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.
Each October, participating school districts must complete and submit a current Provider Update Form (PUF) with copies of each health care professional's current license, certification, degree or transcripts, and NPI number. Complete and return the PUF by mail, email or fax to (360) 725-1152. The form is located below under Resources.
Note: This is a district responsibility. Do not submit expired credentials as it will result in claims denial for that provider.
SBHS program contract
Covered Medicaid services provided to Medicaid eligible Special Education students can be billed to the HCA when a school district contracts with HCA. Reimbursements are based on fee-for-service established rates, and are facilitated via an Intergovernmental Transfer (IGT) process.
Note: HCA has no affiliation with billing consultants. If a school district contracts with a billing consultant to assist in submitting Medicaid claims to HCA, the relationship between the district and its billing consultant is separate from its contractual relationship with HCA.
New Contractors: Complete and return the Contractor Intake Form by email or fax to (360) 725-1152. Disregard check-off list EXCEPT the requirement for your district's W-9. In addition, please email the following:
- Name, title, phone, fax, and email of the employee who transmits the local matching funds.
- Name, title, phone, fax, and email of the employee who will receive the contract from HCA.
- Name, title, phone, fax, and email of the employee who will sign the contract.
When this required information is received, a contract between HCA and the district will be generated. Please send any questions regarding the contractor intake process to the SBHCS Program Specialist.
When a fully executed contract is in place, the district can begin submitting claims for Medicaid covered services. Please send any questions regarding the Intergovernmental Transfer (IGT) process to HCA School Based Health Care 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).
Washington Connection is designed for anyone who would like to find out what benefits and programs they might qualify for in Washington State. The online application is for residents of Washington State to apply for federal, state, or local benefits.
To determine if a child is eligible for health care coverage, a parent or guardian can inquire or submit an application in one of the following ways:
- Online with the Washington Healthplanfinder at www.wahealthplanfinder.org.
- By calling the WA Healthplanfinder Customer Support Center at 1-855-WAFINDER (855-923-4633) or 1-855-627-9604 (TTY).
- By mail to:
PO Box 946
Olympia, WA 98507
In-person application assistance is also available. For information about in-person application assistance in your area, visit www.wahealthplanfinder.org or call the WA Healthplanfinder Customer Support Center.
Want to Receive Provider Alerts?
HCA sends out program updates and provider alerts using the GovDelivery email subscription management services. If you would like to receive provider alerts from HCA, including the SBHS program, follow these steps:
- Go to the Email Updates page, and sign up for a subscription. You can find this link on any HCA website. It is located near the top, in blue type (Email Updates), next to the Facebook, Twitter and printer links.
- After you enter your email address and hit "Submit", click on all the topics you want to receive. For example, if you click on Apple Health Provider Alert, you'll get all the Provider Alerts HCA sends out. You can also choose other email topics including news releases, Health Information Assessment, Healthier Washington and School-Based Health Care Services.
- Click "Submit".
To change your email address, choose when your emails are sent, and set up an optional password, click on "Subscriber Preferences".
Medicaid Customer Service
For urgent issues, call Medical Assistance Customer Service Center at 1-800-562-3022.
Hours: Monday – Friday, 7:30 a.m. to 4:30 p.m.