Today, on the Mental Health Awareness Day of Action, the Biden-Harris Administration is taking bold action to make it easier for schools to provide critical health care services, especially mental health services, for millions of students across the nation. These three significant actions support President Biden’s comprehensive national mental health strategy and deliver on his commitment to tackle the nation’s mental health crisis as part of his Unity Agenda. Through a series of new announcements from the U.S. Departments of Education (ED) and Health and Human Services (HHS), the Administration is continuing to take a whole-of-government approach to meet families where they are and ensure that children have access to the health care they need – especially mental health services.
Specifically, ED is proposing a new rule that would streamline Medicaid billing permissions for students with disabilities. ED predicts of the 500,000 new students who are found eligible under the Individuals with Disabilities Education Act (IDEA) Part B each year, nearly 300,000 are likely to be eligible for Medicaid and impacted by this rule. HHS is issuing new guidance to make it easier for schools to bill Medicaid. HHS also is approving requests from New Mexico and Oregon to expand health care services that schools can deliver to Medicaid enrolled students.
“Students are six times more likely to access mental health when these services are offered in school, and that’s one important reason why making it easier for schools to provide health care is at the heart of the Biden-Harris Administration’s efforts to address the youth mental health crisis and raise the bar for learning conditions in our schools,” said U.S. Secretary of Education Miguel Cardona. “These new resources and proposed rules will help schools live up to the promise that all students, including those with disabilities, receive a free, appropriate public education. We need to continue breaking down barriers that have long undermined state and local efforts to provide health care services to students, including those covered by Medicaid. Ultimately, more children and youth will gain access to the physical and mental health services they need to succeed in school and in life as a result of the actions the Biden-Harris Administration is taking today.”
“We are taking bold actions to strengthen school-based health care services through our Medicaid program so that children in every community have the support they need,” said HHS Secretary Xavier Becerra. “President Biden has made clear that strengthening youth mental health is a top priority of this Administration. We are working across the federal government, as well as with all states, territories and tribes, to meet families where they are and provide students with the services and supports they need to be healthy and thrive.”
IDEA Act Notice of Proposed Rulemaking
ED is releasing a Notice of Proposed Rulemaking under IDEA that would streamline consent provisions when billing for Medicaid services provided through a student’s individualized education program (IEP). This would result in a uniform process applicable to all Medicaid enrolled children, regardless of disability.
Many children with disabilities receiving services under the IDEA are also enrolled in Medicaid either due to their disability status and/or based on their family income. Children with disabilities are more likely to have low income, and those covered by Medicaid are more likely to have greater health care needs than those who are covered by private insurance. Further, the COVID-19 pandemic reduced access to critical services for children with disabilities and other vulnerable populations. To meet the Administration’s goal of increasing access to health and mental health services, and in fulfillment of the Bipartisan Safer Communities Act (BSCA) provision of expanding access to crucial school-based services for mental health and other care needs, it is crucial to remove barriers for schools so they can more easily provide Medicaid-covered services to their students enrolled in Medicaid.
Importantly, the proposed changes announced today do not alter any of the critical parental consent provisions required by IDEA nor do they impact the parental consent obligations under the Family Educational Records and Privacy Act (FERPA). Additionally, the proposed rule does not alter the requirement that IEP services must be delivered at no cost to the child’s family, the requirement that IEP services cannot diminish other Medicaid-reimbursable services, nor Medicaid’s position as payor of first resort for IEP and Individualized Family Service Plan services. Rather, this regulatory change would help cut unnecessary red tape that schools and districts face in billing Medicaid and meet their obligations to ensure students with disabilities receive a free, appropriate public education in accordance with their IEP.
Guide to Expand School-based Services for Millions of Students
Today, HHS, through the Centers for Medicare & Medicaid Services (CMS), is releasing a comprehensive guide for Medicaid school-based services to make it easier for schools to deliver and receive payment for health care services to millions of eligible students. Developed in consultation with ED, the Comprehensive Guide to Medicaid Services and Administrative Claiming represents an important part of the Biden-Harris Administration’s implementation of the BSCA.
In addition to providing billions in funding for school-based mental health personnel and supports to create safe and welcoming school environments, BSCA charged ED and HHS to expand access to school-based health and behavioral health services. The guide released today outlines flexibilities states can adopt to make it easier for schools to get paid for these critical health services delivered to children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), which together provide health coverage to more than half of all children in the United States.
“With this guide, we are helping states and schools bring health care to kids where they are, rather than the other way around,” said CMS Administrator Chiquita Brooks-LaSure. “Children spend most of their waking hours in school. We also know that children have suffered serious declines in access to mental and behavioral health care services during the COVID-19 pandemic. We’re making it easier for states and schools to maximize Medicaid coverage to grow connections to care.”
Medicaid and CHIP cover more than half of all children in this country. That’s more than 41 million children spending over 30 hours weekly in school during most of the year. This comprehensive policy guide helps states and schools leverage Medicaid and CHIP and offers a roadmap of how they can build a bridge between education and health care, including mental health care, to support children enrolled in these programs and help them thrive.
The guide clarifies, consolidates, and expands on a wealth of CMS guidance on how schools can receive payment for providing care for Medicaid- and CHIP-enrolled students, and how states can ease the administrative burden on school-based health providers to promote their participation in Medicaid and CHIP while meeting federal statutory and regulatory requirements. This includes helping states and schools operationalize:
- How payments can be made for school-based services under Medicaid and CHIP;
- How states can simplify billing for school-based services, including in rural and small or under-resourced communities, where care may be particularly challenging;
- Examples of approved methods that state agencies have used to pay for covered services; and
- How to enroll qualified health care providers to participate in Medicaid and furnish services within school settings.
In the months to come, CMS plans to release more resources to help ensure states can optimize children’s access to school-based services. As outlined by BSCA, these resources include $50 million in grant opportunities and a school-based services technical assistance center, in partnership with ED. For more information on the guide, visit Medicaid.gov.
New Mexico and Oregon School-based Services Expansion Approval
HHS, through CMS, also approved state plan amendments (SPAs) for both New Mexico and Oregon that will allow Medicaid to pay for health care services schools delivered to more of their Medicaid-enrolled students. Specifically, these SPAs will allow New Mexico and Oregon to receive Medicaid funding for services provided to all children covered by Medicaid, rather than only those children with an IEP. These approvals expand access to school-based health services, a key priority for the Biden-Harris Administration, that will strengthen Medicaid and help provide resources to combat the youth mental health crisis. New Mexico and Oregon join 12 other states that have already expanded Medicaid payment for school-based health care services under their state plans. These states include: Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Louisiana, Massachusetts, Michigan, Nevada, and North Carolina.
These announcements collectively are part of the Biden-Harris Administration’s commitment to addressing the nation’s mental health crisis by providing more school-based resources and supports to help address students’ mental health needs. Today’s announcement comes on the heels of ED’s announcement earlier this week on the latest tranche of awards to train school-based mental health professionals through the Mental Health Service Professionals demonstration program, which provided another nearly $100 million in awards as part of an overall appropriation of $1 billion in BSCA for school-based mental health services and supports.
Collectively, these announcements build on actions HHS, CMS and ED have taken over the last year to expand access to school-based health care and trauma informed services. Last summer, CMS released guidance for states on to strengthen the delivery of Medicaid and Children Health Insurance Program (CHIP) youth behavioral health services and school-based services. Last fall, ED announced the Stronger Connections Grant program, which provided awards totaling $1 billion to 56 states and territories through BSCA to help schools in high-need districts provide students with safe, welcoming, and supportive learning opportunities and environments that are critical for their success. Last winter, HHS also awarded nearly $245 million to expand trauma informed services and supports for students and their families, including grants to State and Local Education Activities to bolster school-based services.
And at the beginning of the 2022-2023 school year, Secretary of Education Dr. Miguel Cardona and Secretary of HHS Xavier Becerra sent a letter to governors across the country to highlight federal resources available to states and schools to invest in mental health services for students. ED also awarded $122 billion in American Rescue Plan Elementary and Secondary School Emergency Relief funds to help schools reopen and recover, and experts indicate more than $2 billion has been directed to hire more school psychologists, counselors, and other mental health professionals in K-12 schools. With the help of these funds, as of March 2023, compared with the pre-pandemic period, the number of school social workers is up 48%, the number of school nurses is up 42%, and the numbers of school counselors and school psychologists are each up 10%.
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