Health Policy

“We are thrilled that part of the [health reform] legislation calls for an expanded foot print of school-based health clinics … I can’t think of a better way to deliver primary care and preventive care to not only students but their families than through school-based clinics.”
-- Secretary of Health and Human Services Kathleen Sebelius

The Patient Protection and Affordable Care Act (P.L.111-148) includes two important provisions for school-based health centers (SBHCs): language authorizing a federal SBHC grant program for operations, and an emergency appropriation that would provide $200 million for SBHC construction and equipment needs over four years.

A funded federal program for SBHC operations will allow them to achieve the financial sustainability to serve children and adolescents who need them. NASBHC has advanced this agenda over the past six years culminating with the authorization in PPACA at section 4101(b).

Those grants are but one opportunity under the federal health reform landscape. The Prevention and Public Health Fund may provide opportunities for support, as will the many workforce investment provisions of the law including funding for new access points.

Current Legislation
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Current Legislation

The Patient Protection and Affordable Care Act (PPACA):
The Patient Protection and Affordable Care Act (P.L. 111-148) is a federal statute that was signed into United States law by President Barack Obama on March 23, 2010. This act and the Health Care and Education Reconciliation Act of 2010 (signed into law on March 30, 2010) comprised the health care reform of 2010.

Emergency Appropriation
Section 4101(a) of the Affordable Care Act allows for SBHCs to access $200 million in competitive federal funds over the next four years. The grants are limited to facilities expenditures -- such as the acquisition or improvement of land, construction costs, equipment, and similar expenditures.

On May 4, 2011 the House of Representatives voted 235 to 191 to pass H.R. 1214, which would defund grants for school-based health centers. As Linda Juszczak, executive director of NASBHC, said in her statement: "Fortunately, the fight is far from over. H.R. 1214 must still pass the Senate and get signed into law by President Obama before it will go into effect. NASBHC, our champions on Capitol Hill, and SBHC supporters across the country will do everything in our power to prevent this from happening."

Authorization
After decades of providing critical care to the nation’s youth, SBHCs became an authorized federal program in Section 4101(b) of PPACA. NASHBC is working to make sure that the nearly 2000 SBHCs around the country are able to continue providing care through a federal $50 million appropriation for operations. While becoming an authorized federal program is a great victory for SBHCs, authorization does not guarantee funding. NASBHC is launching the next phase of our federal campaign, the aim of which is to get the authorization funded through the appropriations process.

Read Full Text of the Patient Protection and Affordable Care Act
Read more about SBHCs and health reform.

State Children’s Health Insurance Program (SCHIP)
SCHIP reauthorization legislation (H.R. 2, which became Public Law 111-003) was signed on February 4, 2009. Section 505 of the bill reflects a significant step forward for school-based health centers – the first explicit recognition of SBHCs as a potential provider of SCHIP services. The provision clarifies that a state may “…provide child health assistance for covered items and services that are furnished through school-based health centers.”

What does this mean for SBHCs?

Empowers SBHCs to seek provider status in their states’ SCHIP programs and argue for reimbursement by SCHIP managed care plans
Where SCHIP programs are part of Medicaid, helps SBHCs acquired Medicaid provider status
Supports establishment of federal laws and regulations to ensure SBHC reimbursement by government programs and potential federal grant program for SBHCs.

Click here to see the SBHC definition included in SCHIP

See also: Healthy Schools Act of 2009 (111^th Congress): H.R. 2870 and S.1034

To require states find mechanisms to fund school-based health centers under the Children’s Health Insurance Program and Medicaid.

Positions and Priorities

Policy Statements

Definition of School-Based Health Center - Seven key components of SBHCs document a standard of care, nationwide.

Adolescents' Access to Health Care - Numerous evaluations have shown SBHCs to achieve marked improvements in adolescent health care access when compared with adolescent utilization in other settings. This is especially true for important services delivered on site, such as family planning, screening and counseling on sexually transmitted diseases, mental health, and substance abuse services.

Interdisciplinary Care - The purpose of this policy statement is to promote interdisciplinary practice within SBHCs and to confirm that mutual respect and coordination of care between SBHC staff and other health professionals practicing in schools, including nurses, nutritionists, as well as mental health and other counseling professionals are essential to the provision of health care in schools.

Public Comments and Testimonies