SB 684-FN - AS INTRODUCED
2020 SESSION
20-2909
06/05
SENATE BILL 684-FN
AN ACT relative to Medicaid to schools.
SPONSORS: Sen. Kahn, Dist 10; Sen. Levesque, Dist 12; Sen. Rosenwald, Dist 13; Sen. Fuller Clark, Dist 21; Sen. Chandley, Dist 11; Sen. Watters, Dist 4; Sen. Cavanaugh, Dist 16; Sen. Morgan, Dist 23; Sen. Carson, Dist 14; Sen. Gray, Dist 6; Sen. Starr, Dist 1; Sen. Sherman, Dist 24; Sen. Hennessey, Dist 5; Sen. Soucy, Dist 18; Rep. W. Thomas, Hills. 21; Rep. Luneau, Merr. 10
COMMITTEE: Education and Workforce Development
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ANALYSIS
This bill:
I. Authorizes the department of education to adopt rules relative to federal funding available to schools under New Hampshire's Medicaid program.
II. Permits professionals certified by the department of education who are providing medical services in public schools to be licensed by medical and health care boards.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
20-2909
06/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty
AN ACT relative to Medicaid to schools.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Statement of Purpose and Intent. The general court acknowledges the critical importance of ensuring the quality, accessibility, and sustainability of Medicaid services provided in the school setting, as well as ensuring that billing under the program meets all state and federal requirements. The purpose of this act is to strengthen the state's Medicaid to schools and Medicaid to schools for Medical services programs consistent with the Social Security Act. Accordingly, this act shall provide the department of health and human services with the additional authority to adopt administrative rules that maximize the availability of federal financial aid to schools under New Hampshire's Medicaid program. This act also provides a more efficient pathway to allow qualified professionals certified and credentialed by the department of education who are currently providing medical services in public schools to be licensed by medical and health care boards. Finally, this act further facilitates the provision of medical services in the school setting to students who are enrolled in participating public schools and Medicaid, thereby furthering the education and health of New Hampshire's students.
2 Medicaid to Schools Program. RSA 186-C:25, I-III are repealed and reenacted to read as follows:
I. The department of health and human services Medicaid reimbursement program shall be known as the "Medicaid to schools" program, providing medical assistance for covered services furnished to children with disabilities who are enrolled in Medicaid. The purpose of the program is to seek any and all Medicaid reimbursement for medical and health related services provided by local school districts and school administrative units to children with disabilities which are reimbursable under federal law but which were previously fully funded by such districts or administrative units. The program shall be voluntary and is designed to assist children with disabilities by maintaining them in their own homes and communities. The program shall be administered in the same, or similar, manner as the Medicaid to schools for medical services program established in RSA 167:3-k. This subdivision is intended to provide Medicaid funding for services which, in the absence of such funding, nevertheless qualify as special education or related services under this chapter. It is not the intention of this subdivision to increase school district responsibility or liability beyond what is required by other sections of this chapter.
II. A reimbursable service under this section shall be:
(a) A covered New Hampshire Medicaid state plan service, or a service not covered under the state's Medicaid state plan, but coverable pursuant to 1905(a) of the Social Security Act through the Early and Periodic Screening Diagnosis and Treatment (EPSDT) benefit;
(b) Provided to a Medicaid enrolled child after obtaining parental consent;
(c) Provided by a Medicaid qualified provider;
(d) Medically necessary; and
(e) Provided in compliance with applicable state and federal law and rules.
III. Services provided under this subdivision shall:
(a) Offer the least restrictive setting for children receiving the services.
(b) Be in addition to any special education program as defined in the New Hampshire rules for the education of children with disabilities.
III-a. Any provider who orders, refers, prescribes, renders, or provides services under this section shall do so in accordance with the relevant health professional practice act and regulations including, but not limited to, RSA 137-F, RSA 317-A, RSA 326-B, RSA 326-C, RSA 326-E, RSA 326-F, RSA 326-H, RSA 327, RSA 328-A, RSA 328-D, RSA 328-F, RSA 329, RSA 329-B, RSA 330-A, and RSA 330-C.
3 Medicaid to Schools for Medical Services Program. RSA 167:3-k is repealed and reenacted to read as follows:
167:3-k Medicaid to Schools For Medical Services Program.
I. The department of health and human services Medicaid reimbursement program shall be known as the "Medicaid to schools for medical services" program, providing medical assistance for covered services furnished to children in public schools who are enrolled in Medicaid. The purpose of the program is to seek any and all Medicaid reimbursement for medical or health related services provided by local school districts and school administrative units to children which are reimbursable under federal law. General fund dollars allocated to the department of health and human services shall not be used for matching the federal financial participation for Medicaid reimbursement. All matching dollars for Medicaid to schools medical services shall come from the local school districts or school administrative units. The program shall be voluntary and administered by the department in the same, or similar, manner as the Medicaid to schools program established in RSA 186-C:25. This section shall not be construed to increase school district responsibility or liability beyond what is required by other state or federal law.
II. A reimbursable service under this section the service shall be:
(a) A covered New Hampshire Medicaid state plan service, or a service not covered under the state's Medicaid state plan, but coverable pursuant to 1905(a) of the Social Security Act through the Early and Periodic Screening Diagnosis and Treatment (EPSDT) benefit;
(b) Provided to a Medicaid enrolled child after obtaining parental consent;
(c) Provided by a Medicaid qualified provider;
(d) Medically necessary; and
(e) Provided in compliance with applicable state and federal law and rules.
III. Any provider who orders, refers, prescribes, renders, or provides services under this section shall do so in accordance with the relevant health professional practice act and regulations, including, but not limited to, RSA 137-F, 317-A, 326-B, 326-C, 326-E, 326-F, 326-H, 327, 328-A, 328-D, 328-F, 329, 329-B, 330-A, and 330-C.
IV. The commissioner of the department of health and human services, after consultation with the commissioner of the department of education, shall adopt rules, pursuant to RSA 541-A, relative to:
(a) Further defining services eligible for Medicaid reimbursement under this section. In defining such services, the commissioner shall, to the extent practicable, seek to maximize the availability of federal financial assistance to local school districts and school administrative units.
(b) State plans and reimbursement procedures necessary for local school districts or school administrative units to receive appropriate Medicaid reimbursement for eligible services under paragraph II that are provided or paid for by school districts or school administrative units.
(c) Monitoring mechanisms to ensure that services provided under this section meet the requirements of paragraph II. Monitoring responsibilities shall be consistent with the jurisdiction of the different departments.
(d) A financial mechanism by which the federal mandatory matching requirement is met through collection, or other means, of 50 percent of the cost of allowable services from local school districts and/or school administrative units.
V. New Hampshire local school districts or school administrative units shall be the enrolled Medicaid providers for the purpose of administration and billing.
4 Nurse Practice Act; Scope of Practice; Licensed Nursing Assistant. Amend RSA 326-B:14, II-a(b) to read as follows:
(b) A licensed nurse delegates the task of medication administration to the LNA who is employed in the home care, hospice, residential care, public school, or adult day care setting. The board, in consultation with the commissioner of health and human services or a designee, shall adopt rules under RSA 541-A establishing standards for such delegation of medication administration which include, but are not limited to, limitations on the number of delegations per assistive personnel, training and competency requirements, documentation requirements, and medication administration error reporting requirements.
5 New Section; School Psychologist License. Amend RSA 329-B by inserting after section 15 the following new section:
329-B:15-a School Psychologist License.
I. The board shall issue a school psychologist license to any person who:
(a) Is currently certified as a school psychologist by the New Hampshire department of education, bureau of credentialing and was certified as of December 31, 2019, provided the applicant has paid fees established by the office of professional licensure and certification established under RSA 310-A:1-a; or
(b) Has completed all of the following requirements:
(1) Has passed a satisfactory examination in psychology;
(2) Has a master's degree or a doctorate degree in school psychology from a regionally accredited educational institution having a graduate program, or its substantial equivalent in both subject matter and extent of training;
(3) Has had at least 2 years of satisfactory, supervised experience in the field of psychology;
(4) Is of good professional character.
(5) Has paid all fees established by the office of professional licensure and certification and collected by the board.
(6) Has submitted a complete set of fingerprints and a criminal history records release form in accordance with RSA 329-B:14-a.
II. Examinations for applicants under this chapter shall be held by the board at least once each year. The board shall determine the subject and scope of the examination, which may be written, oral, or both. If an applicant fails the first examination, the applicant may be admitted to a subsequent examination upon the payment of an additional fee in the amount established by the board.
III. Unless otherwise licensed under another provision, a school psychologist's licensure is for services provided in those settings that are under the purview of the department of education.
6 New Paragraph; Psychologists; Definitions; School Psychologist. Amend RSA 329-B:2 by inserting after paragraph XII the following new paragraph:
XII-a. "School psychologist" means any person licensed as a school psychologist under this chapter.
7 Board of Psychologists. Amend RSA 329-B:3, I to read as follows:
I. There shall be a board of psychologists composed of 5 licensed psychologists, one licensed school psychologist, and 3 public members. The members shall be appointed to a term of 3 years by the governor with the approval of the council. The members of the board shall elect a chairperson on an annual basis. Chairperson terms shall alternate between psychologist and public members.
8 Psychologists; Board; Responsibilities and Rulemaking Authority. Amend RSA 329-B:10, III to read as follows:
III. The qualifications of applicants in addition to those required by statute. This provision shall not apply to applicants under RSA 329-B:15-a, I(a).
9 Psychologists; Board; Responsibilities and Rulemaking. Amend RSA 329-B:10, VII to read as follows:
VII. Ethical standards, as promulgated by the American Psychological Association, required to be met by each psychologist and school psychologist licensed under this chapter, and how a license may be revoked for violation of these standards.
10 Psychologists; Board; Responsibilities and Authority. Amend RSA 329-B:10, IX-X to read as follows:
IX. Establishment of the scope of practice for psychologists and school psychologists.
X. Procedures for assuring the continuing competence of psychologists and school psychologists licensed under this chapter including, but not limited to, continuing education requirements, and the professional's health program.
11 New Section; School Social Workers. Amend RSA 330-A by inserting after section 18 the following new section:
330-A:18-a School Social Workers. The board shall issue a school social worker license to any person who meets the following requirements:
I. Is currently certified as a school social worker by the department of education, bureau of credentialing and was certified as of December 31, 2019; or
II. Has completed all of the following requirements or their equivalent:
(a) Has received a college undergraduate degree.
(b) Has received a 2-year master's degree or doctorate degree in social work from a school approved by the Council on Social Work Education.
(c) Has completed a minimum of 2 years of post-masters experience including completion of a minimum of 3,000 hours of post-masters, supervised school social work experience by a board approved licensed independent school social worker or licensed clinical mental health counselor supervisor, or any other supervisor based on reasonable and specific criteria established in rules adopted under RSA 330-A:10.
(d) Has passed a national proctored examination approved by the board.
III. Unless otherwise licensed under another provision, schools social worker licensure is for services provided in those settings that are under the purview of the department of education.
12 Mental Health Practice; Board; Responsibilities and Rulemaking Authority. Amend RSA 330-A:10, II to read as follows:
II. The qualifications of applicants in addition to those requirements set by statute. This provision shall not apply to applicants under RSA 330-A:18-a, I.
13 Mental Health Practice; Definitions; Mental Health Discipline. Amend RSA 330-A:2, V to read as follows:
V. "Mental health discipline" means the disciplines of those licensed as pastoral psychotherapists, clinical social workers, school social workers, clinical mental health counselors, and marriage and family therapists.
14 Mental Health Practice; Definitions; Mental Health Practitioner. Amend RSA 330-A:2, VII to read as follows:
VII. "Mental health practitioner" means persons licensed under this chapter as pastoral psychotherapists, clinical social workers, school social workers, clinical mental health counselors, or marriage and family therapists. For purposes of this chapter, the term clinical social worker shall include independent clinical social worker.
15 Mental Health Practice; Definitions; Psychotherapist. Amend RSA 330-A:2, VIII to read as follows:
VIII. "Psychotherapist" means a clinical social worker, school social worker, pastoral psychotherapist, clinical mental health counselor, or marriage and family therapist licensed under this chapter who performs or purports to perform psychotherapy. This definition shall include psychiatrists licensed as physicians under RSA 329 and advanced registered nurse practitioners licensed under RSA 326-B:18 as psychiatric nurse practitioners.
16 Mental Health Practice; Board. Amend RSA 330-A:3, I to read as follows:
I. There shall be a board of mental health practice composed of the following members: one licensed pastoral psychotherapist, one licensed clinical social worker, one licensed school social worker, one licensed marriage and family therapist, one licensed clinical mental health counselor, one member from a community mental health center, one member from a community health center, and 3 public members. The members shall be appointed to a term of 3 years by the governor with the approval of the council. The members of the board shall elect a chairperson on an annual basis. No discipline's representative and no individual public member shall serve as chairperson for more than 2 years consecutively.
17 New Paragraph; Mental Health Practice; Board; Responsibilities and Rulemaking Authority. Amend RSA 330-A:10 by inserting after paragraph X the following new paragraph:
X-a. Ethical standards, as promulgated by the School Social Work Association of America, required to be met by each licensed school social worker, and how a license may be revoked for violation of these standards.
18 Mental Health Practice; Fees. Amend RSA 330-A:12, I to read as follows:
I. The board shall establish fees pursuant to RSA 541-A for review of applicants for licensure; supervisory agreements; applications for licensed pastoral psychotherapist, independent clinical social worker, school social worker, clinical mental health counselor, and marriage and family therapist; renewal of license; renewal of dual license; reinstatement of license; inactive license status; reactivation of an inactive license; examination of applicants; transcribing and transferring records; and other services, including investigations and hearings conducted under this chapter.
19 New Section; Speech Language Specialist Eligibility for Licensure. Amend RSA 326-F by inserting after section 3 the following new section:
326-F:3-a Speech Language Specialist Eligibility for Initial Licensure. The board shall issue a speech-language pathologist license to any person who:
I. Is currently certified as a speech-language specialist by the department of education, bureau of credentialing and was certified as of December 31, 2019; and
II. Possesses a master's degree or higher academic degree in speech-language pathology, communications sciences and disorders, or communications disorders.
20 Effective Date. This act shall take effect 60 days after its passage.
20-2909
1/7/20
SB 684-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to Medicaid to schools.
FISCAL IMPACT: [ ] State [ ] County [ X ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
LOCAL: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable Decrease | Indeterminable Decrease | Indeterminable Decrease |
METHODOLOGY:
This bill repeals and reenacts RSA 186-C:25 (the "Medicaid to Schools Program") and RSA 167:3-k, (the "Medicaid to Schools for Medical Services Program") in order to bring the programs into compliance with federal regulations. Specific changes when compared to the existing statutes are as follows:
RSA 186-C:25, Medicaid to Schools. Compared to existing law, the bill:
RSA 167:3-k, Medicaid to Schools for Medical Services Program. Compared to existing law, the bill:
In addition, the bill amends and/or adds provisions to various health professional practice act requirements related to nursing practice, psychologists, school social workers, mental health practice, and speech language specialists.
Neither the Department of Health and Human Services nor the Department of Education expect the bill to have an impact on state expenditures or revenue. Nor does the proposed rule create any obligation for schools to provide services that they are not otherwise legally obligated to provide. By bringing state statute into compliance with federal regulations governing the Medicaid to Schools program, the bill may result in school districts receiving federal reimbursement for services that are not currently reimbursable. As a result, to the extent that school districts offer those services, local expenditures will decrease as costs will be partially covered by federal Medicaid funds. For illustrative purposes, in FY 2018, school districts were reimbursed $27.3 million for 11,218 students. Total reimbursement may be higher during the FY 2020/21 biennium, as SB 235 in 2017 authorized the expansion of coverage from only those children with Individualized Education Plans (IEP) to all Medicaid-eligible students attending public schools.
It is assumed any fiscal impact from this bill will not occur until FY 2021.
AGENCIES CONTACTED:
Department of Education and Department of Health and Human Services