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School-based health care services (SBHS)
On this page
An updated SBHS billing guide is now available.
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
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SBHS billing information and fee schedule |
Trainings and webinars |
Additional resources |
Forms |
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Annual training for returning SBHS coordinators |
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| Look up a provider's DOH license information | |||
| Remittance advice claim denial remark codes | |||
| Claim adjustment reason codes | |||
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How to submit SBHS claims (for self-billing districts) |
Login in to ProviderOne | ||
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SBHS billing information and fee schedule |
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Additional resources |
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NCCI edits training tool - pdf |
| SBHS billing information and fee schedule |
Trainings and webinars |
Additional Resources |
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How to enroll as a billing provider (setting up a ProviderOne account) |
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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: If you subscribe to our RSS feed and use the Chrome browser, you will need to install the RSS feed extension for Chrome.
Contact
Shanna Muirhead
SBHS Program Specialist
Phone: 360-725-1153
Fax: 360-725-1152
Email: shanna.muirhead@hca.wa.gov
For SBHS A-19 invoice inquiries:
HCA accounting office
Email: HCASchoolBased@hca.wa.gov