Johnson County School Board debates telehealth vendor switch amid billing and legal concerns

Johnson County School Board members met in a March 10 work session to discuss whether to replace the district's current school-based telehealth vendor, EMD, and heard a presentation from Johnson County Community Hospital staff about a proposed program run through Valley Health and the hospital's rural health clinic.

The discussion centered on continuity of care for students and staff, how telehealth visits would be billed, whether parents could face surprise charges, whether contractors perform required site checks and what legal or licensing obligations the district must meet. No formal contract vote was taken at the work session; board members directed staff and the vendors to provide additional materials and said a formal decision would be on the agenda for a Thursday meeting, with April 1 cited as the deadline to give 60 days' notice to the current vendor if the board chooses to terminate the existing arrangement.

Chastity Trivet, administrator at Johnson County Community Hospital, and Rachel Kuhn from the hospital's telehealth team described a school-based telemedicine option that would use Johnson County providers and equipment placed in schools. Trivet said the hospital would bill family insurance when available, offer a cash-pay option for uninsured families and provide technology and staffing supports. "The only thing I care about is just fast, accurate service for the student and staff," Trivet said.

School nurses who currently work with EMD spoke in favor of maintaining the existing relationship, emphasizing familiarity and quick response. Shannon Wood, an LPN at Laurel Elementary, said, "If it's not broke, don't try and fix it." Several nurses described routine on-site workflows that include point-of-care testing (strep, flu, COVID) performed under standing orders and immediate follow-up with a telemedicine provider when needed.

Board members and staff raised several issues they said must be clarified before any change: whether the vendor performs in-person site checks as required by the agreement, who bears liability and malpractice coverage under the memorandum of understanding (MOU), how copays and test fees are billed to families, and how the district ensures a two-year-licensed registered nurse oversees school medical services under state rules. One board member said she had not seen the contract details and asked staff to locate and share the original MOU and any subsequent amendments.

On billing, participants cited different examples from vendors and parents: the current vendor, EMD, charges a $25 copay for some plans, nurses said; Ballad/Valley Health representatives described billing visits as primary-care visits when local primary-care providers are used and said cash-pay or lower-cost asynchronous (photo/chat) visits were possible. The hospital's staff said an asynchronous visit option could be offered for about $30 and that cash-pay urgent-care-style visits could be $45; a hospital representative also mentioned an uninsured cash-pay rate of about $49 in one exchange. Nurses noted that some point-of-care tests generate small additional charges (one figure cited was $6.60 per test) and that test kits themselves can be costly.

Board members asked explicitly for vendor documentation on billing codes, typical patient balances and whether any charges would be absorbed by the vendor or the district. Trustees requested documentation showing how EMD currently codes and bills for tests and visits and asked the hospital/Valley Health team to provide standing orders, registration/consent packet samples and a written explanation of how continuity of care with local primary-care providers would work.

Contract and oversight concerns also dominated the session. Several board members said they could not find evidence of required annual site checks in the original MOU with EMD and asked staff to locate contract records. The board's legal counsel was consulted by phone during the meeting; staff reported that a binding contract change would require public notice and that the board generally should not conduct a binding vote at a work session. Board members therefore said they would place a vote on continuation or termination of EMD on the April agenda and would issue an RFP if they chose to solicit competing proposals.

Nurse staffing and potential conflicts of interest were also raised. Some trustees questioned whether district-employed nurses who also have outside contracts were creating liability or supervision gaps; those concerns prompted requests for payroll and contract records related to district nursing staff. Nurses and providers pushed back, saying they routinely coordinate care with parents and outside providers and that many parents prefer in-person primary-care visits.

Behavioral health and pediatric access came up as secondary but important topics. Valley Health representatives said they are beginning to add behavioral health to school telemedicine offerings and would help the district pursue additional COVID-relief dollars or other funding to support reset-room or behavioral supports. Several nurses said they already work with community behavioral-health partners and expected any new telehealth vendor to coordinate with those services.

Directives and next steps from the meeting: - Board staff will gather and circulate the existing MOU, contract records and site-check documentation for EMD. - EMD and any presenting vendors were asked to provide detailed billing summaries, including CPT coding and sample patient-account scenarios, and to clarify what uninsured patients would be charged and whether the vendor would absorb any test fees. - School staff will prepare a draft RFP and identify where it will be posted if the board votes to solicit proposals. - The board indicated it will consider a formal vote at the next scheduled meeting; April 1 was discussed as the practical deadline to notify EMD if the board chooses to terminate the current arrangement for the following school year.

The session ended without a formal decision. Board members repeatedly emphasized child safety, legal compliance and cost transparency as the criteria they expect to guide any change in telehealth arrangements.