Bipartisan Safer Communities Act Creates Opportunities for Occupational Therapy in Community Mental Health, Medicaid, and Schools
On June 25, the bipartisan Safer Communities Act (Safer Act), S. 2938, was signed into law. The headlines for this bill reflected the bipartisan changes to gun laws included in the bill. However, the bill also made a historic investment in community mental health and includes policies that expand access to community- and school-based mental health services. It does this by creating a nationwide expansion of the Certified Community Behavioral Health Center demonstration program, providing new funding for schools; improving Early and Periodic Screening, Diagnostic, and Treatment services (0-21 services) under Medicaid; and improving the ability of schools to receive reimbursement for Medicaid services. These policies create new opportunities for occupational therapy practitioners working in mental health, pediatrics, and in the schools.
Certified Community Behavioral Health Clinic Nationwide Expansion
In 2015 Congress created a demonstration program to invest in community behavioral health care that would provide a range of comprehensive mental health and substance use services ranging from crisis response to psychiatric rehabilitation services—with increased support from the federal government. When the Substance Abuse Mental Health Services Administration (SAMHSA) created the criteria for these new Certified Community Behavioral Health Clinics (CCBHCs), AOTA, in conjunction with occupational therapy (OT) advocates from across the country, worked to ensure that occupational therapy practitioners were among the list of suggested staffing for CCBHCs.
Originally 8 states were selected to participate in the CCBHC demonstration. In 2018 two more states were added to the demonstration program, and in 2020, individual behavioral health clinics were able to apply individually for SAMHSA grant money to support the provision of this full range of mental health services.
The Safer Act expands this federal investment in mental health to all 50 states, adding 10 new states every year—an estimated federal investment of $8.6 billion over 10 years. As new states launch their CCBHC programs every 2 years, we will have continued opportunities to include occupational therapy as a core part of these programs.
Title IVA Funding
Title IVA of the Every Student Succeeds Act (ESSA) created the Student Support and Academic Enrichment (SSAE) block grant to provide additional resources to all schools, focusing on three general activities:
- Supporting a well-rounded education
- Supporting safe and healthy students
- Supporting the effective use of technology.
The SSAE grant replaced dozens of piecemeal competitive grants with one grant that provides additional resources to all school districts, now commonly referred to as Title IVA grants. AOTA is an active member of the Title IVA Coalition, with staff serving on its Board of Directors, representing the focus on safe and healthy students.
The Safer Act provides $1 billion in supplemental funding to the Title IVA grant, to be used only for activities supporting safe and healthy students. Each state education agency (SEA) will get the same share of grant funding, following the SSAE formula from ESSA. However, the Safer Act requires each SEA to award the funding to high-need school districts on a competitive basis.
Early and Periodic Screening, Diagnostic, and Treatment Services
The Medicaid program’s benefit for infants, children, and adolescents under the age of 21 is known as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services. It was created to assure children receive early assessment and care, so developmental concerns are detected and treated as early as possible. Occupational therapy (OT) is a required EPSDT benefit.
Under the Safer Act, the Department of Health and Human Services (HHS) is required to review each state’s implementation of EPSDT services under Medicaid within the next 24 months, and then every 5 years going forward. The review will be used to identify and provide technical assistance to address any gaps and deficiencies discovered with respect to state compliance with federal EPSDT requirements, including the provision of OT services. HHS will also be required to issue guidance to states on both the requirements for EPSDT services, and best practices for ensuring that children have access to comprehensive health services.
Medicaid in Schools
Medicaid is the third largest single source of funding for education, accounting for between $4 and $5 billion each year. The Individuals with Disabilities Education Act (IDEA) allows schools to bill Medicaid for any student with a disability under the IDEA who is also a Medicaid beneficiary. Not every school district bills Medicaid for the eligible service it provides due to the high administrative burdens required for reimbursement.
AOTA has worked through the Medicaid in Schools coalition since its creation, to preserve and protect Medicaid, and to make it easier for schools to receive reimbursement for services from Medicaid and the Children’s Health Insurance Program (CHIP). AOTA signed onto a coalition letter to CMS in early 2021 requesting that CMS update their guidance on school-based Medicaid reimbursement.
The Safer Act requires the HHS to consult with the Department of Education, and issue updated guidance to state Medicaid agencies, local education agencies (LEA), and school-based entities. The guidance will outline strategies and tools to
- Reduce administrative burdens and simplify billing
- Provide a comprehensive list of best practices and examples of approved methods that State Medicaid agencies and LEAs have used to pay for
- Provide examples of the types of providers, which may include qualified school health personnel.
In addition to this guidance, the Safer Act, creates a new technical assistance center to provide direct assistance to SEAs and LEAs on billing Medicaid for school-based services. It also provides $50 million in grants to help states implement, enhance, or expand billing of school-based services by Medicaid and CHIP.
Conclusion
This bill requires states and the federal government to examine the way in which children receive health care and mental health services, both through school and through Medicaid. Its expansion of Community Behavioral Health Centers to all 50 states has been called the single biggest shift in the provision of mental health services since President John Kennedy signed the Community Mental Health Act into law in 1963. There are great opportunities for occupational therapy, but advocacy at the federal, state, and local levels will be needed. AOTA will be working in partnership with federal agencies and state associations to advance these opportunities. We will need your help, too. Please stay up to date on our advocacy efforts by visiting www.aota.org/advocacy.