School-based health care services (SBHS)
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What is the School-Based Health Care Services (SBHS) program?
The SBHS program is an optional Medicaid program that provides reimbursement to public school districts, educational service districts, charter, and tribal schools for certain early intervention health-related services or special education health-related services.
These services are reimbursable when a student has Title XIX Medicaid coverage and the services are included in the student's current Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP). The SBHS program is funded through Federal and State funds (50/50) and services are paid on a fee-for-service basis per the SBHS fee schedule.
Covered services
Evaluations, reevaluations. and direct health related services which are included in an eligible student's IEP or IFSP, including:
- Audiology services
- Mental health services (individual and group counseling)
- Nursing services
- Occupational therapy services
- Physical therapy services
- Speech-language therapy services
Provider eligibility
In order to receive Medicaid payment for IEP/IFSP health-related services through the SBHS program, the services must be prescribed or recommended by Department of Health (DOH) licensed providers and must be delivered by or under the direction of DOH licensed providers. A list of SBHS eligible providers can be found in the SBHS Billing Guide and in WAC 182-537-0350.
Additional information
- SBHS one-pager
- SBHS 101 training video | pdf
- SBHS billing guide
- SBHS checklist for interested/new school districts
- Sample SBHS contract
- Contractor intake form
- List of SBHS contracted school districts
Resources for SBHS coordinators and providers
- SBHS coordinators
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SBHS billing information and fee schedule
Trainings and webinars
Additional resources
Forms
Annual training for returning SBHS coordinators -
Look up a provider's National Provider Identifier (NPI) Checking Medicaid eligibility Remittance advice claim denial remark codes Claim adjustment reason codes How to submit SBHS claims (for self-billing districts)
Login in to ProviderOne Reading the remittance advice - Service providers
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SBHS billing information and fee schedule
Trainings and webinars
Additional resources
SBHS quarterly newsletters and program notifications
SBHS sends updates via our email communications tool, GovDelivery.
Sign up for email notifications
Past notifications are available to view through our RSS feed.
View past program notifications
Please note: To view past program notifications on the Chrome browser, you will need to install the RSS feed extension for Chrome. If viewing on the Microsoft Edge browser you will need to install the RSS feed extension for Edge.
Contact
Shanna Muirhead
SBHS Program Specialist
Phone: 360-725-1153
Fax: 360-725-1152
Email: shanna.muirhead@hca.wa.gov
Schedule a virtual appointment