An emergency measure, already approved in the Senate, to allow each of Maryland’s 86 school-based health centers to offer telehealth was voted out of a House education subcommittee Tuesday.
The vote sends it to the House Ways and Means Committee which is scheduled to vote on it Friday.
School-based health centers, traditionally located in schools with high concentrations of poverty, are required by regulation to receive approval from the Maryland State Department of Education before they can offer services remotely.
But after a year of COVID-19, only 18 school-based centers have been approved, while most school districts have “thrown up their hands because the process is cumbersome, complicated, confusing and it doesn’t yield the outcome that they need desperately in order to provide health care,” Sen. Cheryl C. Kagan, lead sponsor of the crossfiled bill in the Senate, said on that chamber’s floor last week.
“The Department of Education has not been very supportive and has not made the process easy, so this is going to be us stepping in at the request of our superintendents,” Kagan (D-Montgomery) said. The measure (Senate Bill 278 and House Bill 34) would expedite the process.
Kagan co-sponsored a bill, signed into law last year, authorizing health care practitioners to provide telehealth services. But it did not relieve school-based health centers of the tedious MSDE approval process.
Kagan said she wrote to state superintendent Karen B. Salmon last summer, asking MSDE to remove extra telehealth review requirements for school-based health centers so that the most vulnerable students could get access to medical care.
Kagan said Salmon told her that local superintendents have authority to deploy telehealth, but superintendents said they had to get approval from MSDE first. And that approval process took Howard County more than a year.
“That’s crazy,” Kagan said.
Sen. Shelly L. Hettleman (D-Baltimore County) said that none of her district’s 13 school-based health centers have been approved for telehealth.
“These are students in the midst of a public health pandemic that are not able to get the kinds of services they would be able to get if they were in school, and somehow, our pediatricians, our other our hospitals have been able to pivot quite smoothly to telehealth,” she said. “I think our students and our schools deserve the same.”
Kagan’s proposal would nix MSDE’s and the Department of Health’s requirement for local school system districts to apply for telehealth approval. It would require the two departments to immediately allow school-based health centers to provide telehealth.
MSDE said their approval process ensures that important safeguards are met.
“MSDE is dedicated to the support and maintenance of school-based health centers. The process currently in place provides critical safeguards for students and families and MSDE has continued to work diligently alongside the Maryland Department of Health to meet the requests of all programs that have sought to provide telehealth services to students during this difficult time,” Lora Rakowski, a spokesperson for MSDE, wrote in a statement to Maryland Matters.
Senate Minority Leader Bryan W. Simonaire (R-Anne Arundel) worried that taking the approval process away from the state would leave it up to local jurisdictions to uphold important safeguards.
“God forbid something would happen to one of our students and we would come back and say we took away the approval process to ensure the quality and safety for our students,” he said. “I just think this is a major shift in policy,” he said.
MSDE and MDH would still have oversight over school-based health centers under this measure, Kagan said. The school-based health centers are already established with proper medical professionals, so “there should be no extra hurdle that they have to jump through to be able to provide the exact same services but through telehealth,” Kagan added.
In a bill hearing in January, Harford County Public Schools superintendent Sean Bulson said that all schools have authorized medical partners, thereby making MSDE’s approval process unnecessary. “We still have very good protections in place,” he said.
Some lawmakers said they were concerned that eliminating the state approval process might open doors for the abortion industry to reach students without their parents’ knowledge or consent.
In a voting session of the House Health and Government Operations Committee last month, House Minority Leader Nicholaus R. Kipke (R-Anne Arundel) proposed an amendment that would preclude school-based health centers from offering abortion services via telehealth. He said that the U.S. Food Drug Administration could change which type of abortion drugs could be administered through telehealth.
But MSDE already prohibits school-based health centers from providing counseling on abortion and no local entity can override that policy, Del. Bonnie L. Cullison (D-Montgomery) said, responding to Kipke’s concern. “I want us to focus on the purpose of this bill.”
Kipke’s amendment failed 15-7.
Transferring governance of school clinics
While lawmakers have been debating ways to boost telehealth for Maryland students, they are also discussing the possibility of changing the governance of the brick-and-mortar health clinics that exist in 86 public schools across 12 districts.
Specifically, legislation would transfer the jurisdiction over school-based clinics from the Maryland State Department of Education to the Maryland Department of Health Bureau of Maternal and Child Health.
The change is desirable, said the bill’s House sponsor, Del. Bonnie L. Cullison (D-Montgomery), because school-based clinics are an afterthought to the state education department and align closely with the mission of the Health department. She added that the change would help address health disparities in the state.
“School-based health clinics are really kind of a step-child at MSDE,” Cullison said.
Several public health advocacy groups testified Tuesday in the House Health and Government Operations Committee, that the legislation makes sense from both a public health and education standpoint.
“We have the support of educators, we have the support of nurses, the support of public health professionals and other allies who are seeking health equity across the state,” said Cullison, a former teacher. “Students cannot learn if they aren’t healthy.”
A companion bill has been sponsored by Sen. Clarence K. Lam (D-Howard). A hearing has been scheduled for March 15.
Josh Kurtz contributed to this report.