More attempts to remove parental consent need to be given serious thought! This is an email sent to the Superintendent in SAU21 and the School Board Members.
Dear Superintendent Nadeau,
After reviewing the published September Student Services update to the North Hampton School Board on Medicaid reimbursement to schools, information that was not included is misleading to the School Board. The Update oversimplifies the proposed changes to Medicaid and understates the changes needed in the SAU to qualify for additional funding.
The most important points omitted include:
Changes to Federal policy are only in the Proposal stage and must be adopted by States;
Existing SAU21 policies for services spend more than Medicaid reimburses because many providers do not accept Medicaid patients because of the fees paid;
Any description of SAU21 policies for this school year and specific planned changes, including how many additional students will be “covered” and increased cost;
Schools that are “Full Service Community Schools” will be designated as medical providers. Seabrook School was awarded a grant to do planning for this, but is not complete and does not include other schools;
Statement that additional screening, including medical evaluations, of children will take place; additional mandatory reporting is required; personal (medical) information for children will be retained and shared with third parties;
Parental consent for evaluations and screening is still required. (The update refers only to consent to access Medicaid insurance.)
There may be advantages for a school from Medicaid reimbursements, but it’s important to note and understand problems that could arise. As a board member, I would want to have all the information presented to me so that I could make the best decisions going forward.
Background for 2023 Changes
The Centers for Medicare and Medicaid Services (CMS) published an administrative guide dated 2023 for schools to become medical providers (emphasis added) and begin to bill Medicaid for reimbursement by setting up schools with a hospitalization license (emphasis added): Delivering Services in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming.
This 2023 change was preceded in 2019: A Joint Information Bulletin was released on July 1, 2019, explaining the system of techniques that will be used to identify behavioral/mental health disorders as a disability that, in turn, create interventions at school that now can be used for billing Medicaid reimbursement. (Source: Centers for Medicare & Medicaid Services (CMS) Bulletin: pg. 3)
SAMHSA (Substance Abuse and Mental Health Services Administration) points to PBIS, RTI, and MTSS as techniques approved for intervention services. They ARE INCLUDED in arriving at a disability/disorder for approved Medicaid billing and reimbursement. In addition, SAU21 spends a significant amount of its budget addressing the social-emotional learning and behavioral health needs of students, with trauma-informed, family-engaged implementation of the Multi-Tiered Systems of Support for Behavior and Wellness (MTSS-B).
MTSS models include screening and targeting support for students exhibiting signs of mental health conditions. PBIS, MTSS, and RTI use techniques to identify children, collect data on a child’s behavioral disabilities, use interventions, and then bill Medicaid for mental health disorders. This expansion into the area of attitudes, values, beliefs, and dispositions creates a smorgasbord of disabilities, shifting education into mental health, not academics.
The information presented in the Update (attached) indicates that parents will consent to assessments for these and additional kinds of services. “Parent consent to access a child’s Medicaid insurance is still required.”
The Proposed Rule Change
Earlier this year the Federal administration announced a proposed rule change to Medicaid billing, modifying the current rule for obtaining parental consent. The rule change would remove the requirement for parental consent. They called the rule to obtain parental consent for Medicaid billing “an unnecessary, time-consuming and emotionally fraught process for districts and parents.”
Schools would be allowed to skip over parental informed consent so that mental and medical health treatment of children at school (or by “partner” third parties chosen by the school) and billing Medicaid could move forward. This very significant proposal is omitted from your Update to the School Board and Community.
In addition, The U.S. Department of Education said it is also proposing to remove a requirement under the Individuals with Disabilities Education Act that schools receive parental consent before billing public programs such as Medicaid for the first time for services they provide to students at school.
So-called Community Schools were authorized in the 2022 Federal budget. The new Community Schools (WSCC) could offer children Medicaid-funded health and mental health services. If Medicaid funds are insufficient to pay for the services offered, local taxpayers will bear the additional burden as they do now. As a result, parents may never know what services are provided to their children or by whom. We also know that personally identifiable mental health data on students are being shared by some New Hampshire schools without informed consent by the student or parents.
Personally identifiable mental health data on students has been shared with Keene State BHII without the knowledge or consent of either the students or their parents. School counselors, etc., are violating their Code of Ethics by sharing this sensitive data with the analysts at Keene State BHII. This also appears to be a violation of student privacy per the NH Constitution.
The WSCC Model is being rolled out nationwide in each state (in phases) to establish Community Schools or as they call them, Healthy Schools. WSCC stands for Whole School, Whole Community, Whole-Child.
California committed $4 Billion dollars to community schools, but would this be a wise use of NH taxpayer dollars? School board members and taxpayers should have much more factual information before the SAU changes policies unilaterally, and without full disclosure to residents. In fact, we should proceed with caution before committing the taxpayers in SAU21 to this experiment. Anything that reduces the power of our elected school board members should be scrutinized by those serving the community, and the ones who pay the taxes.
California has committed $4 billion to turning one in three public schools into a Community school. The state education board’s “Community Schools Framework” has endorsed “shared decision-making” in school governance. That means more power for teachers’ unions and less for elected school boards, and even less for parents. More significantly, the extensive testing, assessments and evaluations of students throughout their school years will remain a part of their academic record for life, which may affect schooling and career options.
Schools in SAU21 reflect declining academic results across the District. Proposals to add social service personnel do not reference any effort to address academic decline, while parents remove their children from schools to place them in independent schools. There’s little evidence to support claims that providing social services improves academic achievement, writes Williamson “Bill” Evers, among many other researchers. When Harvard researchers analyzed Harlem Children’s Zone middle schools, they concluded that high-quality schools can “significantly increase academic achievement” for low-income students, but “community programs appear neither necessary nor sufficient.”
A RAND study found “nearly zero improvement in English across three years and nearly zero gains in math during the first two years . . . but an uptick during the last year,” Evers wrote.
Denver Health provides these services. As of July 2022, their plastic surgeons offered chest reconstruction (mastectomy) to youth ages 16 and older.
It seems like now is a good time to revisit school policies to ensure parental consent is required on all mental and medical services Medicaid reimbursements and that no personally identifiable mental or medical health information is shared with anyone or any organization without informed consent by parents.
What can go wrong?
Sex ed and reproductive health in schools meant that 6th-grade girls received surprise gynecological exams without parental notification or consent in Pennsylvania. This year two young children in New Hampshire were given vaccines after their parents sent a notification to their district administrators in Nashua and Rochester telling them not to vaccinate their children.
Children who receive mental health counseling while in school can be denied an opportunity to join the military. DSM codes will identify ALL students with “mental health” disabilities that are billable to Medicaid. Codes on student records will determine what a student can or cannot do in the future.
These are serious consequences that need to be considered by all involved.
When parents are not present, mistakes happen. A better approach would be to offer these services after school hours with parents present.
Years ago, federal investigators uncovered improper billing for school-based Medicaid services, and cases of waste and fraud in several states. Money directed for medical care was used for transportation or school officials’ salaries or benefits.
In Texas, they found close to 300 incorrectly coded claims, resulting in almost $19 million of federal payments for costs not allowed under Medicaid’s in-school services program.
School administrations are supposed to be providing an education to our children— they are not in the business of providing medical services.
Oversity by parents is needed.
Conclusions:
The Update published as part of the Agenda for the North Hampton School Board meeting dated 7 September should be revised and made more complete. The School Board and taxpayers must have complete and accurate information for additional costs anticipated and additional staffing planned in the 2024 budget. Parents must have accurate information about proposals for the treatment of their children.
School Board policies must be updated to include informed consent on all mental and medical services, assessments, treatment, and release of PII.
When teachers and school counselors are identifying our children through screening, subjective judgment observations and interventions, and psychological treatment of the social, emotional, and behavioral personality traits, who will be liable for inaccurate diagnosis? What type of data tracking is done at school for mental health? How are our children protected?
SEPTEMBER 2023 NH Student Services Board Report (1)
