Virginia - School-based health services: Policy requirement

Policy Or Plan Requirements
Policy Type: 
regulation; statute

State law addresses the development of school-based health centers or clinics, even if only through a grant program on some campuses.

Virginia Administrative Code 12 VAC 30-50-130. Nursing Facility Services, Epsdt, Including School Health Services and Family Planning.

C. School health services.

    1. School health assistant services are repealed effective July 1, 2006.
    1. School divisions may provide routine well-child screening services under the State Plan. Diagnostic and treatment services that are otherwise covered under early and periodic screening, diagnosis and treatment services, shall not be covered for school divisions. School divisions to receive reimbursement for the screenings shall be enrolled with DMAS as clinic providers.
      • a. Children enrolled in managed care organizations shall receive screenings from those organizations. School divisions shall not receive reimbursement for screenings from DMAS for these children.
      • b. School-based services are listed in a recipient's individualized education program (IEP) and covered under one or more of the service categories described in § 1905(a) of the Social Security Act. These services are necessary to correct or ameliorate defects of physical or mental illnesses or conditions.
    1. Service providers shall be licensed under the applicable state practice act or comparable licensing criteria by the Virginia Department of Education, and shall meet applicable qualifications under 42 CFR Part 440. Identification of defects, illnesses or conditions and services necessary to correct or ameliorate them shall be performed by practitioners qualified to make those determinations within their licensed scope of practice, either as a member of the IEP team or by a qualified practitioner outside the IEP team.

Code of Virginia 32.1-362.2. Pilot school/community health centers.

The Department of Medical Assistance Services, in cooperation with the Department of Education, shall, consistent with the biennium budget cycle, examine and may revise the funding and components of the pilot school/community health centers. Any revisions shall be designed to maximize access to health care for poor children, and to improve the funding by making use of every possible, cost-effective means, Medicaid reimbursement or program. Any revisions shall be focused on prevention of large costs for acute or medical care and may include, but not be limited to:

  1. Funding sources and means of distribution for the state match which will clearly demonstrate that local governments are not funding the state match for these centers.
  2. The benefits and drawbacks of allowing school divisions to provide services to disabled students as Medicaid providers.
  3. The appropriate credentials of the providers of care in the school health centers, e.g., licensure by the Board of Education and compliance with federal requirements or licensure by a regulatory board within the Department of Health Professions.
  4. Utilization of the individualized education plan, when signed by a physician, as the plan of care authorizing services.
  5. Delivery of medically necessary services, such as rehabilitation services, psychiatric and psychological evaluations and therapy, transportation, and nursing.
  6. Payment for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services, with proper medical oversight, in consultation with the students' primary care physicians.
  7. The role of the Medallion and Options programs in regard to the school health centers and flexibility for school divisions regarding any required referrals. Any funds necessary to support revisions to the school/community health center projects shall be included in the budget estimates for the departments, as appropriate.
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