If the recent House and Senate health care legislative roller coaster we’ve witnessed this spring and summer had a theme song, it could be: “Don’t Know What You’ve Got ‘Til It’s (Almost) Gone.”
[cue late 80s hair metal band power ballad chord]
As a broad coalition of higher education lobbying groups noted in their letter to Senate leaders, the Better Care Reconciliation Act had the potential to cause significant harm to colleges and universities through possible cuts to state higher education budgets and reduced revenue to teaching hospitals through changes to Medicaid. And, of course, many students would have lost their healthcare–either through Medicaid cutbacks or through increased out-of-pocket costs to individual plans that, the American Council on Education rightly notes, would force students to “choose between paying for tuition and books or for higher cost medical care.”
Now that it has been chucked into the 115th congressional dustbin, it is a timely moment to revisit the Affordable Care Act (ACA) and its provisions for supporting sexual and intimate partner violence prevention and supporting survivors. After all, the ACA is the law of the land until it is not the law of the land, and campuses can use the current law to support their prevention efforts and their students’ well-being.
Many campus health care centers are already routinely including screening questions for sexual or intimate partner violence on patient questionnaires. Fewer, however, have implemented an in-person screening process or have formalized their follow-up process for students that screen positively for being at risk for experiencing these issues. One of the challenges that providers face in delivering in-person screening or appropriate follow-up counseling following a positive screening is devoting clinical time to complete an effective screening.
However, under the ACA, screening for sexual or intimate partner violence is a billable service, which means that campus health care providers can bill for the time spent on this important preventive service. Moreover, the billing codes used for screening of intimate partner violence and sexual assault are generic in nature and can cover a variety of other routine screenings as well, and are unlikely to generate suspicion if they appear on a billing statement. In contrast, domestic violence diagnostic codes, while useful for documenting injuries and in providing better data nationally on its prevalence, should be used with careful consideration, and after discussion with the survivor regarding their usefulness and possible safety concerns.
Campus health clinics that decide to adopt universal in-person screening for intimate partner violence may wish to review research on the efficacy of specific screening tools to modify one that fits their campus clinic needs. While a decade old now, this publication from the CDC still remains the most comprehensive review of screening tools currently available. It should be noted, however, that none of these tools have been tested specifically in the campus health clinic context. Futures Without Violence has developed an HHS-funded screening tool and training specifically for campus health clinics that has been developed since the CDC publication, which may be a good choice for consideration on your campus.
Additionally, I would be remiss if I failed to note a few other important protections and benefits that the ACA currently conveys on survivors. Current prohibitions against denying care due to pre-existing conditions explicitly extend to include having experienced sexual or intimate partner violence, and the ACA also requires coverage for substance use treatment and mental health.
Ensure that your clinical administrative staff is knowledgeable of the additional protections related to health insurance that is provided under the ACA so that your campus health clinic support extends from the examination room to the billing and records team as well. Check out this one-page fact sheet from the Department of Health and Human Services for important information about financial assistance for health insurance and other protections available to survivors of intimate partner violence. This site, developed as a part of efforts from the White House Task Force to Protect Students from Sexual Assault, is a terrific resource to help campus health clinics develop or strengthen their trauma-informed practices. The site includes tools and checklists for assessing the clinic environment, training staff, and reviewing policies.
Lastly, as prevention professionals, we know that universal and selective screening is just one part of an effective comprehensive sexual and intimate partner violence prevention strategy for your campus. The Campus Prevention Network’s Sexual Assault Diagnostic Inventory (SADI) is a powerful tool for campuses to use in assessing their campus prevention strengths and benchmarking their practices against a decade of research literature on prevention. Institutions receive no-cost access the SADI by joining the network and taking the pledge.