Category Archives: Education

School-Based Health Clinics Work

On Monday, the House Committee on Government Oversight and Accountability passed HB 1052, a bill to encourage the construction of school-based health care clinics in high-poverty school districts. Many other states, most notably Texas, have robust school-based clinic programs. The following is a memo from my Legislative Assistant Emily Walker summarizing research on these clinics. Conclusions: they work to save money, reduce unnecessary ER visits, and improve the health and education outcomes of students in schools where these clinics exist. 

To:       Representative Barnes

From:   Emily Walker

Re:       School Based Health Clinics

Date:   February 6, 2014


Question:        What are the value of School Based Health Clinics based on academic studies and real world data?


            School Based Health Centers (SBHCs) have developed in the past three decades as a solution to health care access problems in younger populations.  These in-school clinics help to “overcome utilization barriers in a way not previously documented in other clinical settings, even when serving populations that suffer from significant health disparities.”[1] Based on census data collected by the School-Based Health Alliance for 2010-2011, there were 1381 school based clinics that provided primary care and responded to the surveys.[2] SBHCs are found in a variety of communities: 54.2% in urban areas, 27.8% rural areas, 18.0% suburban areas.[3]  Of the responding clinics, 94.4% are located within school buildings.[4] The numbers of these clinics are growing and Missouri already has four located within our state.[5]

            There is no set funding or structured mechanisms for SBHCs.  Financing may come from a variety of sources and control comes from multiple levels (private sector, local government, state government, etc.)  Other states have successfully implemented these clinics on a state level.  Texas recently passed an expansion measure in 2009 to further support SBHCs.[6] HB 281 was a bipartisan bill passed unopposed in the House Public Education and Senate Education committees and signed into law by Governor Perry.[7]  This expansion of the program included stabilized and increased grant funding for the programs.[8]  According to the Census data collected by the School-Based Health Alliance, Texas had 87 school-based health clinics at the time of the survey.[9]

            There are many benefits to the school-based health clinic system.  These clinics have consistently shown decreases in emergency department visits, increases in primary care access, increases in immunizations, and better quality of health care for children who traditionally lack health care resources.  SBHCs knock down many of the barriers that children from high-risk families often battle, including: lack of private health insurance, transportation to appointments, parental absence from work, lack of awareness, and other stressors that keep children away from health professionals.[10] Not only do these programs give children access to health care, the ultimate goal of the clinics serves the ultimate goal of education programs.  As Adams and Johnson explain, “the program is aimed at improving school attendance and classroom performance and the longer-term prospects for these children as they mature”[11] 

            Numerous studies have found the cost saving measures that school-based clinics provide for public insurance programs. In Adams and Johnson’s article, An Elementary School-Based Health Clinic: Can it Reduce Medicaid Costs?, the authors answered the title question in the affirmative.[12]  This study compared children served by a school-based clinic to demographically similar children who did not have access to the same kind of clinic.[13]  There were no significant differences between the groups before the clinic opened, but two years after its opening, the children with access to the clinic had significantly lower instances of inpatient visits, non emergency department transportation, drug, and emergency department Medicaid expenses.[14]  These lower instances of high cost health care items meant that the school-based clinic helped to curb costly health care mechanisms for the children who had access to the SBHC.

            Another study also examined the affect of school-based clinics on the frequency of emergency department visits.  In Young, D’angelo, and Davis’ 2001 article Impact of a School-Based Health Center on Emergency Department Use by Elementary School Students, the authors wrote that emergency room visits are often non-urgent and have the negative effects of increasing medical costs and fragmenting health care.[15]  In their study, the authors examined elementary aged children (5-12) from an inner city neighborhood.[16]  The clinic served a school that had a student population of 95% of the population on free/reduced lunch and 60% African American/40% White.[17]  This study used a retrospective audit of emergency department records that compared the year before implementation of a school-based clinic to the year after its inception.[18] There was a significant drop in emergency room visits after the school-based clinic was introduced to the school.[19]  The results of this study show that SBHCs help to decrease non-urgent emergency department visits, and therefore the higher costs of these visits.

            Key, Washington, and Hulsey provided their findings of lesser emergency department visits by adolescents enrolled in SBHCs into their 2002 article, Reduced Emergency Department Utilization Associated with School-Based Clinic Enrollment.  This was another retrospective cohort study that examined emergency department utilization rates before and after adolescents enrolled in a SBHC.[20]  The subject school was an urban, public high school that’s student population was made up of 80% free/reduced lunch recipients and 99% African American.[21] The study showed a decrease in the emergency department visit rate for both groups from the base year, but this decrease was only statistically significant for the students who chose to enroll in the SBHC (enrollees had a 41% decrease of emergency room visits after enrolling in the clinic).[22]  The authors noted that because the study compared a population with prior emergency room use and then recorded the changes following the enrollment in a SBHC, the SBHC should be attributed as the cause of the decrease.[23]

            Beyond the scope of saving money on decreased emergency room visits, SBHCs serve other important interests as well.  One major benefit to note is the ability of SBHCs to help with vaccination rates in adolescents. In the article Addressing Adolescent Immunization Disparities: A Retrospective Analysis of School-Based Health Center Immunization Delivery, the authors performed a study to determine if SBHCs can improve rates of immunizations among at risk children and adolescent populations.[24] The study was a retrospective cohort analysis of children and adolescents who were split into groups that received health care from either a Denver SBHC or Community Health Center (CHC).[25]  For most types of vaccinations, children and adolescents were more likely to be up-to-date on their immunizations if they received health care from SBHCs.[26]  Along with this, for vaccines that require multiple doses over a set period of time, SBHCs were more likely to guarantee children received all doses.[27]  The authors noted a variety of reasons for why SHBCs are better for vaccinations, including: easier access to care, reminders to come back for care are easier, the tracking system is easier within the school system, many SBHCs see patients without any payment requirements, parents do not have to leave work, and students do not have to leave campus for the care.[28]

            Finally, a more recent study addresses all of the issues discussed above and the overall strong benefits of SBHCs.  In the article School-Based Health Centers: Improving Access and Quality to Care for Low Income Adolescents, the authors wanted to examine all of the advantages of SBHCs.[29] This was a retrospective cohort study that tracked the use of health care and markers of quality of care for adolescents enrolled in SBHCs compared to adolescents who used other community care entities.[30]  The SBHCs helped to increase uninsured adolescents access to care for primary health care.[31]  This increase in access to care through SBHCs led adolescents to report a higher likelihood to have three or more primary care visits, less emergency department visits, more health maintenance visits, and a higher likelihood to receive a flu vaccine, a tetanus booster, and a Hepatitis B vaccine.[32]  The authors of this study strongly established that SBHCs provide underserved adolescents and children with better access to care and an overall higher quality of health care than traditional community health systems do.

            There are multiple studies available to show the benefits of SBHCs to serve populations of children and adolescents that traditionally have not received quality health care.  These clinics have statistically shown they can reduce Medicaid expenditures through better preventive care measures, they increase immunization rates, and overall, they provide higher quality of care for a population that is often underserved.

[1] Steven Federico, et. al., Addressing Adolescent Immunization Disparities: A Retrospective Analysis of School-Based Health Center Immunization Delivery, 100:9 American Journal of Public Health,1630-1634 (2010).

[2], 2010-2011: Census Report of School-Based Health Centers, School Based Health Alliance, 2012, (last visited February 6, 2014).

[3] Id.

[4] Id.

[5] Id.

[6], Legislative Efforts, Texas Association of School-Based Health Centers, 2009, (last visited February 6, 2014).

[7] Id.

[8] Id.

[9] 2010-2011: Census Report of School-Based Health Centers.

[10] Thomas Young, et. al., Impact of a School-Based Health Center on Emergency Department Use by Elementary School Students, 71:5 Journal of School Health, 196 (2001).

[11] E. Kathleen Adams and Veda Johnson, An Elementary School-Based Health Clinic: Can it Reduce Medicaid Costs?, 105 Pediatrics, 780-788 (2000).

[12] Id.

[13] Id.

[14] Id.

[15] Young, D’angelo, and Davis.

[16] Id.

[17] Id.

[18] Id.

[19] Id.

[20] Janice Key M.D., E. Camille Washington, M.D., Thomas C. Hulsey M.S.P.H., Sc. D., Reduced Emergency Department Utilization Associated with School-Based Clinic Enrollment, 30:4 Journal of Adolescent Health, 273-278 (2002).

[21] Id.

[22] Id.

[23] Id.

[24] Id.

[25] Id.

[26] Id.

[27] Id.

[28] Id.

[29] Mandy A. Allison, MD, MSPH, et al. School-Based Health Centers—Improving Access and Quality of Care for Law-Income Adolescents, 120:4 Pediatrics, 887-894 (2007).

[30] Id.

[31] Id.

[32] Id.

Education Establishment Asks State Board to Pretend It Has a Magic Wand

On Tuesday, the state’s education establishment joined together to offer a “plan” to fix struggling schools in our state. Their plan is simple. It asks the State Board of Education to wave its magic wand and declare a struggling district cured through a simple administrative pronouncement. Here’s how it would work. Once the State Board declared a district unaccredited, the district could enter into a contract with the State Board promising to improve… and presto!, the district would magically be declared provisionally accredited.

This plan doesn’t require any evidence of actual improvement, and it makes a joke of the accreditation process. It changes the school accreditation process from one which requires accountability to one which perpetuates failure without consequence. It’s geared toward protecting existing power structures rather than ensuring substantive changes to improve the lives of Missouri families with students trapped in struggling schools. In addition, it arguably violates the letter of existing state laws and undoubtedly violates the intent of SB 125, the education reform bill I helped pass just last year.

In recent years, the State Board has shown it has the political courage to make difficult decisions regarding struggling districts, and it’s my hope that the Board will continue that tradition. 

Zip Code Should Not Determine Destiny

Increasing Opportunity for Low-Income Students
A child’s zip code should not determine their destiny. For more than two centuries, America has been the greatest nation in history because of the freedoms guaranteed by our Constitution. Indeed, Americans are the most free to realize their full potential through their own “pursuit of happiness.”The up-by-the-bootstraps story is fundamental to the American identity. Regardless of what you think of President Obama’s politics, his presidency is a living testament to upward mobility in America. The son of a Kenyan immigrant and a Kansas farm-girl, there aren’t many places in the world where a man with that background could become president. The same can be said of House Speaker John Boehner, who was born to a family of modest means. These stories are, of course, not limited to elected officials. Consider Missouri’s own Sam Walton, or Jack Dorsey of St. Louis, founder of Twitter, among other countless examples.Over the last 40 years, however, the American dream has been slipping away in some zip codes. A recent Harvard study found that children born in poverty in Kansas City and St. Louis are approximately 50 percent less likely to eventually earn a middle to upper-class income than their same aged peers born in poverty in mid-Missouri.Liberals see stats like these and oft ask how government can ensure an “equality of stuff.” The left’s solution is generally geared towards centralized power and a redistribution of wealth from cradle-to-grave to make society more equal. What the progressive often believes works best is more rules, more organization, and more government money.

Conservatives understand that inequality alone is not a bad thing. (In fact, recent history has shown that equality increases during a recession.) Economic activity is not a zero-sum game and “equality of stuff” is neither just nor possible. The world learned that lesson in the Cold War. The Soviet Union was perhaps the most unequal society in history – the vast majority of the population lived in poverty, while the politically powerful enjoyed the fruits of their connections. We know how the Cold War ended. To paraphrase Reagan, “We won. They lost.”

Conservatives, by contrast, ask how government can better ensure “equality of opportunity.” The best way to ensure equal opportunity is for government to create and enforce a basic framework of rules that empower citizens to reach their potential. And while increased inequality is not necessarily a bad thing if the entire economy is improving, social mobility matters.

The conflicting philosophies of conservatives and liberals is clear in the contrasting approaches to the challenge of education in high poverty neighborhoods. Liberals tend to focus on increased funding and more centralized control. Sometimes their logic seems more focused on buildings and protecting existing power structures than helping real-life children.

House Bill 1579, which I have sponsored, takes a more comprehensive and conservative approach to improving education in high-poverty struggling school districts. It does so by empowering families in these communities to choose the school which will work best for them – as they see it, not as someone else does. The bill would:

  1. Encourage the rapid expansion of high-performing charter schools;
  2. Create scholarships for students in low-income families to attend the same schools as students from wealthy families, on the condition that the school they choose abides by the same requirements as traditional public schools and agrees not to compel any scholarship recipient to attend a religious class or ceremony;
  3. Protect the freedom these families have under current law to choose a different traditional public school, but allows “receiving schools” to place reasonable restrictions on transfers to ensure there is enough classroom space to help; and
  4. Allow students to choose courses in virtual education as an alternative to brick-and-mortar schools.
Beyond protecting and increasing these families’ freedom to choose their own path, HB 1579 would help improve struggling schools by creating a fund to pay bonuses to high-performing teachers and a more equitable transfer funding formula to prevent potential bankruptcies.I anticipate that discussions on big education legislation this year will take a long and winding path. My focus will be on increasing opportunities for families in struggling districts to pursue their own happiness, and not be held back by the arbitrary silo of an unfortunate zip-code, and I’ll do my best to ensure that the principles and policies included in HB 1579 are included in any legislation that makes it to the finish line.

The Education Establishment Manufactures Fake Controversies After State Board and Dr. Nicastro Refuse to Endorse the Status Quo

If you follow Missouri education policy, you’ve heard about a few alleged controversies which has led to a trio of teacher’s unions and a handful of Democratic lawmakers to ask for the resignation of Dr. Chris Nicastro, the Commissioner of the Department of Elementary and Secondary Education. Dr. Nicastro’s alleged wrongs? (1) Conferring with a group likely to place an initiative petition on next year’s ballot regarding teacher tenure – and recommending a changed suggestion to the fiscal note on the bill which was recently upheld by a Missouri court, and (2) refusing to allow the status quo in Kansas City to continue.

What you probably don’t know is the long backstory on this which exposes it for the farce that it is.

You’d think by the tone of their statements that the allegedly controversial meetings on the ballot initiative were only recently revealed to these unions. After all, if they’re so far out of line, it would make sense that the unions would cry foul right away. Turns out, however, that the unions have had them since early May.

So why would they wait nearly half a year before saying anything? Because they had a lot of issues to hang over Dr. Nicastro’s head over the last six months. 

  1. First, there was the decision whether to accredit the Kansas City schools or not. To the Board of Education and Commissioner Nicastro’s credit, the Board refused to allow the status quo to continue.
  2. Next there was the issue of what to do about transfers in the St. Louis area. Rumor has it there was a push for DESE to issue guidelines to effectively end the transfers. The Board issued some basic guidelines (in my opinion to help protect districts from themselves), but appropriately refused to attempt to change the law by bureaucratic fiat. 
  3. Then there is the ongoing issue of how to change the transfer statute. Rumor has it that the Establishment is pushing DESE and the Commissioner to stop the transfers via administrative rule – skipping right past the legislature, never mind the legalities of such a maneuver. To their credit, DESE and the Commissioner, I’m told, have said that wasn’t advisable or possible. 
  4. Finally, there was a lawsuit filed against the initiative petition on teacher tenure. The unions challenged multiple aspects of the initiative petition, including the fiscal note. On November 19, the teacher’s unions’ lawsuit was rejected by a Missouri judge. The very next day the Associated Press reported that unions were criticizing Nicastro for the meetings related to the initiative.

Connect the dots? Here’s how the unions want to pull this one off. First, gather the “evidence” early – and hold on to it. Next, see what you can do to get favorable decisions for your issues from your target. If things go your way, hold on to your trump card as long as you can. Who knows when you might need to use it? Then, and only if your target isn’t cooperating, go nuclear. Hopefully you get her removed. And if you do, you know her replacement will know who’s in charge here. It’s you. Any questions?

The criticisms of Dr. Nicastro are driven purely by the fact that she and the State Board have proven time-and-again-and-again-and-again that they have the backbone required to resist bowing to political pressure from special interest groups whose biggest interest is not the education of children but to oppose anything that endangers their monopolies of control over failing school districts.  

Much credit goes to State Board of Education President Peter Herschend for immediately defending Dr. Nicastro here and here.  Not everyone is going to agree with everything the Board or Dr. Nicastro does. At times, I’ve been a vocal critic of the Board. But all Missourians should be thankful for a Board of Education doing its best to deal with very difficult, if not impossible, issues – and proving by its actions that it won’t simply kowtow to special interests.  

Quick Thoughts on “Controversy” of State Official Giving Technical Advice on Ballot Initiative

The education establishment that puts adults ahead of children and blocks every education effort imaginable, and, in some cases, even agrees to stand-down on reform legislation and then turns around less than 24 hours later and changes their position, is atwitter over the fact that Commissioner Chris Nicastro met with, conferred, and maybe even advised a group seeking to place an education-related initiative on the Missouri ballot.

A few quick thoughts:

1. The Commissioner of the Department of Elementary and Secondary Education is, per §161.020, is appointed by the State Board of Education. It seems there’s fairly widespread confusion on this. It’s not the typical way a director of state department is appointed.

2. We have a past history in Missouri of technical problems with ballot initiatives. For example, the minimum wage initiative inadvertently undid decades of overtime practices for firefighters and nurses – to the detriment of both labor and management – and the legislature had to come back later to fix it. A second example comes from the renewable energy mandate – which is a little bit different – but where proponents sold their measure as only costing one percent of current energy costs and then later completed the bait-and-switch by convincing the PSC to hold that one percent really means 11 percent. Because of these examples (and I’m sure there are more), I think directors of state departments impacted by ballot initiatives which could plausibly make it to the ballot ought to consult and advise proponents of those initiatives to help avoid unintended consequences. 

Troubling Social Promotion Policies in St. Louis Public Schools

State Auditor Tom Schweich released a report yesterday on St. Louis Public Schools. Two points worthy of quick note:

  • The district violated state law by regularly promoting students to the next grade level even if they can’t read. The P-D explains:

But what troubled Schweich the most is the district’s practice of moving children to the next grade level even though their reading skills are sub par. More than 2,000 students tested at the “below basic” level — the lowest performance category — in the 2011 and 2012 reading section of the Missouri Assessment Program. Yet just 158 and 128 students were held back those years, respectively. Holding back each child who is behind in reading, as mandated by state law, would be too costly, administrators told Schweich’s staff.

“I don’t know what the priorities are as far as finances go, but at least in our view students who can’t read should be the highest financial priority,” Schweich said in downtown St. Louis.

Rick Sullivan, president of the district’s state-imposed Special Administrative Board, said the retention issue was a tough problem to solve.

“The number of students who would be retained would be staggering,” he said. “But that’s the question people have asked for years and years.”

Social promotion might help the school’s finances in the short-run, but doesn’t help the kids – or the district – in the long-run. 

  • Schweich found the district did an inadequate job of detecting or deterring cheating on standardized tests. There’s good news here though. In 2012, I sponsored legislation to require the Department of Elementary and Secondary Education to buy software to detect and deter cheating on standardized tests statewide. That bill did not pass, but after continued discussions with DESE, the department requested funds in this year’s budget to buy the software. Because it just passed in this year’s budget, the software wasn’t available for use during the testing periods covered by Auditor Schweich’s report. However, it should be available everywhere in the state for this year’s standardized tests. 

Bringing the Scientific Method to the Classroom

What works in education? Forget the hype and the hunches, the NYTimes reports on new research from the “Institute of Education Sciences” – a little-known department within the U.S. Department of Education – applying scientific rigor to competing education methods. The office has conducted 175 randomized studies to date. Some findings: one popular math textbook showed demonstrably better results than its competitors; another computer-aided math program had no effect on learning. 

The studies are conducted through randomized clinical trialsResults are available for teachers and administrators at the department’s What Works Clearinghouse.

Why I’m Voting to Lower Taxes

When the General Assembly reconvenes in a few weeks for veto session, the biggest question before the body will be whether to override Governor Nixon’s veto of HB 253, the first comprehensive tax cut to pass in Missouri in nearly a century. I voted in favor of HB 253 and will do so again at veto session.

Here’s why: economic growth matters.

States with growing economies have lower unemployment rates, decreasing welfare programs, and increased state revenue. To quote President Kennedy, “A rising tide lifts all boats.” States with stagnant economies have higher unemployment rates, more welfare, and frequent budget crises – all of which can work to start a vicious cycle of increasing taxes and fees to keep up with growing needs even though the result of such hikes is to slow or halt the economic growth needed for a state to move forward.

Today, it’s easier and easier than ever for entrepreneurs and job creators to move locations.  As a result, Missouri must compete with surrounding states and other countries, like India and China, to attract investment. In an age where “the world is flat,” capital flows easily through the path of least resistance, including human capital.

So, how do we spur economic growth? Over the past decade, it’s obvious the legislature has taken the wrong approach. Instead of focusing on broad-based tax relief that lowers rates for all businesses, the focus has been on gimmicks and targeted tax breaks limited to businesses savvy enough to hire high-powered lawyers and lobbyists to petition the Department of Economic Development for special treatment. Unfortunately, this special favors approach has proven not to work for the larger economy. Often, it doesn’t even work for the savvy supplicant. (See Mamtek, as the worst example.) This approach has not worked. Over the past decade, Missouri has ranked 48th in the country in economic growth.

We need to take a different approach – one that incentivizes growth for all businesses and encourages entrepreneurial activity to grow Missouri’s economy. With HB 253, we reject the vicious cycle of tax hikes and further economic stagnation and choose a virtuous cycle of economic growth instead.

Of course, opponents of HB 253 paint a different picture. They take the vicious cycle approach and claim reducing tax rates puts education funding at risk. Governor Nixon has even taken the constitutionally dubious approach of pre-emptively withholding funding from education or other programs to scare certain representatives into voting his way. Opponents claim HB 253 will cost the state approximately $800 million. What they don’t tell you, however, is that (1) this cost estimate does not come from actual reductions in net revenues, but instead from slower increases in revenue, and (2) their analysis assumes zero economic growth from the reduction in marginal tax rates.  

Another argument of opponents is that drafting errors with HB 253 should prevent the legislature from acting on this measure.  Instead, opponents argue we should wait until next year. On this, the opponents have good points. All too often, the General Assembly acts with such haste in the last few weeks of session that drafting errors slip through the process. This isn’t a new problem – but it is one that we need to fix. In regards to HB 253, however, the legislature can and should take action now to lower the tax burden on all Missourians – and then immediately fix any drafting problems with the bill. I trust that Democrats will join us in clarifying the language in HB 253 on prescription drugs and the Marketplace Fairness Act. 

Nixon Signs SB 125 – Education Reform Bill

Gov. Nixon signed SB 125 this morning, an education reform bill which (1) puts St. Louis on equal footing with the rest of the state in how it removes ineffective teachers, and (2) allows for faster intervention by the State Board of Education to help struggling school districts turn things around. This is a big win for parents and students across the state. Thank you Governor Nixon and Sen. Jamilah Nasheed, the bill’s sponsor. 

DESE’s Transfer Guidelines Good – But Districts Shouldn’t Mistake Them for a Free Pass to Violate State Law

The Department of Elementary and Secondary Education released guidelines this morning for districts impacted by the Supreme Court’s recent decision upholding a Missouri law which allows students in failing districts to improve their education by enrolling in neighboring, more successful schools. See here: Student Transfer Guidance for Unaccredited Schools. There is no doubt that implementing these transfers will be difficult for administrators. And the guidelines released by DESE are a good effort to help districts think about implementation.

Districts, however, shouldn’t confuse one important guideline with actual state law. In particular, paragraph 4 of DESE’s guidelines recommends a non-discriminatory method for receiving districts to determine which students to accept and which not. It states as follows:

(4) If a school district does not have sufficient capacity to enroll all pupils who submit a timely application, the school district should institute an admissions process to ensure all applicants an equal chance of admission, except that a school district may give preference for admission to siblings of children who are already enrolled in the school district under this section.

However, §167.241 does not make a “sufficient capacity” exception. Its last sentence provides very clearly that, “Each pupil shall be free to attend the public school of his or her choice.” Full statute pasted below. There’s also no “receiving district’s recalcitrance” exception to this statutory right.  As a result, there can be no education lottery under §167.241. Administrators in receiving districts are going to have to figure out how to serve these new students seeking a better education.

To DESE’s credit, the guidelines do not take an explicit position on whether these lotteries comport with §167.241. Instead, the absence of any explicit position leads me to believe that paragraph 4 may have been crafted with the realization that some receiving districts may deny access under an “impossibility” argument and DESE wanted to be sure that , at the very least, receiving district’s which deny students only do so under the fairest policy possible. 

To the extent a receiving district is going to flagrantly flout state law by closing their doors to transfer students, I believe this is the best policy. DESE’s “equal chance” policy ensures that decisions aren’t made on improper bases such as income, race, familial status, neighborhood, politics, athletics, or previous academic results. But any district which adopts the “equal chance” policy is only going to do so after violating state law – and that’s unacceptable. The people of Missouri expect better from public institutions.


District not accredited shall pay tuition and transportation, when–amount charged.

167.131. 1. The board of education of each district in this state that does not maintain an accredited school pursuant to the authority of the state board of education to classify schools as established in section 161.092 shall pay the tuition of and provide transportation consistent with the provisions of section 167.241 for each pupil resident therein who attends an accredited school in another district of the same or an adjoining county.

2. The rate of tuition to be charged by the district attended and paid by the sending district is the per pupil cost of maintaining the district’s grade level grouping which includes the school attended. The cost of maintaining a grade level grouping shall be determined by the board of education of the district but in no case shall it exceed all amounts spent for teachers’ wages, incidental purposes, debt service, maintenance and replacements. The term “debt service”, as used in this section, means expenditures for the retirement of bonded indebtedness and expenditures for interest on bonded indebtedness. Per pupil cost of the grade level grouping shall be determined by dividing the cost of maintaining the grade level grouping by the average daily pupil attendance. If there is disagreement as to the amount of tuition to be paid, the facts shall be submitted to the state board of education, and its decision in the matter shall be final. Subject to the limitations of this section, each pupil shall be free to attend the public school of his or her choice.