Standardize the MTSS framework

Prevention, Early Intervention, & Youth
Parity, Coverage, & Equitable Access
social determinants of health
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Coverage & Standards
Covered Benefits
Support Services
Federal department
Health and Human Services
house committees
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senate committees
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The Department of Education (DOE) should build a standardized framework for schools to implement the Multi-Tiered Systems of Support (MTSS) framework, establish dashboards for data collection and resources libraries on the MTSS framework, establish a certification program that recognizes districts that have implemented MTSS best practices, and establish a permanent position for school-based Medicaid services to support state education agencies in implementation.The Centers for Medicare & Medicaid Services (CMS) should also clarify that Tier 1 supports under MTSS include prevention and early intervention services under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.


The MTSS framework is an evidence-based prevention system consisting of three tiers of intensity for instruction, intervention, and support for students needing academic, social, and emotional support. Tier 1 supports are preventive supports and programming for all students and may include screening for additional areas of need. Tier 2 supports are small group, targeted standardized academic interventions or mental health supports using validated intervention programs for students identified as at-risk. Tier 3 supports are intensified and individualized interventions for students not responding to Tier 2 through instruction and supports that are intensified and individualized based on student needs.[1]

States and districts across the country have adopted MTSS as a governing framework for school-based mental health, but there is little consistency in how this framework is defined and implemented across states and districts. This results in programming that is implemented with varying fidelity to best practices. States and districts should be following a consistent set of MTSS-aligned best practices for mental healthcare delivery, but it is difficult to do so without federal guidelines that outline standard definitions and best practices for each tier of the MTSS framework.[2]

The DOE should create clear, standardized definitions of best practices for each tier of the MTSS framework, a certification program that recognizes districts that have implemented these best practices, and collect and publish federal dashboards to report on key mental health performance metrics and MTSS adherence, and build a federal resource library of professional and adult learning content on youth mental health.[2]

To mitigate common confusion over whether Tier 1 supports, which are inherently preventative, fit under “prevention” under Medicaid’s EPSDT coverage mandate for youth (note: the “P” stands for “Prevention”), CMS should clarify that Tier 1’s preventative supports and programming are indeed within the scope of “prevention” under EPSDT.

Additionally, the DOE should establish a permanent position for school-based Medicaid services at the DOE that can support state education agencies in implementation. Absent this action, Congress should require DOE to do so.


1. Center on Multi-tiered Systems of Supports at the American Institute for Research. “Essential Components of MTSS.” Last Accessed July 25, 2023.

2. Effective School Solutions. “Will to Wellness: Six Steps to Reinventing Mental Health in Schools.” Last Accessed, August 4, 2023.