Caring for Children With Special Needs: A Preliminary Report Comparing Children in Medicaid and a Commercial Product Line

11/01/1996

Elizabeth A. Shenkman, Ph.D.

INTRODUCTION

Despite the growing interest in enrolling children with special health care needs in managed care plans, remarkably little is known about the effects of managed care on this vulnerable group.1, 2 This lack of information is due, in part, to the fact that many private managed care organizations (MCOs) are unwilling to release person level use data so that analyses can be conducted on those enrollees who have special health care needs. In addition, states with Medicaid managed care plans have exempted some or all children with special needs from enrollment in these plans. Therefore very limited data from the public sector are available.3, 4

Many concerns have been raised about how children with special health care needs and their families will fare within a managed care environment. It is not known whether families will be able to obtain the services their children need in an environment where health care use and expenditures are closely monitored. Within the current fee-for-service system, families often face strong financial burdens both in terms of out-of-pocket expenses and caregiving time. These financial burdens are disproportionately borne by lower-income families.5 Some believe that placing children with special health care needs in managed care arrangements will result in even higher out-of-pocket expenses for families as they enter a system with stringent health care utilization management and potential financial disincentives to physicians to provide care or make referrals.6

 

PURPOSE

The purpose of this paper is to present preliminary information about families' out-of-pocket expenses when caring for children with special health care needs. Families' expenses for two groups of children are presented. The first group are commercially-insured children with special needs who are receiving care through private health maintenance organizations. The second group are children with special needs who are receiving care through Medicaid fee-for-service or primary case management programs.

The information in this paper is preliminary because we are continuing to collect data both for the Commercially insured and the Medicaid populations. In addition, we are presenting the findings from the survey data only. We have actual health care use data from the HMOs and Medicaid from their claims and encounter data bases for each child in the study. However, these data have not been completely analyzed and therefore are not included in this report.

 

METHODS

The Third Party Payers Participating in the Study

The Third Party Payers--Commercial: The commercially insured children participating in this study to date are insured through a special program designed to provide subsidized insurance premiums to previously uninsured children. Families with incomes below 130% of the federal poverty level (FPL) pay $5.00 per child per month; those between 131% and 185% of the FPL pay $15.00 per child per month; and those at 186% of the FPL or above paid the full premium of $50.00 per child per month. Approximately 30,000 children are currently enrolled. The benefit package is the same as that offered through Medicaid (Table 1). A key program feature is the provision of care through the private sector. The program is not intended to extend Medicaid coverage or to provide health care as a variation of the current Medicaid system for children in Florida. A private not-for-profit corporation negotiates contracts with HMOs to assume the financial risk and to provide health care services for the children. Four HMOs currently have contracts and deliver care through private physicians' offices and clinics in the children's communities. Both pediatricians and family practitioners serve as the children's primary care providers. Extensive specialty networks including tertiary care facilities are available through the HMOs. Program enrollment is voluntary.

The Third Party Payers--Florida Medicaid: The Medicaid Program in Florida offers coverage to the following children: (1) children less than one year of age and pregnant women at 134% to 185% of the FPL; (2) children one to six years of age at 101% to 133% of the FPL; and (3) children six to thirteen years at 100% of the FPL or below. Forty-nine percent of children receiving Medicaid are enrolled in the Medipass Program which is a Primary Care Case Management Program. Physicians provide care coordination for these children on a capitated basis. Any services provided beyond care coordination are reimbursed at a Medicaid fee-for-service rate. Catastrophic coverage is available through Florida Medicaid.

Sample Selection

Children were initially identified for possible inclusion in the study through the following steps:

  1. Each HMO and Florida Medicaid provided child-specific health care use data including International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM) codes for each health care encounter.

  2. In collaboration with two physicians from the University of Florida, Department of Pediatrics, we developed a list of ICD-9-CM codes that might indicate the child had a special health care need. The list was intentionally broad and included conditions of high and low prevalence (Appendix A).

  3. The health care use data bases were searched to identify those children who had at least one health care visit during which an eligible ICD-9-CM code was identified. We then identified those children with an eligible ICD-9-CM code who were enrolled within three months preceding the sample selection. We wanted to include those who were recently enrolled so that the survey data and health care use data were as contemporaneous as possible.

    Table 2 shows the number of children identified across each HMO and Florida Medicaid for possible inclusion in the study. As expected, significantly more children were identified as possibly having a special health care need through the Medicaid data base than through the private HMO data bases (33% versus 14%).

  4. Once the commercially insured children were identified from the data bases, we contacted a census of all those potentially eligible and administered a series of screening questions to determine final eligibility into the study. The screening questions were used to ensure that we only included those children who had moderate to severe health care needs. The following screening questions were used:

    1. Because of a physical or mental condition, does your child require more supervision than other children of his/her age?
    2. Does your child require extra or specialized medical care, therapies, supplies or medical equipment because of a special health care need?
    3. Has your child had his/her special health care need for 6 months or longer?

    Those children whose families answer yes to question a or b and c will be included in the study. That is, a family who has a child (1) requiring increased supervision or has a child who requires specialized medical care, therapies, supplies, or medical equipment because of a special health need; and (2) the child has had the condition for 6 months or longer were included in the study.

    Questions about activities of daily living (ADLS) were not used as initial screening questions because, based on our past work, a significant number of children may have special health care needs with no ADL deficits. For example, a child with mental retardation could have many needs for educational interventions and supervision resulting in additional financial and caregiving burdens on the families; yet have no ADL deficits.

    Table 3 shows the number of parents with commercially insured children meeting the ICD-9-CM criteria who were contacted, the number who met the screening question criteria, and the number who participated in the survey.

  5. Because so many children in the Medicaid data base had an ICD-9-CM code that might qualify them for inclusion in the study, we obtained a simple random sample of the Medicaid enrollees to contact. The same screening questions described in Step 4 also are being used to determine final study eligibility for the Medicaid population. We randomly selected 5,500 children, administered screening questions to 112 parents to date, and obtained 76 completed interviews (Table 3). We expected to find not only a greater number of children with special health care needs in the Medicaid data base, but also more children with significant health care needs when compared to the HMO population. As expected, more children in the Medicaid data base met the screening questions for inclusion into the study when compared to the pediatric HMO population (23% versus 10%).

  6. At the present time, we have completed surveys for 387 children in the commercial product line and 76 children participating in the Medicaid Program. The data for these children are presented in this report. As previously mentioned, we are continuing to conduct surveys among the Medicaid enrollees and also among children who are receiving health insurance through other commercial product lines offered by the HMOs with whom we are working.

Measures of Caregivers' Out-of-Pocket Expenses

We developed the Caregivers' Out-of-Pocket Expense (COPE) Survey to assess the following dimensions for expenses:

  • Direct Expenses--medical care expenditures for diagnosis, treatment, continuing care, rehabilitation and terminal care. Expenses for the following services are included in this category: physical therapy, occupational therapy, speech therapy, skilled nursing (registered nurse/ licensed practical nurse), personal attendant, respiratory therapy, specialized day care, counseling, doctor's visits in clinic or office, hospital care, medications and home medical equipment.
  • Other Direct Expenses--expenditures for the following items or services: respite care, special diets or formulas, medical supplies, special or additional clothing, diapers not normally used at the child's age, transportation costs, educational services related to the child's special health care need, assistive technologies, transportation related to the child's special health care needs, emergency transportation, purchase of a car or van related to the child's special health care needs, and home modifications.
  • Indirect Expenses--time spent in providing care for the child and lost employment opportunities.

Survey items initially were developed based on a literature review of expenses families incur when caring for children with disabilities.7, 8, 9 A panel of reviewers reviewed the first two drafts of the surveys for content. Reviewers included: a generalist pediatrician from an academic health center who specializes in caring for children with special health care needs, a family economist, a health care economist, two state Title V Children with Special Health Care Needs (CSHCN) Program Directors, two families who have children with special health care needs, and two policy analysts from the former Congressional Office of Technology Assessment. Following the content reviews, the survey was revised and field tested with 60 families. Based on the field testing, a final version of the survey was developed and used in this research.

This phase of our research focuses on families reported direct and other direct expenses. Families were determined to have incurred direct or other direct out-of-pocket expenses if the respondent indicated that the child received the particular service or item and it was paid for either entirely or in part by the parent or guardian, another relative residing in the household, or the child's Supplemental Security Income (SSI) check. The respondent was asked what the out-of-pocket expense was for the preceding month and for the preceding year for each service or item the child received. He or she also was asked if the expenditure for the month was typical or not and if the dollar amount provided was based on actual records or an estimate.

If the family was required to pay a co-payment for a service and the payment was made according to the criteria described in the preceding paragraph; the dollar amount was attributed to the particular category for which the co-payment was required. For example, in the commercially insured population, families are required to pay a $3.00 co-payment for an acute care visit to their primary care provider. The $3.00 co-pay would be described as an out-of-pocket expense for a doctor's visit. Thus out-of-pocket expenses could represent a co-payment for a particular service or item; an expenditure for a service or item not covered in the benefit package; or a service or item that was covered by the benefit package but the maximum amount allowed for payment was exceeded and the family had to begin paying.

Measures of Child's Functional Status

We used the Functional Status Rating Scale [FSII(R)], short form, to assess the children's level of functioning. The FSII(R) assess a child's functioning in the areas of social behavior, sleeping, eating, and activities.10 The instrument also was specifically designed to detect changes in a chronically ill child's functioning across time. The short version contains 14 items and has an alpha coefficient of 0.80. An alpha coefficient measures the degree to which the items on an instrument measure the same concept.11 The alpha coefficient of .80 means that the items on the FSII(R) are consistently measuring the same concept.

The instrument is scored from 0 to 100 with 100 representing the highest functioning. The developers established concurrent validity by correlating the FSII(R) measures with established measures of morbidity such as days in hospital and school absences. The correlations were moderate ranging from .24 to .47. A copy of the items are contained in Appendix B.

Demographic Measures

We gathered information about the family's race and ethnicity, respondent's age, total family income, and participation in the SSI Program for children. In addition, we asked about the child's age and diagnosis.

Data Analysis

Descriptive data only are presented for this phase of the study. Specifically we will describe the following:

  • The children's demographic characteristics.
  • The diagnoses (grouped together into diagnostic categories) and the FSII(R) scores by diagnostic category of the children in the HMOs and Medicaid.
  • The amount families spent on direct and other direct expenses expressed both in dollar amounts and as a percentage of family income for children in the HMOs and Medicaid.
  • The amount families spent on direct and other direct expenses expressed both in dollar amounts and as a percentage of family income by diagnostic category for children in the HMOs and Medicaid.
  • The dollar amount spent for specific services and items (i.e. physical therapy, supplies, medications, and others) for children in the HMOs and Medicaid.

 

RESULTS

The Study Sample

Children enrolled in Medicaid varied from children in the commercial program on several characteristics (Table 4). A higher percentage of children in Medicaid were African-American (15% versus 8%) and from lower income homes. Thirty percent of the Medicaid enrollees reported an average family income of less than $9,999 per year compared to only 13% of the commercially insured. However, overall both groups had low incomes with 15% or less of the respondents reporting a family income over $35,000 per year. In addition, children in the Medicaid program had significantly lower scores on the FSII(R) than the commercially insured children (p<.01). When reporting out-of-pocket expenses, it is important to note that a higher percentage of families in the commercially insured group when compared to the Medicare group used actual records rather than recall to report their expenses.

More than 70 different diagnoses are represented in this study. Given the diverse array of diagnoses, children were classified into categories (Table 5). We used the Social Security Administration's diagnostic categories that are contained in their medical listings of impairments. Children in Medicaid had a broader range of diagnoses and more severe diagnoses than children in the commercially insured group. The most striking example can be found in the respiratory category. Ninety-two percent of the commercially insured children in the respiratory category had a diagnosis of asthma compared to only 2% of the children receiving Medicaid. Children who received Medicaid and were classified in the respiratory category had diagnoses including: ventilator dependency, cystic fibrosis, and chronic respiratory failure.

The greatest similarity in diagnoses was found in the category of mental and emotional disorders. Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) were the most frequently occurring conditions with 80% of the commercially insured children and 74% of the children in Medicaid in this category having one of these two diagnoses. Depression and mental retardation were also seen in this category for both groups.

In addition to classifying into diagnostic groups, we obtained FSII(R) scores on each child. Prior research has documented that there is wide variability in functioning both between and within diagnoses; therefore classifying children according to their functioning as opposed to a diagnostic label is a valuable approach. The children's FSII(R) score by diagnostic category is contained in Table 5. With the exception of neoplastic diseases, children in Medicaid had lower scores for each diagnostic category when compared to commercially insured children. For both groups, children with mental and emotional disorders had the lowest scores in functioning. However, these low scores may reflect the fact that the instrument used contains many items that could be indicative of a mental or behavioral problem such as items referring to the child's mood, cheerfulness, and crying behavior. Few of the items specifically refer to limitations in physical activity.

The Amount Families Spend on Direct and Other Direct Out-of-Pocket Expenses

Given the higher functional status scores of children in the commercially insured program, it is not surprising that families incurred less out-of-pocket expenses in both absolute dollar amounts and in terms of the amount spent as a percent of family income when compared to Medicaid enrollees. Tables 6 and 7 illustrate the amount families spent out-of-pocket on direct and other direct expenses. Cross-tabulations of families' out-of-pocket expenses by income level reveal that families with incomes below $14,999 per year spend a disproportionate amount of their income on caring for their children when compared to families with incomes above that amount. While the average amount of out-of-pocket expenses as a percent of family income was only about 2% for the commercially insured, these expenses represented 12% of family income for those reporting incomes below $14,999. A similar regressive pattern was noted for Medicaid recipients with families at the lowest income levels paying as much as 32% of their income to care for their children with special needs.

Families with children in the commercial insurance program spent about equal amounts of money per month on direct and other direct expenses. However, families who had children in the Medicaid program spent greater amounts of money on other direct expenses. These other direct expenses included items and services that are not traditionally covered by Medicaid or other third party payers. Table 8 describes specific expenditures by third party payer category. Families incurred expenses for medications, special diets, assistive technologies, and respite care that are not contained in the Medicaid benefit package. Those families who received supplemental security income (SSI) reported spending this money on these and other items that were described in the "other direct expense" category. Ninety percent of families reported using the child's SSI check for one or more of the items or services in this category.

An important but often neglected area of out-of-pocket expenses to the family is that of indirect expenses or the time families spent caring for the child and lost employment opportunities. For this report, we calculated the average amount of time in hours that families reported spending in caregiving activities for their children with special needs. The number of hours spent in caregiving was obtained through the following methods:

  • Obtaining a listing of each person residing in the household, the person's age and relationship to the child with special needs;
  • For each person 18 years of age or older, asking if that person spent any time providing care to the special needs child, and if so the number of hours spent providing that care; and
  • Summing the number of caregiving hours across all members of the household who indicated that provided care.

We obtained the following results:

  • Eighty-five percent of families whose children were receiving Medicaid reported spending time in specific caregiving activities. They reported spending an average of 15.33 hours per day (± 9.19; range 0 to 24 hours) in care provision.
  • Forty-eight percent of families whose children were commercially insured reported spending time in specific caregiving activities. On average, these families spent 8.76 hours per day (± 3.2; range 0 to 11 hours) providing care.

We have several more items about families caregiving activities and the impact that this has had on their employment. These data will be analyzed in future work.

 

SUMMARY

The data contained in this report are preliminary. We are gathering more survey data from Medicaid and from other commercial product lines. However, some patterns are noted in these data that have important implications when designing health care programs and financing mechanisms for children with special health care needs.

Families incur significant out-of-pocket expenses when caring for their children. Lower income families bear the heaviest financial burden with expenses as high as 32% of their total income. While families with children in the HMOs have less expenses than those families with children in Medicaid, they still bear out-of-pocket expenses that take the heaviest toll on the lowest income groups. Benefit packages must be designed that consider the broad array of services required by children with special health care needs including respite care and educational technologies.

Moreover, the impact on the family in terms of their time must be considered. Perhaps health care expenditures can be minimized but at great personal cost to families. Particularly for families receiving Medicaid, more than half of their day can be spent providing care to their children with special needs. The economic impact of this activity must be considered.

Often it is difficult to compare out-of-pocket expenses between different third party payers due to differences in benefit packages. In this phase of our study, all of the children received the same benefits. Although this is a preliminary report, differences in out-of-pocket spending can largely be attributed to differences in the children's health status. Children in Medicaid had much lower scores on functioning when compared to children in the commercially insured group.

Further analytic work will be conducted using regression techniques to more fully describe the factors influencing out-of-pocket expenses. In addition, we will include the children's health care use data from the claims data bases as well as measures of the time families spend in caregiving.

 

NOTES

  1. Ireys, HT. "Children with Special Health Care Needs: Evaluating Their Needs and Relevant Service Structures." Paper commission by the Institute of Medicine. Baltimore, MD: Johns Hopkins University, November 1994.
  2. Batavia, AI. "Health Care Reform and People with Disabilities." Health Affairs. 1993; 12:40-55.
  3. Ireys, HT. "Children with Special Health Care Needs: Evaluating Their Needs and Relevant Service Structures." Paper commission by the Institute of Medicine. Baltimore, MD: Johns Hopkins University, November 1994.
  4. Butler, P, RL Mollica, and T Riley. Children's Health Plans. Portland, ME: National Academy for State Health Policy, 1993.
  5. Rasell, E, J Bernstein, and K Tang. "The Impact of Health Care Financing on Family Budgets." Challenge. November-December 1993:12-21.
  6. Newacheck, PW, DC Hughes, JJ Stoddard, and N Halfon. "Children with Chronic Illness and Medicaid Managed Care." Pediatrics. 1994; 93:497-500.
  7. Newacheck, PW, and N Halfon. "The Financial Burden of Medical Care Expenses for Children." Medical Care. 1986; 24:1110-1117.
  8. Jacobs, P, and S McDermott. "Family Caregiver Costs of Chronically Ill and Handicapped Children: Method and Literature Review." Public Health Reports. 1989; 104:158-163.
  9. Leonard, B, JD Brust, and JJ Sapienza. "Financial and Time Costs to Parents of Severely Disabled Children." Public Health Reports. 1992; 107:302-312.
  10. Stein, REK, and DJ Jessop. Manual for the Functional Status II(R) Measure. New York: Albert Einstein College of Medicine of Yeshiva University, 1991.
  11. Aday, L. Designing and Conducting Health Surveys. San Francisco, CA: Jossey-Bass, 1991.
TABLE 1. Summary of Medicaid Benefits in Florida*
Category Reimbursement
Durable Medical Equipment
  • Limited to one per day per recipient
  • District service authorization required for certain orthotics, prosthetics, and other equipment for Medicaid eligible EPSDT children under the age of 21
The lesser of the amount billed or the established maximum Medicaid fee.
Home Health Care Services
  • Intermittent and private duty/personal care
The lesser of the amount billed or the maximum allowable
Hospice Care
  • Routine or continuous home care
  • Inpatient respite or general inpatient care
Medicaid allowable rate
Hospital Services--Inpatient 45 day limit
Hospital Services--Outpatient $2.00 co-payment for Medicaid
Laboratory Medicaid allowable rate
Eye Care
  • Refractions
  • Eyeglasses
$3.00 co-payment
Covered every two years with a $10.00 co-pay. Only Medicaid frames.
Physician Services $2.00 co-payment for Medicaid; $3.00 co-payment for commercial product line.
Podiatry Services $2.00 co-payment for Medicaid. Certain limitations.
Prescription Drugs 31 day supply with a $2.00 co-pay; $3.00 co-pay for commercially insured
Occupational Therapy Services One treatment per day; reassessments every 6 months; minimum treatment period; Medicaid allowable rate
Physical Therapy Services One treatment per day; reassessments every 6 months; minimum treatment period; Medicaid allowable rate
Respiratory Therapy Services One therapy per day; minimum treatment period of 30 minutes; reassessment every 6 months; Medicaid allowable rate
Speech Therapy One therapy per day; minimum treatment period of 30 minutes; reassessment every 6 months; Medicaid allowable rate
Mental Health 20 visits per year with $5.00 co-pay
Extended Care Varies by type of extended care required
Transportation Emergency transport covered in full
*Does not include all benefits offered such as special waivers, birth centers, nursing homes.

 

TABLE 2. Total Number of Children Identified From the Health Care Use Data Bases Using Selected ICD-9-CM Codes
Category Florida
Medicaid
Commercially
Insured
Total number of children screened for ICD-9-CM codes that may reflect a special health care need 307,241 27,487
Total number of children enrolled within the last three months of selecting the sample 253,562 13,591
Total number of children with at least one ICD-9-CM code indicating a possible special health care need enrolled in the last three months of selecting the sample 84,315 1,916
Percentage of enrollees with at least one ICD-9-CM code indicating a possible special health care need and enrolled within the last three months of selecting the sample 33% 14%

 

TABLE 3. Families Screened for Study Participation and Surveys Completed
Category Florida
Medicaid
Commercially
Insured
Completed screening questions 112 547
Did not qualify 12 (10%) 128 (23%)
Qualified but refused to participate 24 32
Qualified and completed a survey 76 387

 

TABLE 4. Demographic Characteristics of the Study Sample
Category Children
Receiving
Medicaid
Commercially
Insured
Children
Respondent Gender
  • Female
  • Male
 
97%
3%
 
95%
5%
Respondent Age 37.43 ± 10.90 39.55 ± 9.99
Child's Age 9.23 ± 5.23 10.48 ± 6.21
FSII(R) Score 78.53 ± 18.69
(range 17 to 100)
87.20 ± 15.33
(range 21 to 100)
Child's Racial Background
  • White
  • African-American
  • Other
 
80%
15%
5%
 
85%
8%
7%
Child's Ethnicity
  • Hispanic
  • Non-Hispanic
 
11%
89%
 
12%
88%
Average Family Income
  • Less than $9,999
  • $10,000 to 14,999
  • $15,000 to 19,999
  • $20,000 to 24,999
  • $25,000 to 34,999
  • $35,000 to 44,999
  • $45,000 or more
  • Don't know/refused
 
30%
17%
14%
12%
10%
7%
7%
2%
 
13%
22%
19%
15%
12%
8%
5%
7%
Cash Assistance-SSI for Child
  • Used actual records to respond to question
  • Used an estimate of expenses
 
35%
35%
65%
 
0%
47%
53%

 

TABLE 5. Children's Primary Diagnostic Categories and FSII(R) Scores
Category Children Receiving Medicaid (N=76) Commercially Insured Children (N=387)
Percent
Children
FSII(R) Mean Score & Standard Deviation Min. Max. Percent
Children
FSII(R) Mean Score & Standard Deviation Min. Max.
Mental and Emotional Disorders** 16% 67 ± 20 18 100 39% 75 ± 22 18 100
Respiratory System 13% 69 ± 206 50 100 40% 90 ± 15 46 100
Neurological 25% 76 ± 19 28 100 4% 82 ± 18 24 100
Musculskeletal System 17% 86 ± 13 31 100 2% 92 ± 10 53 100
Special Sense Organs 8% 80 ± 18 42 100 4% 86 ± 15 44 100
Endocrine System <1% 71 ± 0 71 NA 3% 90 ± 12 20 100
Cardiovascular 4% 88 ± 12 71 100 <1% 88 ± 0 88 NA
Digestive System 3% 88 ± 20 43 100 <1% 90 ± 0 90 NA
Multiple Body Systems* 6% 88 ± 09 67 100 0% NA NA NA
Genito-Urinary System 1% 76 ± 10 64 100 1% 86 ± 18 42 100
Hemic and Lympahtic System <1% 67 ± 0 67 NA 0% NA NA NA
Neoplastic Diseases--Malignant <1% 100 ± 0 100 NA <1% 86 ± 0 86 NA
Immune System 2% 87 ± 13 71 100 <1% 87 ± 0 87 NA
Growth Impairment 2% 96 ± 07 85 100 0% NA NA NA
* Includes Down Syndrome, multiple body dysfunction, and catastrophic congenital anomalies
** Includes mental retardation

 

TABLE 6. Direct and Other Direct Expenses for the Month and Year in Dollars
Category Children Receiving Medicaid Commercially Insured Children
% Reporting Expense Mean Min. Max. % Reporting Expense Mean Min. Max.
Direct Expenses Per Month
Direct Expenses Per Year
37%
 
38%
131.89 ± 392.25
 
1072 ± 14629.1
0
 
0
3050
 
5780
87%
 
86%
28.59 ± 139.2
 
384.11 ± 1582
0
 
3.00
2562
 
6200
Other Direct Expenses Per Month
Other Direct Expenses Per Year
89%
 
89%
162.57 ± 305.93
 
1444.1 ± 1779.2
0
 
0
3077
 
9680
63%
 
63%
30.79 ± 69.8
 
689.4 ± 2502.6
0
 
1.00
660
 
2890

 

TABLE 7. Direct and Other Direct Expenses for the Month and Year Expressed as a Percent of Family Income
Category Children Receiving Medicaid Commercially Insured Children
% Reporting Expense Mean Min. Max. % Reporting Expense Mean Min Max.
Direct Expenses Per Month
Direct Expenses Per Year
37%
 
36%
4.87 ± 32.4
 
4.33 ± 12.2
0
 
0
698.0
 
128.95
87%
 
87%
2.32 ± 10.38
 
2.8 ± 12.78
0
 
.10
146.4
 
1698.7
Other Direct Expenses Per Month
Other Direct Expenses Per Year
89%
 
88%
12.79 ± 21.9
 
11.25 ± 25.6
0
 
0
129.8
 
487.0
63%
 
63%
2.11 ± 6.2
 
2.25 ± 10.98
0
 
.04
72.0
 
1587.6

 

TABLE 8. Specific Expenses in Dollars for Children in Medicaid and Commercially Insured
Category Children Receiving Medicaid Commercially Insured Children
Percent Incurring Expense Cost/Month in Dollars Mean and Standard Deviation Percent Incurring Expense Cost/Month in Dollars Mean and Standard Deviation
Physical Therapy 1% 70.0 ± 98.9 <1% 175 ± 168.5
Occupational Therapy 1% 71.0 ± 97.6 0% 0
Speech Therapy 1% 50.1 ± 86.5 <1% 15.0 ± 21.2
Skilled Nursing 0% 0 <1% 600 ± 848.6
Personal Attendant <1% 400.0 ± 0 <1% 85 ± 0
Respiratory Therapy and Supplies 1% 45.0 ± 35.3 9% 7.5 ± 26.4
Day Care 2% 147.25 ± 97.2 <1% 50.0 ± 70.7
Counseling 3% 25.2 ± 21.7 22% 7.8 ± 13.7
Doctors Visits 11% 82.1 ± 123.78 88% 8.5 ± 27.6
Hospital 4% 500.0 ± 1,110.0 9% 16.5 ± 80
Respite Care 11% 85.7 ± 226.8 2% 59.3 ± 119.2
Medications 24% 31.0 ± 52.7 90% 10.3 ± 31.5
Special Diet 14% 110.5 ± 98.7 6% 94.0 ± 132.6
Medical Supplies 17% 24.6 ± 32.7 11% 6.5 ± 10.7
Special Clothing 18% 62.8 ± 54.1 5% 30.1 ± 31.5
Home Medical Equipment 7% 31.4 ± 60.9 7% 16.9 ± 54.9
Diapers 38% 61.8 ± 66.3 3% 31.33 ± 45.7
Assistive Technologies 3% 339.1 ± 328.2 0% 0
Educational Services 2% 37.1 ± 38.9 2% 21.6 ± 41.8
Additional Phone Charges 24% 20.0 ± 25.1 10% 13.4 ± 24.0
Additional Utility Bills 13% 56.4 ± 58.7 11% 45.8 ± 48.9
Higher Health Insurance Premiums 1% 167.6 ± 143.0 2% 21.5 ± 27.7
Additional Health Insurance 1% 237.6 ± 217.2 <1% 16.6 ± 28.7
Transportation to Doctor 31% 41.4 ± 63.9 58% 7.5 ± 15.2
Emergency Transportation 0% 0 0% 0
Home Modifications 7% 52.1 ± 103.6 5% 23.6 ± 65.2

 

APPENDIX A. ICD-9-CM CODES USED TO IDENTIFY CHILDREN FROM THE CLAIMS/ENCOUNTER DATA

Code Condition
042 Human Immunodeficiency Virus (HIV)/AIDS
  • (Use additional codes to identify all manifestations of HIV)
142
  • 142.0
  • 142.1
  • 142.2
  • 142.8
  • 142.9
  • 147.0
  • 147.1
  • 147.2
  • 147.3
  • 147.8
  • 147.9
Malignant Neoplasm of Major Salivary Glands
  • Parotid gland
  • Submandibular gland
  • Sublingual gland
  • Other major salivary glands
  • Salivary gland, unspecified
  • Superior wall
  • Posterior wall
  • Lateral wall
  • Anterior wall
  • Other specified sites of nasopharynx
  • Nasopharynx, unspecified
155
  • 155.0
  • 155.1
  • 155.2
Malignant Neoplasm of Liver and Intrahepatic Bile Ducts
  • Liver, primary
  • Intrahepatic bile ducks
  • Liver, not specified as primary or secondary
158
  • 158.0
  • 158.8
  • 158.9
Malignant Neoplasm of Retroperitoneum and Peritoneum
  • Retroperitoneum
  • Specified parts of peritoneum
  • Peritoneum, unspecified
170
  • 170.0
  • 170.1
  • 170.2
  • 170.3
  • 170.4
  • 170.5
  • 170.6
  • 170.7
  • 170.8
  • 170.9
Malignant Neoplasm of Bone and Articular Cartilage
  • Bones of skull and face, except mandible
  • Mandible
  • Vertebral column, excluding sacrum and caccyx
  • Ribs, sternum, and clavicle
  • Scapula and long bones of upper limb
  • Short bones of upper limb
  • Pelvic bones, sacrum, and coccyx
  • Long bones of lower limb
  • Short bones of lower limb
  • Bone and articular cartilage, site unspecific
171
  • 171.0
  • 171.2
  • 171.3
  • 171.4
  • 171.5
  • 171.6
  • 171.7
  • 171.8
  • 171.9
Malignant Neoplasm of Connective and Other Soft Tissue
  • Head, face, and neck
  • Upper limb, including shoulder
  • Lower limb, including hip
  • Thorax
  • Abdomen
  • Pelvis
  • Trunk, unspecified
  • Other specific sties of connective and other soft tissue
  • Connective and other soft tissue, site unspecified
189
  • 189.0
  • 189.1
  • 189.9
Maligant Neoplasm of Kidney and other Unspecified Urinary Organs
  • Kidney, except pelvis
  • Renal pelvis
  • Urinary organ, site unspecified
190
  • 190.0
  • 190.5
  • 191.0
  • 191.1
  • 191.2
  • 191.3
  • 191.4
  • 191.5
  • 191.6
  • 191.7
  • 191.8
  • 191.9
Malignant Neoplasm of Eye
  • Eyeball, except conjunctiva, cornea, retina, and choriod
  • Retina
  • Cerebrum, except lobes and ventricles
  • Frontal lobe
  • Temporal lobe
  • Parietal lobe
  • Occipital lobe
  • Ventricles
  • Cerebellum NOS
  • Brain stem
  • Other parts of brain
  • Brain, unspecified
192
  • 192.0
  • 192.1
  • 192.2
  • 192.3
  • 192.8
  • 192.9
Malignant Neoplasm of Other Unspecified Parts of Nervous
  • Cranial nerves
  • Cerebral meninges
  • Spinal cord
  • Spinal meninges
  • Other specified sites of nervous system
  • Nervous system, part unspecified
196
  • 196.0
  • 196.1
  • 196.2
  • 196.3
  • 196.5
  • 196.6
  • 196.8
  • 196.9
Secondary and Unspecified Malignant Neoplasm of Lymph Nodes
  • Lymph nodes of head, face, and neck
  • Intrathoracic lymph nodes
  • Intra-abdominal lymph nodes
  • Lymph nodes of axilla and upper limb
  • Lymph nodes of inguinal region and lower limb
  • Intrapelvic lymph nodes
  • Lymph nodes of multiple sides
  • Site unspecific
197
  • 197.0
  • 197.1
  • 197.2
  • 197.3
  • 197.4
  • 197.5
  • 197.6
  • 197.7
  • 197.8
Secondary Maligant Neoplasm of Respiratory and Digestive System
  • Lung
  • Mediastium
  • Pleura
  • Other respiratory organs
  • Small intestine, including duodenum
  • Large intestine and rectum
  • Retroperitoneum and peritoneum
  • Liver, specified as secondary
  • Other digestive organs and spleen
200
  • 200.0
  • 200.1
  • 200.2
  • 200.8
Lymphosarcoma and Reticulosarcoma
  • Reticulosarcoma
  • Lymphosarcoma
  • Burkitt's tumor or lymphoma
  • Other named variants
201
  • 201.0
  • 201.1
  • 201.2
  • 201.4
  • 201.5
  • 201.6
  • 201.7
  • 201.9
Hodgkin's Disease
  • Hodgkin's paragranuloma
  • Hodgkin's granuloma
  • Hodgkin's sarcoma
  • Lymphocytic-histiosytic predominance
  • Nodular sclerosis
  • Mixed cellularity
  • Lymphocytic depletion
  • Hodgkin's disease, unspecified
202
  • 202.3
  • 202.4
  • 202.5
  • 202.8
  • 202.9
Other Malignant Neoplasms of Lymphoid and Histiocytic Tissue
  • Malignant histiocytosis
  • Leukemic reticuloendotheliosis
  • Letter-Siwe disease
  • Other lymphomas
  • Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue
204
  • 204.0
  • 204.1
  • 204.8
Lymphoid Leukemia
  • Acute
  • Chronic
  • Other lymphoid leukemia
205
  • 205.0
  • 205.1
  • 205.2
  • 205.3
  • 205.8
  • 205.9
Myeloid Leukemia
  • Acute
  • Chronic
  • Subacute
  • Myeloid sarcoma
  • Other myeloid leukemia
  • Unspecified myeloid laukemia
206
  • 206.0
  • 206.1
  • 206.2
  • 206.8
  • 206.9
Monocytic Leukemia
  • Acute
  • Chronic
  • Subacute
  • Other monocytic leukemia
  • Unspecified monocytic leukemia
207
  • 207.0
  • 207.1
  • 207.2
  • 207.8
Other Specified Leukemia
  • Acute erythremia and erythroleukemia
  • Chronic erythremia
  • Megakaryocytic leukemia
  • Other specified leukemia
208
  • 208.0
  • 208.1
  • 208.2
  • 208.8
  • 208.9
Leukemia of Unspecified Cell Type
  • Acute
  • Chronic
  • Subacute
  • Other leukemia of unspecified cell type
  • Unspecified leukemia
210
  • 210.0
  • 210.1
  • 210.2
  • 210.4
  • 210.5
  • 210.6
  • 210.7
  • 210.8
  • 210.9
Benign Neoplasm of Lip, Oral Cavity, and Pharynx
  • Lip
  • Tongue
  • Major salivary glands
  • Other and unspecified parts of the mouth
  • Tonsil
  • Other parts of oropharynx
  • Nasopharynx
  • Hypopharynx
  • Pharynx, unspecified
213
  • 213.7
Benign Neoplasm of Bone and Articular Cartilage
  • Long bone of lower limb
215 Other Benign Neoplasm of Connective and Other Soft Tissue
216 Benign Neoplasm of Skin
225
  • 225.0
Benign Neoplasm of Brain and Other Parts of Nervous System
  • Brain
228
  • 228.0
  • 228.00
  • 228.01
  • 228.02
  • 228.03
  • 228.04
  • 228.09
  • 228.1
Hemangioma and Lymphangioma, any site
  • Hemangioma, any site
  • Of unspecified site
  • Of skin and subcutaneous tissue
  • Of intracranial structures
  • Of retina
  • Of intra-abdominal structures
  • Of other sites
  • Lymphangioma, any site
229
  • 229.0
  • 229.8
  • 229.9
Benign Neoplasm of Other and Unspecified Sites
  • Lymph nodes
  • Other specified sites
  • Site unspecified
237
  • 237.70
  • 237.71
  • 237.72
Neoplasm of Uncertain Behavior of Endocrine Glands and Nervous System
  • Neurofibromatosis, unspecified
  • Neurofibromatosis, Type I [von Recklinghousen's disease]
  • Neurofibromatosis, Type II [acoustic neurofibromatosis]
250
  • 250.0
  • 250.1
  • 250.2
  • 250.3
  • 250.4
  • 250.5
Diabetes Mellitos, Type I [insulin dependent type] [IDDM] [ juvenile type], uncontrolled
  • Diabetes mellitus without mention of complication
  • Diabetes with ketoacidosis
  • Diabetes with hyperosmolarity
  • Diabetes with other coma
  • Diabetes with renal manifestations
  • Diabetes with ophthalmic manifestations
277
  • 277.0
  • 277.00
  • 277.01
Other and Unspecified Disorders of Metabolism
  • Cystic fibrosis
  • Without mention of meconium ileus
  • With meconium ileus
282
  • 282.60
  • 282.61
  • 282.62
  • 282.63
  • 282.69
Hereditary Hemolytic Anemias
  • Sickle-cell anemia, unspecified
  • Hb-S disease without mention of crisis
  • Hb-S disease with mention of crisis
  • Sickle-cell/Hb-C disease
  • Other
292
  • 292.0
  • 292.11
  • 292.12
  • 292.2
Drug Psychoses
  • Drug withdrawal syndrome
  • Drug-induced organic delusional syndrome
  • Drug-induced hallucinosis
  • Pathological drug intoxication
293
  • 293.0
  • 293.1
  • 293.8
  • 293.81
  • 293.82
  • 293.83
  • 293.89
  • 293.9
Transient Organic Psychotic Conditions
  • Acute delirium
  • Subacute delirium
  • Other specified transient organic mental disorders
  • Organic delusional syndrome
  • Organic hallucinosis syndrome
  • Organic affective syndrome
  • Other
  • Unspecified transient organic mental disorder
294
  • 294.1
Other Organic Psychotic Conditions (Chronic)
  • Dementia in conditions classified elsewhere
295
  • 295.1
  • 295.2
  • 295.3
  • 295.4
  • 295.5
  • 295.6
  • 295.7
  • 295.8
  • 295.9
Schizophrenic Disorders [0=unspecified] [1=subchronic] [2=chronic] [3=subchronic with acute exacerbation]
  • [4=chronic with acute exacerbation] [5=in remission]
  • Disorganized type
  • Catatonic type
  • Paranoid type
  • Acute schizophrenic episode
  • Latent schizophrenia
  • Residual schizophrenia
  • Schizo-affective type
  • Other specified types of schizophrenia
  • Unspecified schizophrenia
296
  • 296.2
  • 296.3
  • 296.9
Affective Psychoses
  • Major depressive disorder, single episode
  • Major depressive disorder, recurrent episode
  • Other and unspecified affective psychosis
299
  • 299.0
  • 299.1
  • 299.8
  • 299.9
Psychoses with Origin Specific to Childhood
  • Infantile autism
  • Disintegrative psychosis
  • Other specified early childhood psychoses
  • Unspecified
300
  • 300.0
  • 300.00
  • 300.01
  • 300.02
  • 300.09
  • 300.10
  • 300.11
  • 300.12
  • 300.13
  • 300.16
  • 300.19
  • 300.20
  • 300.3
  • 300.4
  • 300.5
  • 300.7
  • 300.8
  • 300.81
  • 300.9
Neurotic Diseases
  • Anxiety states
  • Anxiety states, unspecified
  • Panic disorder
  • Generalized anxiety disorder
  • Other
  • Hysteria, unspecified
  • Conversion disorder
  • Psychogenic amnesia
  • Psychogenic fugue
  • Factitious illness with psychological symptoms
  • Other and unspecified factitious illness
  • Phobia, unspecified
  • Obsessive-compulsive disorder
  • Neurotic depression
  • Neurasthenia
  • Hypochondriasis
  • Other neurotic disorders
  • Somatization disorder
  • Unspecified neurotic disorder
301
  • 301.10
  • 301.20
  • 301.50
  • 301.51
  • 301.59
  • 301.7
Personality Disorders
  • Affective personality disorder, unspecified
  • Schizoid personality disorder, unspecified
  • Histrionic personality disorder, unspecified
  • Chronic factitious illness with physical symptoms
  • Other histrionic personality disorder
  • Antisocial personality disorder
302
  • 302.3
  • 302.50
  • 302.51
  • 302.52
  • 302.53
  • 302.6
  • 302.85
Sexual Deviations and Disorders
  • Transvestitism
  • With unspecified sexual history
  • With asexual history
  • With homosexual history
  • With heterosexual history
  • Disorders of psychosexual identity
  • Gender identify disorder of adolescent or adult life
306
  • 306.0
  • 306.3
  • 306.4
Physiological Malfunction Arising from Mental Factors
  • Musculoskeletal
  • Skin
  • Gastrointestinal
307
  • 307.0
  • 307.1
  • 307.2
  • 307.20
  • 307.21
  • 307.22
  • 307.23
  • 307.3
  • 307.40
  • 307.41
  • 307.42
  • 307.43
  • 307.46
  • 307.47
  • 307.50
  • 307.51
  • 307.52
  • 307.53
  • 307.54
  • 307.59
  • 307.6
  • 307.7
  • 307.80
  • 307.81
  • 307.9
Special Symptoms or syndromes, Not Elsewhere Classified
  • Stammering and stuttering
  • Anorexia nervosa
  • Tics
  • Tic disorder, unspecified
  • Transient tic disorder of childhood
  • Chronic motor tic disorder
  • Gilles de la Tourette's disorder
  • Stereotyped repetitive movements
  • Nonorganic sleep disorder, unspecified
  • Transient disorder of initiating or maintaining sleep
  • Persistent disorder of initiating or maintaining sleep
  • Transient disorder of initiating or maintaining sleep
  • Somnambulism or night terros
  • Other dysfunction's of sleep stages or arousal from sleep
  • Eating disorder, unspecified
  • Bulimia
  • Pica
  • Psychogenic rumination
  • Psychogenic vomiting
  • Other
  • Enuresis
  • Encopresis
  • Psychogenic pain, site unspecified
  • Tension headache
  • Other and unspecified special symptoms or syndromes, not elsewhere classified
308
  • 308.0
  • 308.1
  • 308.2
  • 308.3
  • 308.4
  • 308.9
Acute Reaction to Stress
  • Predominant disturbance of emotions
  • Predominant disturbance of consciousness
  • Predominant psychomotor disturbance
  • Other acute reactions to stress
  • Mixed disorders as reaction to stress
  • Unspecified acute reaction to stress
309
  • 309.0
  • 309.1
  • 309.21
  • 309.22
  • 309.23
  • 309.24
  • 309.28
  • 309.3
  • 309.4
  • 309.82
  • 309.83
  • 309.89
  • 309.9
Adjustment Reaction
  • Brief depressive reaction
  • Prolonged depressive reaction
  • Separation anxiety disorder
  • Emancipation disorder of adolescence and early adult life
  • Specific academic or work inhibition
  • Adjustment reaction with anxious mood
  • Adjustment reaction with mixed emotional features
  • With predominant disturbance of conduct
  • With mixed disturbance of emotions and conduct
  • Adjustment reaction with physical symptoms
  • Adjustment reaction with withdrawal
  • Other
  • Unspecified adjustment reaction
310
  • 310.2
  • 310.8
Specific Nonpsychotic Mental Disorders Due to Organic Brain Damage
  • Postconcussion syndrome
  • Other specified nonpsychotic mental disorders following organic brain damage
312
  • 312.0
  • 312.1
  • 312.2
  • 312.30
  • 312.31
  • 312.32
  • 312.33
  • 312.34
  • 312.35
  • 312.39
  • 312.4
  • 312.8
  • 312.81
  • 312.82
  • 312.89
  • 312.9
Disturbance of Conduct, Not Elsewhere Classified
  • Undersocialized conduct disorder, aggressive type
  • Undersocialized conduct disorder, unaggressive type
  • Socialized conduct disorder
  • Impulse control disorder, unspecified
  • Pathological gambling
  • Kleptomania
  • Pyromania
  • Intermittent explosive disorder
  • Isolated explosive disorder
  • Other
  • Mixed disturbance of conduct and emotions
  • Other specified disturbances of conduct, not elsewhere classified
  • Conduct disorder, childhood onset type
  • Conduct disorder, adolescent onset type
  • Other conduct disorder
  • Unspecified disturbance of conduct
313
  • 313.0
  • 313.1
  • 313.2
  • 313.3
  • 313.81
  • 313.82
  • 313.83
  • 313.89
Disturbance of Emotions Specific to Childhood and Adolescence
  • Overanxious disorder
  • Misery and unhappiness disorder
  • Sensitivity, shyness, and social withdrawal disorder
  • Relationship problems
  • Oppositional disorder
  • Identity disorder
  • Academic underachievement disorder
  • Other
314
  • 314.00
  • 314.01
  • 314.1
  • 314.2
  • 314.8
  • 314.9
Hyperkinetc Syndrome of Childhood
  • Without mention of hyperactivity
  • With hyperactivity
  • Hyperkinesis with developmental delay
  • Hyperdinetic conduct disorder
  • Other specified manifestations of hyperkinetc syndrome
  • Unspecified hyperkinetic syndrome
315
  • 315.0
  • 315.00
  • 315.01
  • 315.02
  • 315.09
  • 315.1
  • 315.2
  • 315.3
  • 315.31
  • 315.39
  • 315.4
  • 315.5
  • 315.8
  • 315.9
Specific Delays in Development
  • Specific reading disorder
  • Reading disorder, unspecified
  • Alexia
  • Developmental dyslexia
  • Other
  • Specific arithmetical disorder
  • Other specific learning difficulties
  • Developmental speech or language disorder
  • Developmental language disorder
  • Other
  • Coordination disorder
  • Mixed development disorder
  • Other specified delays in development
  • Unspecified delay in development
316 Psychic Factors Associated with Diseases Classified Elsewhere
317 Mild Mental Retardation
318
  • 318.0
  • 318.1
  • 318.2
Other Specified Mental Retardation
  • Moderate mental retardation
  • Severe mental retardation
  • Profound mental retardation
319 Unspecified mental retardation
330
  • 330.0
  • 330.1
  • 330.2
  • 330.8
  • 330.9
Cerebral Degenerations Usually Manifest in Childhood
  • Leukodystrophy
  • Cerebral lipidoses
  • Cerebral degeneration in generalized lipidoses
  • Other specified cerebral degenerations in childhood
  • Unspecified cerebral degenerations in childhood
331
  • 331.1
  • 331.3
  • 331.4
Other Cerebral Degenerations
  • Pick's disease
  • Communicating hydrocephalus
  • Obstructive hydrocephalus
343
  • 343.0
  • 343.1
  • 343.2
  • 343.3
  • 343.4
  • 343.8
  • 343.8
  • 343.9
Infantile Cerebral Palsy
  • Diplegic
  • Hemiplegic
  • Quadriplegic
  • Monoplegic
  • Infantile hemiplegia
  • Other specified cerebral palsy
  • Other specified infantile cerebral palsy
  • Infantile cerebral palsy, unspecified
344
  • 344.0
  • 344.00
  • 344.01
  • 344.02
  • 344.03
  • 344.04
  • 344.09
  • 344.1
  • 344.2
  • 344.3
  • 344.30
  • 344.31
  • 344.32
  • 344.4
  • 344.40
  • 344.41
  • 344.42
  • 344.5
  • 344.6
  • 344.60
  • 344.61
  • 344.8
  • 344.81
  • 344.89
Other Paralytic Syndromes
  • Quadriplegia and quadriparesis
  • Quadriplegia, unspecified
  • C1-C4, complete
  • C1-C4, incomplete
  • C5-C7, complete
  • C5-C7, incomplete
  • Other
  • Paraplegia
  • Diplegia of upper limbs
  • Monoplegia of lower limb
  • Affecting unspecified side
  • Affecting dominant side
  • Affecting nondominant side
  • Monoplegia or upper limb
  • Affecting unspecified side
  • Affecting dominant side
  • Affecting nondominant side
  • Unspecified monoplegia
  • Cauda equina syndrome
  • Without mention of neurogenic bladder
  • With neurogenic bladder
  • Other specified paralytic syndromes
  • Locked-in state
  • Other specified paralytic syndrome
345
  • 345.0
  • 345.1
  • 345.2
  • 345.3
  • 345.4
  • 345.5
  • 345.6
  • 345.8
  • 345.9
Epilepsy
  • Generalized nonconvulsive epilepsy
  • Generalized convulsive epilepsy
  • Petit mal status
  • Grand mal status
  • Partial epilepsy, with impairment of consciousness
  • Partial epilepsy, without mention of impairment of consciousness
  • Infantile spasms
  • Other forms of epilepsy
  • Epilepsy, unspecified
369
  • 369.00
  • 369.10
  • 369.3
  • 369.4
  • 369.60
  • 369.61
  • 369.70
Blindness and Low Vision
  • Impairment level not further specified
  • Impairment level not further specified
  • Unqualified visual loss, both eyes
  • Legal blindness, as defined in U.S.A.
  • Impairment level not further specified
  • One eye: total impairment; other eye: not specified
  • Impairment level not further specified
370
  • 370.0
  • 370.00
Keratitis
  • Corneal ulcer
  • Corneal ulcer, unspecified
389
  • 389.00
  • 389.01
  • 389.02
  • 389.03
  • 389.04
  • 389.08
  • 389.1
  • 389.10
  • 389.11
  • 389.12
  • 389.14
  • 389.18
  • 389.2
  • 389.7
  • 389.8
  • 389.9
Hearing Loss
  • Conductive hearing loss
  • Conductive hearing loss, external ear
  • Conductive hearing loss, tympanic membrane
  • Conductive hearing loss, middle ear
  • Conductive hearing loss, inner ear
  • Conductive hearing loss of combined types
  • Sensorineural hearing loss
  • Sensorineural hearing loss, unspecified
  • Sensory hearing loss
  • Neural hearing loss
  • Central hearing loss
  • Sensorineural hearing loss of combined types
  • Mixed conductive and Sensorineural hearing loss
  • Deaf mutism, not elsewhere classifiable
  • Other specified forms of hearing loss
  • Unspecified hearing loss
394
  • 394.0
  • 394.1
  • 394.2
  • 394.9
Diseases of Mitral Valve
  • Mitral stenosis
  • Rheumatic mitral insufficiency
  • Mitral stenosis with insufficiency
  • Other and unspecified mitral valve diseases
395
  • 395.0
  • 395.1
  • 395.2
  • 395.9
Diseases of Aortic Valve
  • Rheumatic aortic stenosis
  • Rheumatic aortic insufficiency
  • Rheumatic aortic stenosis with insufficiency
  • Other and unspecified rheumatic aortic diseases
396
  • 396.0
  • 396.1
  • 396.2
  • 396.3
  • 396.8
  • 396.9
Diseases of Vitral and Aortic Valves
  • Mitral valve stenosis and aortic valve stenosis
  • Mitral valve stenosis and aortic valve insufficiency
  • Mitral valve insufficiency and aortic valve stenosis
  • Mitral valve insufficiency and aortic valve insufficiency
  • Multiple involvement of mitral and aortic valves
  • Mitral and aortic valve diseases, unspecified
493
  • 493.0
  • 493.1
  • 493.2
  • 493.9
Asthma
  • Extrinsci asthma
  • Intrinsic asthma
  • Chronic obstructive asthma
  • Asthma, unspecified
494 Bronchiectasis
580 Acute Glomerulonephritis
581
  • 581.0
  • 581.1
  • 581.2
  • 581.3
  • 581.81
  • 581.89
  • 581.9
Nephrotic Syndrome
  • With lesion of proliferative glomerulonephritis
  • With lesion of membranous glomerulonephritis
  • With lesion of membranoproliferative glomerulonephritis
  • With lesion of minimal change glomerulonephritis
  • Nephrotic syndrome in diseases classified elsewhere
  • Other
  • Nephrotic syndrome with unspecified pathological lesion in kidney
584
  • 584.5
  • 584.6
  • 584.7
  • 584.8
  • 584.9
Acute Renal Failure
  • With lesion of tubular necrosis
  • With lesion of renal cortical necrosis
  • With lesion of renal medullary (papillary) necrosis
  • With other specified pathological lesion in kidney
  • Acute renal failure, unspecified
585 Chronic Renal Failure
586 Renal Failure, Unspecified
587 Renal Sclerosis, Unspecified
588
  • 588.0
  • 588.1
  • 588.8
  • 588.9
Disorders Resulting From Impaired Renal Function
  • Renal osteodystrophy
  • Nephrogenic diabetes insipidus
  • Other specified disorders resulting from impaired renal function
  • Unspecified disorder resulting from impaired renal function
589
  • 589.0
  • 589.1
  • 589.9
Small Kidney of Unknown Cause
  • Unilateral small kidney
  • Bilateral small kidneys
  • Small kidney, unspecified
714
  • 714.3
  • 714.30
  • 714.31
  • 714.32
  • 714.33
Rheumatoid Arthritis and Other Inflammatory Polyarthropathies
  • Juvenile chronic polyarthritis
  • Polyarticular juvenile rheumatoid arthritis, chronic or unspecified
  • Polyarticular juvenile rheumatoid arthritis, acute
  • Pauciarticular juvenile rheumatoid arthritis
  • Monoarticular juvenile rheumatoid arthritis
741
  • 741.0
  • 741.9
  • 742.0
  • 742.1
  • 742.2
  • 742.3
Spina Bifida
  • With hydrocephalus
  • Without mention of hydrocephalus
  • Encephalocele
  • Microcephalus
  • Reduction deformities of brain
  • Congenital hydrocephalus
744
  • 744.5
  • 744.83
  • 744.84
  • 744.9
Congenital Anomalies of Ear, Face, and Neck
  • Webbing of neck
  • Macrostomia
  • Microstomia
  • Unspecified anomalies of face and neck
745
  • 745.0
  • 745.1
  • 745.12
  • 745.19
  • 745.2
  • 745.3
  • 745.4
  • 745.5
  • 745.6
  • 745.60
  • 745.61
  • 745.69
  • 745.7
  • 745.8
  • 745.9
Bulbus Cordis Anomalies and Anomalies of Cardiac Septal Closure
  • Common truncus
  • Transposition of great vessels
  • Carrected transportation of great vessels
  • Other
  • Tetralogy of fallot
  • Common ventricle
  • Ventricular septal defect
  • Ostium secundum type atrial septal defect
  • Endocardial cushion defects
  • Endocardial cushion defect, unspecified type
  • Ostium primum defect
  • Other (absence of atrial septum, atrioventricular canal type ventricular septal defect, common atriventricular canal, common atrium)
  • Cor biolculare
  • Other
  • Unspecified defect of septal closure
746
  • 746.0
  • 746.00
  • 746.01
  • 746.02
  • 746.09
  • 746.1
  • 746.2
  • 746.3
  • 746.4
  • 746.5
  • 746.6
  • 746.7
  • 746.8
  • 746.81
  • 746.82
  • 746.83
  • 746.84
  • 746.85
  • 746.86
  • 746.87
  • 746.89
  • 746.9
Other Congenital Anomalies of Heart
  • Anomalies of pulmonary valve
  • Pulmonary valve anomly, unspecified
  • Atresia, congenital
  • Stenosis, congenital
  • Other
  • Tricuspid atresia and stenosis, congenital
  • Ebstein's anomaly
  • Congenital stenosis of aortic valve
  • Congenital insufficiency of aortic valve
  • Congenital mitral stenosis
  • Congenital mitral insufficiency
  • Hypoplastic left heart syndrome
  • Other specified anomalies of heart
  • Subaortic stenosis
  • Cor triatriatum
  • Infundibular pulmonic stenosis
  • Obstructive anomalies of heart, not elsewhere classified
  • Coronary artery anomaly
  • Congenital heart block
  • Malposition of heart and cardiac apex
  • Other
  • Unspecified anomaly of heart
747
  • 747.0
  • 747.1
  • 747.2
  • 747.20
  • 747.21
  • 747.22
  • 747.29
  • 747.3
  • 747.4
  • 747.40
  • 747.41
  • 747.42
  • 747.49
  • 747.5
  • 747.6
  • 747.60
  • 747.81
Other Congenital Anomalies of Circulatory System
  • Patent ductus arteriosus
  • Coarctation of aorta
  • Other anomalies of aorta
  • Anomaly of aorta, unspecified
  • Anomalies of aortic arch
  • Atresia and stenosis of aorta
  • Other
  • Anomalies of pulmonary artery
  • Anomalies of great veins
  • Anomaly of great veins, unspecified
  • Total anomalous pulmonary venous connection
  • Partial anomalous pulmonary venous connection
  • Other anomalies of great veins
  • Absence or hypoplasia of umbilical artery
  • Other anomalies of peripheral vascular system
  • Anomaly of the peripheral vascular system, unspecified site
  • Anomalies of cerebrovascular system
748
  • 748.0
Congenital Anomalies of Respiratory System
  • Choanal atresia
749
  • 749.00
  • 749.01
  • 749.02
  • 749.03
  • 749.04
  • 749.1
  • 749.10
  • 749.11
  • 749.12
  • 749.13
  • 749.14
  • 749.20
  • 749.21
  • 749.22
  • 749.23
  • 749.24
  • 749.25
Cleft Palate and Cleft Lip
  • Cleft palate, unspecified
  • Unilateral, complete
  • Unilateral, incomplete
  • Bilateral, complete
  • Bilateral, incomplete
  • Cleft lip
  • Cleft lip, unspecified
  • Unilateral, complete
  • Unilateral, incomplete
  • Bilateral, complete
  • Bilateral, incomplete
  • Cleft palate with cleft lip, unspecified
  • Unilateral, complete
  • Unilateral, incomplete
  • Bilateral, complete
  • Bilateral, incomplete
  • Other combinations
750
  • 750.4
  • 750.5
Other Congenital Anomalies of Upper Alimentary Tract
  • Other specified anomalies of esophagus
  • Congenital hypertrophic pyloric stenosis
751
  • 751.0
  • 751.1
  • 751.2
  • 751.3
  • 751.4
  • 751.5
  • 751.6
  • 751.60
  • 751.61
  • 751.62
  • 751.69
  • 751.7
  • 751.8
Other Congenital Anomalies of Stomach
  • Meckel's diverticulum
  • Atresia and stenosis of small intestine
  • Atresia and stenosis of large intestine, rectum, and anal canal
  • Hirschsprung's disease and other congenital functional disorders of colon
  • Anomalies of intestinal fixation
  • Other anomalies of intestine
  • Anomalies of gallbladder, bile ducts, and liver
  • Unspecified anomaly of gallbladder, bile ducts, and liver
  • Biliary atresia
  • Congenital cystic disease of liver
  • Other anomalies of gallbladder, bile ducts, and liver
  • Anomalies of pancreas
  • Other specified anomalies of digestive system
754
  • 754.11
Certain Congenital Musculoskeletal Deformities
  • Double outlet right ventricle
758
  • 758.0
  • 758.1
  • 758.2
  • 758.3
  • 758.4
  • 758.6
  • 758.7
  • 758.8
  • 758.9
Chromosomal Anomalies
  • Down's syndrome
  • Patau's syndrome
  • Edwards's syndrome
  • Autosomal deletion syndomes
  • Balanced autosomal translocation in normal individual
  • Gonadal dysgenesis
  • Klinefelter's syndrome
  • Other conditions due to sex chromosome anomalies
  • Conditions due to anomaly of unspecified chromosome
765
  • 765.0
  • 765.1
Disorders Relating to Short Gestation and Unspecified Low Birth Weight
  • Extreme immaturity
  • Other preterm infants
766
  • 766.0
  • 766.1
  • 766.2
Disorders Relating to Long Gestation and High Birth Weight
  • Exceptionally large baby
  • Other "heavy-for-dates" infants
  • Post-term infant, not "heavy-for-dates"
770
  • 770.0
  • 770.1
  • 770.2
  • 770.3
  • 770.4
  • 770.5
  • 770.6
  • 770.7
  • 770.8
  • 770.9
Other Respiratory Conditions of Fetus and Newborn
  • Congenital pneumonia
  • Meconium aspiration syndrome
  • Interstitial emphysema and related conditions
  • Pulmonary hemorrhage
  • Primary atelectasis
  • Other and unspecified atelectasis
  • Transitory tachypnea of newborn
  • Chronic respiratory disease arising in the perinatal period
  • Other respiratory problems after birth
  • Unspecified respiratory condition of fetus and newborn
771
  • 771.0
  • 771.1
  • 771.2
Infectious Specific to the Perinatal Period
  • Congenital rebella
  • Congenital cytomegalovirus infection
  • Other congenital infections
800
  • 800.0
  • 800.1
  • 800.2
  • 800.3
  • 800.4
  • 800.5
  • 800.6
  • 800.7
  • 800.8
  • 800.9
Fracture of Vault of Skull
  • Closed without mention of intracranial injury
  • Closed with cerebral laceration and contusion
  • Closed with subarachnoid, subdural, and extradural hemorrhage
  • Closed with other and unspecified intracranial hemorrhage
  • Closed with intracranial injury of other and unspecified nature
  • Open without mention of intracranial injury
  • Open with cerebral laceration and contusion
  • Open with subarachnoid, subdural, and extradural hemorrhage
  • Open with other and unspecified intracranial hemorrhage
  • Open with intracranial injury of other and unspecified nature
801
  • 801.0
  • 801.1
  • 801.2
  • 801.3
  • 801.4
  • 801.5
  • 801.6
  • 801.7
  • 801.8
  • 801.9
Fracture of Base of Skull
  • Closed without mention of intracranial injury
  • Closed with cerebral laceration and contusion
  • Closed with subarachnoid, subdural, and extradural hemorrhage
  • Closed with other and unspecified intracranial hemorrhage
  • Closed with intracranial injury of other and unspecified nature
  • Open without mention of intracranial injury
  • Open with cerebral laceration and contusion
  • Open with subarachnoid, subdural, and extradural hemorrhage
  • Open with other and unspecified intracranial hemorrhage
  • Open with intracranial injury of other and unspecified nature
802
  • 802.0
  • 802.1
  • 802.2
  • 802.20
  • 802.21
  • 802.22
  • 802.23
  • 802.24
  • 802.25
  • 802.26
  • 802.27
  • 802.28
  • 802.29
  • 802.3
  • 802.30
  • 802.31
  • 802.32
  • 802.33
  • 802.34
  • 802.35
  • 802.36
  • 802.37
  • 802.38
  • 802.39
  • 802.4
  • 802.5
  • 802.6
  • 802.7
Fracture of Face Bones
  • Nasal bones, closed
  • Nasal bones, open
  • Mandible, closed
  • Unspecified site
  • Condylar process
  • Subcondylar
  • Coronoid process
  • Ramus, unspecified
  • Angle of jaw
  • Symphysis of body
  • Alveolar border of body
  • Body, other and unspecified
  • Multiple sites
  • Mandible, open
  • Unspecified site
  • Condylar process
  • Subcondylar
  • Coronoid process
  • Ramus, unspecified
  • Angle of jaw
  • Symphysis of body
  • Alveolar border of body
  • Body, other and unspecified
  • Multiple sites
  • Malar and maxillary bones, closed
  • Malar and maxillary bones, open
  • Orbital floor (blow-out), closed
  • Orbital floor (blow-out), open
803
  • 803.0
  • 803.1
  • 803.2
  • 803.3
  • 803.4
  • 803.5
  • 803.6
  • 803.7
  • 803.8
  • 803.9
Other Unqualified Skull Fractures
  • Closed without mention of intracranial injury
  • Closed with cerebral laceration and contusion
  • Closed with subarachnoid, subdural, and extradural hemorrhage
  • Closed with other and unspecified intracranial hemorrhage
  • Closed with intracranial injury of other and unspecified nature
  • Open without mention of intracranial injury
  • Open with cerebral laceration and contusion
  • Open with subarachnoid, subdural, and extradural hemorrhage
  • Open with other and unspecified intracranial hemorrhage
  • Open with intracranial injury of other and unspecified nature
806
  • 806.0
  • 806.00
  • 806.01
  • 806.02
  • 806.03
  • 806.04
  • 806.05
  • 806.06
  • 806.07
  • 806.08
  • 806.09
  • 806.1
  • 806.10
  • 806.11
  • 806.12
  • 806.13
  • 806.14
  • 806.15
  • 806.16
  • 806.17
  • 806.18
  • 806.19
  • 806.2
  • 806.20
  • 806.21
  • 806.22
  • 806.23
  • 806.24
  • 806.25
  • 806.26
  • 806.27
  • 806.28
  • 806.29
  • 806.3
  • 806.30
  • 806.31
  • 806.32
  • 806.33
  • 806.34
  • 806.35
  • 806.36
  • 806.37
  • 806.38
  • 806.39
  • 806.4
  • 806.5
  • 806.6
  • 806.60
  • 806.61
  • 806.62
  • 806.69
  • 806.7
  • 806.70
  • 806.71
  • 806.72
  • 806.79
  • 806.8
  • 806.9
Fracture of Vertebral Column with Spinal Cord Injury
  • Cervical, closed
  • C1-C4 level with unspecified spinal cord injury
  • C1-C4 level with complete lesion of cord
  • C1-C4 level with anterior cord syndrome
  • C1-C4 level with central cord syndrome
  • C1-C4 level with other specified spinal cord injury
  • C5-C7 level with unspecified spinal cord injury
  • C5-C7 level with complete lesion of cord
  • C5-C7 level with anterior cord syndrome
  • C5-C7 level with central cord syndrome
  • C5-C7 level with other specified spinal cord injury
  • Cervical, open
  • C1-C4 level with unspecified spinal cord injury
  • C1-C4 level with complete lesion of cord
  • C1-C4 level with anterior cord syndrome
  • C1-C4 level with central cord syndrome
  • C1-C4 level with other specified spinal cord injury
  • C5-C7 level with unspecified spinal cord injury
  • C5-C7 level with complete lesion of cord
  • C5-C7 level with anterior cord syndrome
  • C5-C7 level with central cord syndrome
  • C5-C7 level with other specified spinal cord injury
  • Dorsal [Thoracic], closed
  • T1-T6 level with unspecified spinal cord injury
  • T1-T6 level with complete lesion of cord
  • T1-T6 level with anterior cord syndrome
  • T1-T6 level with central cord syndrome
  • T1-T6 level with other specified spinal cord injury
  • T5-T12 level with unspecified spinal cord injury
  • T5-T12 level with complete lesion of cord
  • T5-T12 level with anterior cord syndrome
  • T5-T12 level with central cord syndrome
  • T5-T12 level with other specified spinal cord injury
  • Dorsal [Thoracic], open
  • T1-T6 level with unspecified spinal cord injury
  • T1-T6 level with complete lesion of cord
  • T1-T6 level with anterior cord syndrome
  • T1-T6 level with central cord syndrome
  • T1-T6 level with other specified spinal cord injury
  • T5-T12 level with unspecified spinal cord injury
  • T5-T12 level with complete lesion of cord
  • T5-T12 level with anterior cord syndrome
  • T5-T12 level with central cord syndrome
  • T5-T12 level with other specified spinal cord injury
  • Lumbar, closed
  • Lumbar,open
  • Sacrum and coccyx, closed
  • With unspecified spinal cord injury
  • With complete cauda equina lesion
  • With other cauda equina injury
  • With other spinal cord injury
  • Sacrum and coccyx, open
  • With unspecified spinal cord injury
  • With complete cauda equina lesion
  • With other cauda equina injury
  • With other spinal cord injury
  • Unspecified, closed
  • Unspecified, open
807 Fracture of Rib(s), Sternum, Larynx, and Trachea
940
  • 940.0
  • 940.1
  • 940.2
  • 940.3
  • 940.4
  • 940.5
  • 940.9
Burn Confined to Eye and Adnexa
  • Chemical burn of eyelids and periocular area
  • Other burns of eyelids and periocular area
  • Alkaline chemical burn of cornea and conjunctival sac
  • Acid chemical burn of cornea and conjunctival sac
  • Other burn of cornea and conjunctival sac
  • Burn with resulting rupture and destruction of eyeball
  • Unspecified burn of eye and adnexa
941
  • 941.0
  • 941.1
  • 941.2
  • 941.3
  • 941.4
  • 941.5
Burns of Face, Head, and Neck (include all 5th digit code)
  • Unspecified degree
  • Erythema (first degree)
  • Blisters, epidermal loss (second degree)
  • Full-thickness skin loss (third degree NOS)
  • Deep necrosis of underlying tissues (deep third degree) without mention of loss of a body part
  • Deep necrosis of underlying tissues (deep third degree) with loss of a body part
942
  • 942.0
  • 942.1
  • 942.2
  • 942.3
  • 942.4
  • 942.5
Burn of Trunk (include all 5th digit codes)
  • Unspecified degree
  • Erythema (first degree)
  • Blisters, epidermal loss (second degree)
  • Full-thickness skin loss (third degree NOS)
  • Deep necrosis of underlying tissues (deep third degree) without mention of loss of a body part
  • Deep necrosis of underlying tissues (deep third degree) with loss of a body part
943
  • 943.0
  • 943.1
  • 943.2
  • 943.3
  • 943.4
  • 943.5
Burn of Trunk (include all 5th digit codes)
  • Unspecified degree
  • Erythema (first degree)
  • Blisters, epidermal loss (second degree)
  • Full-thickness skin loss (third degree NOS)
  • Deep necrosis of underlying tissues (deep third degree) without mention of loss of a body part
  • Deep necrosis of underlying tissues (deep third degree) with loss of a body part
944
  • 944.0
  • 944.1
  • 944.2
  • 944.3
  • 944.4
  • 944.5
Burn of Trunk (include all 5th digit codes)
  • Unspecified degree
  • Erythema (first degree)
  • Blisters, epidermal loss (second degree)
  • Full-thickness skin loss (third degree NOS)
  • Deep necrosis of underlying tissues (deep third degree) without mention of loss of a body part
  • Deep necrosis of underlying tissues (deep third degree) with loss of a body part
945
  • 945.0
  • 945.1
  • 945.2
  • 945.3
  • 945.4
  • 945.5
Burn of Trunk (include all 5th digit codes)
  • Unspecified degree
  • Erythema (first degree)
  • Blisters, epidermal loss (second degree)
  • Full-thickness skin loss (third degree NOS)
  • Deep necrosis of underlying tissues (deep third degree) without mention of loss of a body part
  • Deep necrosis of underlying tissues (deep third degree) with loss of a body part
946
  • 946.0
  • 946.1
  • 946.2
  • 946.3
  • 946.4
  • 946.5
Burns of Multiple Specified Sites
  • Unspecified degree
  • Erythema (first degree)
  • Blisters, epidermal loss (second degree)
  • Full-thickness skin loss (third degree NOS)
  • Deep necrosis of underlying tissues (deep third degree) without mention of loss of a body part
  • Deep necrosis of underlying tissues (deep third degree) with loss of a body part
947
  • 947.0
  • 947.1
  • 947.2
  • 947.3
  • 947.4
  • 947.8
  • 947.9
Burn of Internal Organs
  • Mouth and pharynx
  • Larynx, trachea, and lung
  • Esophagus
  • Gastrointestinal tract
  • Vagina and uterus
  • Other specified sites
  • Unspecified site
948
  • 948.0
  • 948.1
  • 948.2
  • 948.3
  • 948.4
  • 948.5
  • 948.6
  • 948.7
  • 948.8
  • 948.9
Burns Classified According to Extent of Body Surface Involved
  • Burn (any degree) involving less than 10 percent of body surface (include all 5th digit codes)
  • 10-19 percent of body surface
  • 20-29 percent of body surface
  • 30-39 percent of body surface
  • 40-49 percent of body surface
  • 50-59 percent of body surface
  • 60-69 percent of body surface
  • 70-79 percent of body surface
  • 80-89 percent of body surface
  • 90percent or more of body surface
949
  • 949.0
  • 949.1
  • 949.2
  • 949.3
  • 949.4
  • 949.5
Burn, Unspecified
  • Unspecified degree
  • Erythema (first degree)
  • Blisters, epidermal loss (second degree)
  • Full-thickness skin loss (third degree (NOS)
  • Deep necrosis of underlying tissues (deep third degree) without mention of loss of a body part
  • Deep necrosis of underlying tissues (deep third degree) with loss of a body part
995.5 Child maltreatment syndrome

 

APPENDIX B. ITEMS USED TO MEASURE FUNCTIONAL STATUS

Enter child number and first/last name of child with special health care needs listed in Section 1, #16.

Child Number:__________ First Name:__________ Last Name:__________

FUNCTIONAL STATUS II (R) 14-ITEM VERSION (English)

Here are some statements that mothers have made to describe their children. Thinking about __________ (INDEX CHILD), during the last two weeks did he/she...

  PART 1 PART 2  
Never of Rarely Some of the Time Almost Always Fully Partly Not At All
17. Eat well 0* 1* 2___ 2 1 0___ FS1
18. Sleep well 0* 1* 2___ 2 1 0___ FS2
19. Seem contented and cheerful 0* 1* 2___ 2 1 0___ FS3
20. Act moody 0 1* 2*___ 2 1 0___ FS4
21. Communicate what he/she wanted 0* 1* 2___ 2 1 0___ FS5
22. Seem to feel sick and tired 0 1* 2*___ 2 1 0___ FS6
23. Occupy himself/herself 0* 1* 2___ 2 1 0___ FS7
24. Seem lively and energetic 0* 1* 2___ 2 1 0___ FS8
25. Seem unusually irritable or cross 0 1* 2*___ 2 1 0___ FS9
26. Sleep through the night 0* 1* 2___ 2 1 0___ FS10
27. Respond to your attention 0* 1* 2___ 2 1 0___ FS11
28. Seem unusually difficult 0 1* 2*___ 2 1 0___ FS12
29. Seem interested in what was going on around him/her 0* 1* 2___ 2 1 0___ FS13
30. React to little things by crying 0 1* 2*___ 2 1 0___ FS14

Copyright 1981
Ruth E.K. Stein, M.D.
Catherine K. Riessman, Ph.D.
Dorothy Jones Jessop, Ph.D.

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