School-based health care services (SBHS)

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 (CNP/MNP) coverage and the services are included in the student's current Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).

Covered services

The SBHS program reimburses for 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.

SBHS funding structure

The SBHS program is funded with federal and state funds and services are paid on a fee-for-service basis per the SBHS fee schedule.

  • For services provided prior to July 1, 2022, SBHS was funded with 56.2% federal funds, 26.28% school district (local matching funds), and 17.52% state funds.
  • For services provided after July 1, 2022, SBHS is funded with 56.2% federal funds and 43.8% state funds.

How can I participate?

Additional information

Resources for SBHS coordinators and providers

SBHS coordinators

 

Service providers

SBHS billing information and fee schedule

Trainings and webinars

Additional resources

SBHS billing guide

SBHS 101 training - video | pdf

Apply for a National Provider Identifier (NPI)

SBHS fee schedule

Billing for audiology services - video | pdf

NPI registry

SBHS program expansion FAQ

Billing for mental health services - video | pdf

Department of Health

 

Billing for nursing services - video | pdf

 

 

Billing for occupational therapy services - video | pdf

 

 

Billing for physical therapy services - video | pdf

 

 

Billing for speech-language therapy services - video | pdf

 

SBHS quarterly newsletters and program notifications

SBHS sends updates via our email communications tool, GovDelivery.

Past notifications are available to view through our RSS feed.

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.