The Evolving Landscape around Supportive Services in Schools

July 6, 2023

As you know, the recently enacted New York state budget includes a provision that will increase the rates paid to Article 31 Outpatient satellite clinics for certain school-based services by as much as 25%.  The FY’24 final Medicaid Scorecard lists the effective date of this new initiative as 10/1/2023.

In our continuing efforts to inform our members regarding the latest trends in mental health and substance use disorder services for children and youth, here’s some information you may not know:

NYS currently has authority to expand access to services in School Supportive Health Services Programs (SSHSP) per last year’s enacted state budget.  Previously the services had to be medically necessary, ordered or prescribed by a NYS Medicaid enrolled physician or other licensed practitioner and included in the student’s Individualized Education Program (IEP).  Recently we learned that the state is seeking approval from CMS for a State Plan Amendment (SPA), which will amend the eligibility criteria to eliminate the need for the services to be documented in an IEP, allowing for additional Medicaid-enrolled students to access critical services, and to allow for school districts to access additional resources to support the delivery of these services in the school setting.  The services the hopes to expand include:

  1. Physical therapy services
  2. Occupational therapy services
  3. Speech therapy services
  4. Psychological evaluations
  5. Psychological counseling
  6. Skilled nursing services
  7. Medical evaluations
  8. Medical specialist evaluations
  9. Audiological evaluations

Here is some more info about the existing program: NYSED::Medicaid in Education

There has also been some chatter about new guidance from CMS re: “Free Access” –  Delivering Services in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming.  

And finally, CMS recently launched an SBS Technical Assistance (TA) Center in conjunction with the Department of Education (ED). The state is currently reviewing this guidance.  Here’s an excerpt from the page (linked directly above):  

The TAC seeks to assist and expand the capacity of State Medicaid agencies, local education agencies (LEAs), and school-based entities to provide greater assistance under Medicaid. This will include convening small group stakeholder calls with target audience members, including a special emphasis on schools located in small, rural communities. The TAC also seeks to develop specific resource materials tailored to the specific needs of LEAs and their communities. The primary “target audience” for the TAC is made up of State Medicaid Agencies and their directors/designees, State Education Agencies, LEAs, and School-Based Entities.

We hope this information is useful as you consider strategies that will increase your ability to serve New York’s children and youth in school settings.