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 (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 July 1, 2022-May 10, 2023, SBHS was funded with 56.2% federal funds and 43.8% state funds.
- For services provided on or after May 11, 2023, SBHS is funded with 50% federal funds and 50% state funds.
How can I participate?
- School districts, ESDs, charter or tribal schools interested in participating in the SBHS program may download the SBHS checklist for interested/new school districts for next steps.
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) 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 Checking Medicaid eligibility - Service providers
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SBHS billing information and fee schedule
Trainings and webinars
Additional resources
Program updates
SBHS sends updates via our email communications tool, GovDelivery. Sign up for SBHS email notifications. Recent bulletins are linked below, and older bulletins are available upon request.
Date | Bulletin |
---|---|
April 12, 2023 | SBHS quarterly newsletter |
February 2, 2023 | SBHS quarterly newsletter |
October 20, 2022 | Breakdown of SBHS Medicaid reimbursements |
October 12, 2022 | SBHS quarterly newsletter |
September 22, 2022 | Updated SBHS billing guide |
August 18, 2022 | SBHS annual trainings and resources |
July 12, 2022 | Updated SBHS billing guide and fee schedule |
July 6, 2022 | Updated SBHS billing guide |
June 14, 2022 | SBHS quarterly newsletter |
May 16, 2022 | SBHS ARPA refund |
April 7, 2022 | SBHS telehealth updates coming July 1, 2022 |
March 29, 2022 | SBHS funding structure update |
March 23, 2022 | Information on claim denials |
Contact
Shanna Muirhead
SBHS Program Specialist
Phone: 360-725-1153
Fax: 360-725-1152
Email: shanna.muirhead@hca.wa.gov
Schedule a virtual appointment