Students at dozens of public schools in Maryland who get routine medical care through their schools have been unable to access that care during the COVID-19 pandemic. Unlike other medical providers, these school-based health centers are not allowed to use telehealth to reach their patients.
A bill the state Senate passed Wednesday would change that by immediately authorizing school-based health centers to offer their usual services remotely.
Half of the state’s 24 jurisdictions have at least one of these school-based health centers. Each center usually has either a pediatrician or a nurse practitioner on site who provides primary, mental health and sometimes dental care, Robyn Elliott, a consultant with the Maryland Assembly on School-Based Health Care, told members of the Senate Education, Health and Environmental Affairs Committee during a hearing last month.
“By design, school-based health centers are located in schools with high concentrations of poverty and act as a safety net provider,” Joy Twesigye, board president of the Maryland Assembly on School-Based Health Care and a nurse practitioner, told the committee. “We're talking about kids who are homeless, who are uninsured or under-insured youth, youth without a medical home, youth with language barriers, and we establish care relationships, just like you do with your health care providers.”
In the last year, the state has made it easier for medical providers to treat patients via telehealth. However, these school-based medical providers cannot get approved for telehealth as easily.
Of the 86 school-based health centers across the state, Elliott said only about 18 have been approved for telehealth.
“School-based health centers have essentially shut down,” she said. “They are not able to connect with students during this period.”
The Maryland State Department of Education has a process through which local school districts can apply for telehealth approval.
However, Sen. Cheryl Kagan, the Montgomery County Democrat sponsoring the bill, says the existing process isn’t working.
“The State Board of Education is not processing these requests, these approval processes, and we need to be able to expedite that,” Kagan told her colleagues during debates on the Senate floor this week.
She said the onerous application process deters some local school systems from even applying.
Local school leaders “have just all 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,” Kagan said.
She said Wicomico County, which has two sites, had its application denied, while Howard County, which has nine sites, was approved more than a year after submitting the application.
Kagan’s bill would immediately approve all 86 school-based health sites for telehealth, as well as eliminate the additional telehealth approvals required by the Maryland State Department of Education. Once a school-based health center is approved to operate in person, it would also be approved to operate via telehealth.
A spokeswoman for the State Department of Education did not respond to a request for comment.
Sen. Shelly Hettleman, a Democrat who represents part of Baltimore County, highlighted her county’s 13 school-based health centers, which have not been approved for telehealth.
“These are students in the midst of COVID, 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,” Hettleman said. “And somehow our pediatricians, our other — our hospitals have been able to pivot quite smoothly to telehealth.”
At last month’s hearing, Harford County Public Schools Superintendent Sean Bulson said the medical providers treating students already are subject to rigorous standards, making the additional hurdles established by the Maryland State Department of Education unnecessary.
Without the agency’s approval process, “we still have very good protections in place,” he said.
However, this week, Senate Minority Leader Bryan Simonaire questioned whether taking approval authority away from the state removes key 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,” Simonaire said.
The bill passed the Senate along a mostly party-line vote and now goes to the House of Delegates. If it becomes law, it will take effect immediately.
