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 Medicaid covered health care related services provided to Title XIX Medicaid eligible children requiring special education services consistent with section 1905(a) and section 1903(c) of the Social Security Act.

These services must be included in the student's current Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) and must be provided by or under the supervision of a licensed health care provider.

Client eligibility

Children with a disability (age 0 through age 20) who require early intervention or special education and related services must be receiving Title XIX Medicaid under a categorically needy program (CNP) or medical needy program (MNP) and must have eligible services included in their IEP or IFSP. Children enrolled in managed care receive SBHS on a fee-for-service basis.

Covered services

Evaluations, reevaluations and direct health care related services  which are included in a child's IEP or IFSP, including:

• Audiology services
• Mental health services
• Nursing services
• Occupational therapy services
• Physical therapy services
• Speech-language therapy services

Provider eligibility

School-based health care services must be delivered by or under the supervision of licensed health care providers. A list of eligible providers can be found in the SBHS Billing Guide and in WAC 182-537-0350.

Reimbursement

The SBHS program is an optional Medicaid match program with a 50/30/20 federal/local/state match funding structure. Reimbursements are based on fee-for-service established rates per the SBHS Fee Schedule, and are facilitated via an Intergovernmental Transfer (IGT) process. In order to participate in the SBHS program, school districts must enter into a contract with the SBHS program and must have an active ProviderOne account.

Resources

SBHS quarterly newsletters and program notifications

SBHS sends updates via our email communications tool, GovDelivery.

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Past notifications are available to view through our RSS feed.

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