Students Speak Out

Victories

National Victories

Strides in Federal Policy for School-Based Health Care

In the early years of the School-Based Health Care Policy Program (SBHCPP), few might have predicted the degree of progress that would transpire over the next several years in advancing federal policy change on behalf of school based health centers (SBHCs). In 2004, SBHCs attracted little attention in federal policy circles, either within Congress or among other advocacy groups that worked to advance the interests of children and families. Since that time, much has changed.

Children’s Health Insurance Program Reauthorization Act

The Children’s Health Insurance Program Reauthorization Act (CHIPRA.pdf) defines and recognizes SBHCs as a potential provider of services, for the first time establishing a legal basis for being reimbursed for their services.

Achieving recognition of SBHCs in CHIPRA was precedent setting–no federal insurance program had ever before included a definition of a SBHC. Based on language provided by the National Assembly on School-Based Health Care and its state partners in the SBHCPP, the Act stipulates that a state may “…provide child health assistance for covered items and services that are furnished through SBHCs,” a provision that allows SBHCs to seek status as a provider eligible to receive reimbursement from their states’ Children’s Health Insurance Programs(CHIP).1 The provision also enables SBHCs to negotiate with managed care plans that participate in CHIP for reimbursement for the services they provide and to help SBHCs obtain provider status under Medicaid in those states where the CHIP program is part of the Medicaid program. This recognition provides SBHCs nationwide with a platform and legal foundation on which to negotiate payments and reimbursement from insurers and managed care organizations. As a staff member on the Committee that oversees the CHIP legislation noted, the fact that SBHCs are now codified into law provides a major foothold for SBHCs and opens the door for emerging opportunities for reimbursement and recognition from the federal government. This achievement enables SBHCs to broaden its revenue streams by more easily negotiating agreements for reimbursement with managed care organizations for the care they provide to the organization’s CHIP enrollees. CHIPRA is expected to enable 6.5 million new children to become eligible to receive coverage by the CHIP and Medicaid.

In addition, as the National Assembly reports, “the language validating SBHCs as CHIP providers, and the existence of a statutory definition, should ease the way for the establishment of federal laws and regulations to ensure that SBHCs are reimbursed by government programs, and possibly, for the creation of a federal grant program for SBHCs.”2

CHIPRA’s definition of a SBHC, as specified originally by the National Assembly and a state association in the Act’s language, also specifically includes SBHCs run by the Indian Health Service, the Bureau of Indian Affairs or by tribal governments. By recognizing these entities as providers of SBHC services, CHIPRA creates the legal precedent for SBHCs to be reimbursed for the services they provide to Native American children covered by these systems and programs.

Patient Protection and Affordable Care Act

In March, 2010, advocates for school-based health centers experienced an unprecedented legislative victory: a SBHC grant program was established in the historic health reform legislation, the Patient Protection and Affordable Care Act (PPACA.pdf). A detailed account of the legislation’s provisions for SBHCs can be found here.

Creating a grant program for SBHCs provides a legal channel for allocating federal revenue in support of SBHCs nationwide and establishes the federal government’s commitment to support SBHCs. This legislation represents a path breaking accomplishment that sets the stage for developing designated and ongoing federal appropriations for SBHCs.

“We are thrilled that part of the [health reform] legislation calls for an expanded footprint of school-based health clinics,” said Secretary of Health and Human Services, Kathleen Sebelius, speaking at the Coalition for Community Schools biannual convention in 2010. “I can’t think of a better way to deliver primary care and preventive care to not only students but their families than through school-based clinics. …the Secretary of Education and I have already talked about how we’re going to leverage that money, how widely we can expand that footprint, and how quickly we can get it done.”3

PPACA also included a $200 million appropriation for SBHCs’ construction and equipment needs. This funding helps sites buy licenses for electronic medical records which will help SBHCs comply with the technology mandates of health care reform. SBHCs are also eligible for the incentives for providers to get ready to be a “meaningful use provider” in the implementation of health reform in 2014, e.g., electronic medical records and information and insurance exchanges.  The language that specifically called out SBHCs in the legislation is important in future advocacy for sustainable SBHCs.

Securing authorizing legislation for SBHCs through health reform reflects the culmination of years of work around establishing a federal standalone legislation to authorize SBHCs. The School-Based Health Clinic Establishment Act of 2007, a bill to authorize a federal grants program for SBHCs, helped set the stage for the current legislation by mobilizing the field, engaging in Washington D.C.-based outreach, and building Congressional champions in collaborative and broad-based advocacy for a federal authorization program.

 

 

 


  1. For the SBHC language in CHIP, see National Assembly on School-Based Health Care website: http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.4956831/k.5CD7/Advocacy_SCHIP_language.htm. Accessed June 2009.
  2. SCHIP Reauthorization Passes. National Assembly on School-Based Health Care Web site. http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.3083789/k.5A51/Advocacy_Hill_Activity.htm#CHIP. Accessed June 2009.
  3. National Assembly on School-Based Health Care Capstone Report, 2006-2010. Outcomes of policy advocacy for goal 4. 2010;22.