The federal Centers for Medicaid and Medicare Services (CMS) rule enacted in January 2014, allows each state's health plan to incorporate the rule that allows Medicaid programs to provide reimbursement of community prevention services provided by non-licensed practitioners (which may include CFLEs). Specifically, the rule states that preventive services can be services recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under state law at state option to 1) Prevent disease, disability, and other health conditions or their progression; 2) Prolong life; and 3) Promote physical and mental health and efficiency.

The ruling certainly provides opportunities for public health educators but given the important role that the family plays in behavioral and physical health, it also opens the door for family life educators to become more directly involved in providing services reimbursed by Medicaid. As a member of the National Council on Family Relations (NCFR), and the Society of Public Health Educators (SOPHE), as well as a member of the New Jersey SOPHE, I have encouraged collaboration between NCFR and SOPHE. This effort resulted in SOPHE having a representative at the NCFR 2013 Focused Dialogue session at NCFR's annual conference in Phoenix, Arizona, and in Dawn Cassidy representing NCFR at SOPHE's 2014 national conference.

SOPHE has encouraged their members to meet with state Medicaid offices to respond to the opportunities afforded by the CMS Ruling. SOPHE's Advocacy and Policy Committee recently developed a toolkit for its members to use toward this effort. I wish to publicly thank SOPHE for this effort.

I am taking the opportunity of this column in the CFLE Network to issue a call to action to CFLEs and members of NCFR to develop a similar tool-kit for use in pursuing Medicaid reimbursement for family life education services. This directly fits into the overall goal of the Future of Family Science initiative.

The toolkit would provide information and resources that could be used in making the case for family life educators to be reimbursed for their services via Medicaid. The NCFR white paper, Family Life Education: A Profession with a Proven ROI (return on investment) (Cenizal, Kirby-Wilkins, Cassidy and Taner, 2014) provides a useful foundation for this toolkit. This document provides ample useful information that defines and identifies practical applications, and validates the ROI of family life education (FLE). One of the key advocacies is to offer FLE as a key universal, selective, and indicated prevention strategy for behavioral health where nothing currently exists. Behavioral health impacts include the reduction of the acuity of mental health episodes and the concomitant mental health crises for family members of those suffering from mental health disorders. Further, evidence-based FLE is a proven strategy for the prevention of the early on-set use of alcohol and other drugs by increasing the protective factors of youth and reducing risk factors. Simply by delaying the onset of use, a significant reduction occurs in the incidence of addiction and other high risk behaviors among the population that participates. This certainly provides an argument for the inclusion of family life education services in behavioral health services.

Next, the tool-kit must provide a CMS Ruling Overview. The ruling in its entirety can be found on the CMS Center for Consumer Information & Insurance Oversight Regulations and Guidance webpage. We can draw from the NCFR white paper key items included in the SOPHE Toolkit including the ROI, the definition of family life education and its importance, and details of the Certified Family Life Educator designation, outlining the provider qualifications. And we need to add a section outlining a brief overview of state government structures.

The steps to seeking the Medicaid Plan Amendment for billing must outline goals of the campaign, describe the issue and solution, explain FLE service delivery, identify opportunities and barriers, and provide additional resources. The CMS Essential Benefits Rule (CMS-2334-F) for billing of prevention services requires collaboration of CFLEs, health education specialists, prevention specialists, community health workers and others within a state.

In New Jersey, I have personally met with our state Medicaid office as well as those of the Division of Mental Health and Addiction Services, a state legislator, and a group of prevention specialists/administrators of several well-recognized prevention programs. I have made inroads for FLE to become infused into the substance abuse treatment system for clients as well as family members, and lastly, while serving on the New Jersey Behavioral Health Planning Council, I have most recently advocated that the state consider supporting efforts for Medicaid funding.

The wheel of advocacy continues to move forward. Let's join forces and develop a tool-kit to assist in reaching the goal of making family life educator services Medicaid billable. The promotion of FLE as a recognized profession worthy of funding will take us closer to making participation in FLE the norm across the lifespan.

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