The Patient Protection & Affordable Care Act (ACA)

Policy Matters, NASP's policy and advocacy blog contains up-to-date policy news from Capitol Hill and across the country.

Although the fate of the Affordable Care Act (ACA), also known as “Obamacare,” was in limbo for some time, the Supreme Court decision to uphold the law and President Obama's reelection ensure its full implementation. Both the ACA and the related expansion of Medicaid have implications for school psychologists and the delivery of mental health services in the schools. In particular school psychologists are included in the definition of "mental health service professional" and "qualified health professional" within the federal law, although not all states recognize school psychologists as eligible providers for Medicaid reimbursement. School psychologists can work with their state associations to ensure that Medicaid definitions are aligned with the federal law. 

In summer 2012, a Supreme Court decision upheld the constitutionality of the Affordable Care Act (ACA). In addition, it ruled that individual states can choose to opt-in to the expansion of Medicaid, which is authorized by this law. Most states had decided to postpone decisions related to changes in Medicaid as many speculated the continuance of the ACA was dependent on the outcome of the presidential election (i.e., many believed Mitt Romney, if elected, would repeal the ACA). Given that Obama was reelected for a second term, the ACA will likely continue on course.

Both the ACA and the expansion of Medicaid have implications for school psychologists and the delivery of mental health services in the schools. The ACA specifically includes school psychologists in the definition of "mental health service professional" and "qualified health professional." This was a great win for school psychology. In addition, the expansion of Medicaid means that millions more children will be eligible for Medicaid services. Medicaid policy allows for school districts to receive reimbursement for select services that are provided to Medicaid-eligible students who also have a disability and an IEP. These services must be deemed medically necessary and include speech therapy, physical therapy, occupational therapy, and mental health and behavioral counseling. Unfortunately, despite the explicit inclusion of school psychologists in federal law, not every state recognizes a school psychologist credentialed by the State Department of Education as a qualified provider of Medicaid services. Therefore, we need each of you to be involved in the effort to ensure that school psychologists are considered qualified providers of Medicaid Services.

Read the Updated NASP ACA Document that will provide you with relevant policy contained in ACA as it pertains to school psychology and suggestions for what you can be doing now, and what you should be planning for in the coming months.

What is NASP doing?

At the national level, there are ongoing discussions taking place between administrators at the Center for Medicare and Medicaid Services, officials at the Department of Education and the Department of Health and Human Services, administrators in state Medicaid agencies, and leaders in other allied professional organizations (e.g. American Association of School Administrators) about who will be considered eligible qualified providers of these services in the future.

As of March 2013 NASP has engaged in the following activities:

  1. NASP presented information about ACA and the impact on school psychology at all four regional meetings in fall 2012.
  2. NASP staff directors, ATS, and representatives (GPR) presented relevant information at convention at the ATS state leadership and SPAN meetings. Representative of these groups continue to present to various stakeholders within the organization.
  3. NASP GPR presented at the National Alliance for Medicaid in Education (NAME) Conference on the school psychologist's role in Medicaid.
  4. NASP submitted written questions for Medicare and Medicaid Services at the NAME Conference, to which CMS is obligated to respond. The questions focused on updating federal guidelines to include school psychologists as eligible providers.
  5. NASP has sent proposed regulatory language to CMS (Center for Medicare and Medicaid Services).
  6. NASP continues to encourage and actively advocate for CMS to update federal guidelines to reflect the statutory language of ACA that explicitly identifies school psychologists as eligible providers of services.
  7. NASP has worked with states that have requested assistance, and will continue to do so as requests come in.
  8. NASP has drafted a state model policy that will soon be disseminated to all states.
  9. NASP is in the process of creating additional resources to help states understand how ACA may impact school psychologists. These resources will soon be available on the NASP website.
  10. NASP has submitted a proposal to present on this issue at the Center for School Mental Health (CSMH) Conference in October 2013.

What can you do?

NASP leadership, state delegates and state association leaders have been planning for any potential action that will need to take place at the state level. If you would like to be involved, reach out to your delegate or state association leadership.