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Sununu at odds with feds over Medicaid in schools 

Monitor staff
Published: 10/2/2019 6:50:19 PM

New Hampshire officials are moving to quell concerns about the state’s “Medicaid to Schools” program, months after a federal agency issued new restrictions over how the program can be used.

In a Sept. 27 letter sent to school superintendents, Gov. Chris Sununu attempted to reassure them that state officials will help officials deal with changes to the program, known as “Medicaid to Schools.”

“Over the past several weeks, my office has heard from many school districts who are concerned about federally required changes to the Medicaid to Schools program,” Sununu wrote in the letter, adding that he “share(s) those concerns.”

The Medicaid to Schools program allows New Hampshire schools to be reimbursed for services through Medicaid – a federal health care program primarily targeted to low-income people. The program was expanded under a 2017 law that allowed schools to use it for all students who qualify for Medicaid, not just those with Individualized Education Plans.

But this spring, a new guidance issued by the federal Centers for Medicare and Medicaid Services (CMS), which oversees Medicaid, restricted that reimbursement.

In guidance to New Hampshire state officials, CMS said that schools could only receive Medicaid reimbursement for services that fall under the state’s Medicaid plan. That meant that simple services administered by school nurses or guidance counselors could not qualify for the reimbursement, which up until then had paid back schools for 50% of the cost of services.

Failing to reform its practices could cause the whole state school Medicaid program to lose funding, the federal government warned New Hampshire.

Following the federal warning, outcry and alarm from school administrators prompted the state Department of Health and Human Services to put in place an emergency rule. That rule, established Aug. 27, solidifies the CMS guidance and requires schools to work within the new limits.

Moving forward, schools may only be reimbursed if they use specifically licensed medical professionals, according to guidance sent out by Henry Lipman, the state Medicaid director, last month.

Those can include physicians, nurses ranging from ARPNs to LNs, psychologists licened by the state board of psychology, occupational theraapists, speech therapists and licensed clinical social workers.

Not following that new rule could open schools to punishment from Washington and could hurt the state overall, according to a letter from DHHS Commissioner Jeff Meyers released to school superintendents last week.

“... Absent immediate action by the Department, the state and school districts would face increasing liability that may result in recoupment of millions of dollars and harsh penalties for the state,” Meyers wrote to schools.

Meyers said he understood the confusion and uncertainty created by the new emergency rule adding that “we look forward to working collaboratively with all involved to remove any barriers to ensuring children in the program receive the medical services they need.”

DHHS will establish a working group sometime in October “to resolve the discord between past practice of school districts and the CMS approved state plan,” Meyers announced.

That group will continue to develop new tweaks to the state rules around the Medicaid to Schools program in an attempt to bring school officials up to qualification for Medicaid reimbursement.

And Meyers and Sununu stressed that New Hampshire would attempt to work outside the state to attempt to alleviate any additional burdens. DHHS is looking to collaborate with other states “to determine where the state is able to expand reimbursement opportunities,” Meyers said.

Meanwhile, the two said they would be in contact with CMS in Washington for ways to increase the flexibility of the new guidance.

“We are committed to working with CMS, as well as stakeholders, to ensure that we receive as much flexibility and common sense in these regulations as possible,” Sununu wrote, adding that he would be “reaching out directly.”

“My goal is to ensure that schools have the ability to ensure students are getting the services they need without risking federal funding for the program,” Sununu wrote.

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