The NASP Advocacy Roadmap for States: School-Based Medicaid Services A state level response resource to changes in school-based psychological services for Medicaid eligible students

NASP Advocacy Roadmap for States: School-Based Medicaid Services Set of resources designed to help state associations plan their grassroots advocacy response to changes in school-based psychological services to Medicaid eligible students. State association leaders and members need to actively monitor and respond to any changes in school-based psychological services and limitations placed upon these services provided by school psychologists.

NASP Advocacy Roadmap for States: School-Based Medicaid Services Since Medicaid State Plans and credentialing standards are prerogatives of state governments, school psychology leaders within states wishing to respond to changes within their state should become familiar with the content of the Roadmap and begin working at the state level to identify areas of need and appropriate activities for advocacy.

Exhibit A: Overview of School- based Medicaid Services This is a brief handout that summarizes key issues related to Medicaid and recent changes that have impacted the provision of school-based psychological services to Medicaid eligible students.

Key Issues What are School-based Medicaid Services? Individual State Medicaid Plans EPSDT Medicaid qualified providers Medicaid guidelines on provider qualifications

Exhibit B: Brief Summary of the Federal Medicaid Statute Summary of the authorization statute for school-based Medicaid services.

Exhibit C: Summary of the U.S. Department of Health and Human Services Office of Inspector General’s Medicaid Audits The Department of Health and Human Services’ Office of Inspector General (OIG) has engaged in numerous audits of school-based Medicaid services. The stated objective of these audits is to “determine whether local education agencies and cooperatives appropriately furnished, documented, and billed school- based services claimed for Federal Medicaid reimbursement and whether states appropriately claimed Federal funding for the services.” Only a small percentage of the audits analyzed services provided by school psychologists, broad recommendations regarding “provider qualifications” have resulted from many of these audits.

Highlights of OIG Audits 21 State OIG audits were reviewed (CT, FL, IL, IA, KS, ME, MD, MA, MN, NV, NJ, NY, NC, OK, OR, RI, TX, UT, VT, WA, WI), for a total of 42 audit reports. 4 audits (MA, NY, RI, TX) addressed, in part, school-based counseling services.

The CMS Medicaid and School Health: A Technical Assistance Guide (1997) In order for schools or school providers to participate in the Medicaid program and receive Medicaid reimbursement, they must meet the Medicaid provider qualifications. It is not sufficient for a state to use Department of Education provider qualifications for reimbursement of Medicaid-covered school health services Further, Medicaid regulations [42 CFR § ] require that provider qualifications be uniform and standard. This means that states cannot have one set of provider qualifications for school providers and another set of provider qualifications for all other providers. Schools should check with the state Medicaid agency to determine specific state requirements regarding provider qualifications for participation in the Medicaid program

Of the 21 states that were audited by the OIG : 15 states have a pathway for non-doctoral psychologists to provide services outside the school setting (CT, FL, IL, KS, ME, MD, MA, MN, NJ, NV, NC, OR, TX, VT, WI), 1 state obtained a “letter of equivalency” from the state attorney general’s office (OK), 5 states have no pathway for non-doctoral level psychologists to practice outside of school (IA, NY, RI, WA, UT). Of these 5 states, only NY and RI experienced procedural changes for reimbursement of school-based psychological services. Washington does not bill for counseling services provided by school psychologists.

Exhibit D: State Attorney Generals’ Opinions Related to School Psychology Official opinions offered by the State Attorneys General were reviewed for all 50 states. Relevant opinions related to school psychologists are summarized in this exhibit. These opinions may be helpful in formulating a state advocacy plan

Oklahoma Attorney General Scope of practice of a school psychologist is substantially equivalent to that of a licensed psychologist. Allows for Medicaid reimbursement.

Exhibit E: State Responses to Changes in Medicaid Reimbursement for School Psychological Services A survey was conducted with state school psychology associations’ executives, NASP SPAN Coordinators, and NASP State delegates to ascertain changes in school-based Medicaid services. A total of 33 responses from 28 states were received. This exhibit contains comments and feedback provided by various states.

Highlights of Survey Several states do not bill Medicaid for psychological services in the schools Changes in Medicaid reimbursement procedures have had a direct impact upon delivery of school psychology services and hiring of school psychologists. Some states have developed positive strategies to ensure continuation of services. In general, states that have uniform and standard qualifications for providers in the schools and providers in all other settings are able to continue eligibility for reimbursement of services.

Exhibit F: Checklist for State Advocacy Planning Responding to changes in Medicaid reimbursement procedures for school psychological services requires careful planning by state associations. This document summarizes the major advocacy activities that need to be addressed in order to provide a comprehensive and coordinated response.

The Top 10 Essential Advocacy Activities 1.Identify association leaders and develop a clear set of procedures for monitoring and responding to changes in Medicaid State Plan. 2.Conduct a needs assessment of the advocacy skills and knowledge of leaders and members. 3.Conduct a “risk” assessment (Exhibit I) of how vulnerable your state is to potential policies that would remove the right of non-doctoral and non-licensed school psychologists to be eligible to be reimbursed for services provided to Medicaid eligible students in school settings. 4.Complete the NASP Advocacy Roadmap for States: School- Based Medicaid Services, Profile of School Psychology Credentialing and Psychologist Licensing (Exhibit F). 5.Respond to needs assessment, risk assessment, Profile of State Credentialing, and other NASP Advocacy Roadmap for States: School-Based Medicaid Services materials by developing a State Action Plan (Exhibit H).

The Top 10 Essential Advocacy Activities 6.Set up ongoing State Action Plan (Exhibit H) monitoring and evaluation system. 7.Establish communication methods with state school psychologists where regular updates are posted, questions answered, and time sensitive action requests can be made. 8.Identify and reach out to key stakeholders, allies and allied organizations. 9.Prepare information packets or an “issue kit” that can be accessed easily and quickly. 10.Work with state administrators, psychology licensing boards, state credentialing boards, and other public policy agencies and personnel to work out agreements that articulate why school psychologists are essential to the mission and purpose of schools.

Exhibit G: Profile of School Psychology Credentialing and Psychologist Licensing Related to School-based Psychological Services It is recommended that every state gather information about the school psychology credentialing and psychologist licensing practices of their state. This Credentialing Profile will help states identify key information, public policy makers, and licensing and credentialing procedures so that school psychologists in each state are prepared to mount a grassroots advocacy campaign in response to changes in reimbursement procedures.

Exhibit H: Summary of School Psychology Advocacy Materials This handout provides links to a variety of advocacy materials developed to help state associations fine-tune their message regarding the critical importance of the services provided by highly qualified non- doctoral school psychologists.

Exhibit I: State Advocacy Action Plan Template This is a template to help state associations create an effective advocacy plan in response to changes in Medicaid reimbursement for school psychological services. This tool will assist states in identifying specific goals, associated activities, timelines, personnel responsible, needed resources, and anticipated outcomes.

Exhibit J: Risk and Asset Assessment Questionnaire This document is designed to help state associations determine the degree of risk and their assets in responding to potential changes in Medicaid reimbursement procedures for school-based services.

Exhibit K: Summary of Critical Resources for States This document provides a summary of critical online links to general Medicaid resources, related websites and allied professional groups. It includes links to state level resources and sample items from states.

Exhibit L: Frequently Asked Questions about Working with a Lobbyist One strategy that states may use in responding to changes in Medicaid reimbursement procedures is to hire a lobbyist to help in monitoring and responding to unfriendly legislation or regulations. This guide provides helpful tips on working with a lobbyist.

Exhibit M: Assistance Available to States This document summarizes resources, materials, and leader and staff contacts that NASP is able to provide state associations in mounting a campaign to defeat any unfriendly proposals emerging from changes in Medicaid reimbursement procedures.

Where do I go from here? Become familiar with resources in the Roadmap. Help others within your state association understand the resources of the Roadmap. Assess the needs of your state. Develop an Action Plan based upon your needs.

Exhibit N: Using the NASP Advocacy Roadmap: SBMS PPT This exhibit is this PowerPoint presentation….

For More Information … Stacy Skalski, NASP Director of Public Policy Gordy Wrobel, GPR Committee John Kelly, GPR Committee