The Bipartisan Safer Communities Act Makes It Easier for Schools to Receive Payments for Critical Health Services for Children Enrolled in Medicaid and CHIP
November 16, 2023
Overview
This year, the Department of Health and Human Services (HHS) released its Comprehensive Guide to Medicaid Services and Administrative Claiming, a 184-page guidance document implementing the recently passed Bipartisan Safer Communities Act and outlining how states can make it easier for schools to get paid for school-based Medicaid services.
In 2022, Congress passed the Bipartisan Safer Communities Act, requiring updates to outdated billing guides and providing more assistance to states, local education agencies (LEAs), and school-based entities seeking Medicaid reimbursement for school-based services (SBS). This year, the Department of Health and Human Services (HHS) released its Comprehensive Guide to Medicaid Services and Administrative Claiming, a 184-page guidance document implementing the new law and outlining how states can make it easier for schools to get paid for school-based Medicaid services.
Until 2014, schools and school districts were operating under longstanding guidance from the Centers for Medicare & Medicaid Services (CMS) that only allowed Medicaid to be billed for health services provided to Medicaid students if the service was included in an Individualized Education Plan (IEP). This policy, known as the “free care” rule, was reversed by CMS in 2014. The new guidance allowed school districts to expand their school-based Medicaid programs to cover more students, clarifying that schools could seek reimbursement for covered services provided to all students enrolled in Medicaid—not just those with IEPs.
Section 11003 of the BSCA, entitled “Supporting Access to Health Care Services In Schools,” codifies the free care policy reversal and requires the Secretary of HHS, in consultation with the Secretary of Education, to issue guidance to support the delivery of services to students covered by Medicaid and the Children’s Health Insurance Program (CHIP) in school-based settings. The new guidance issued this year by HHS, through CMS, provides states with the first explicit instructions from CMS regarding which services are eligible for Medicaid reimbursement.
The guidance states that federal funds for Medicaid services, including SBS, are only available when several requirements are met, including that the individual receiving the service is an enrolled Medicaid individual, the service is a covered Medicaid service, and the billing provider for the service is a participating Medicaid provider, among many other requirements.
In addition to the CMS guidance, the Department of Education has also published a Notice of Proposed Rulemaking under the Individuals with Disabilities Education Act (IDEA) that would streamline consent provisions when billing for Medicaid services provided through a student’s IEP. The current rule requires a public agency to obtain a one-time consent from the parent, after providing written notification, before accessing the child’s or the parent’s public benefits or insurance for the first time. The proposed rule would remove the requirement for parental consent prior to accessing a child’s or parent’s public benefits or insurance for the first time.
Ultimately, the new law and subsequent administrative actions should make it easier for schools to get paid for critical health services delivered to children enrolled in Medicaid and CHIP. The Network has issued a fact sheet entitled Medicaid Reimbursement for School Nursing Services, which explains the new federal law and implementing guidance, and provides an overview of various state legislative approaches.
This post was written by Max Breene, J.D. Candidate, Class of 2024, University of Maryland Francis King Carey School of Law and reviewed by Kerri McGowan Lowrey, J.D., M.P.H., Deputy Director of the Public Health Law Network Eastern Region. The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.