School-based Health Care Services

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The School-Based Health Care Services (SBHS) program reimburses school districts for Medicaid covered health care services provided to Medicaid eligible children in Special Education. These services must be included in the student's current Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) and be provided by a licensed health care provider.

Covered Services

  • Evaluations when the child is determined to have a disability, and needs special education and health care-related services.
  • Reevaluations to determine whether a child continues to need special education and health care-related services.
  • Direct health care-related services, including:
    • Audiology services
    • Counseling services
    • Nursing services
    • Occupational therapy services
    • Physical therapy services
    • Psychological assessments
    • Speech-language therapy services

Provider Qualifications Requirements

School-Based Health Care Services must be delivered by a health care provider who meets federal requirements and state licensure requirements according to Washington State law (WAC 182-537-0350). All providers must apply for an National Provider Identification (NPI) number and must be enrolled as a rendering or servicing provider under the school district’s billing National Provider Identification (NPI) number.