Programs & services

Due to COVID-19, HCA’s lobby is closed. Learn more about your customer service options.

HCA is closed Thursday, November 26 and Friday, November 27. All Apple Health (Medicaid), PEBB, and SEBB customer services phones lines will be down after 5 p.m. Wednesday, November 25 through Monday morning, November 30.

School-based health care services (SBHS)

An updated SBHS billing guide is now available.

View the guide (11/23/2020)

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 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 COVID-19 FAQ

Billing for mental health services - video / pdf

Department of Health

SBHS program expansion FAQ

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

 

 

NCCI edits training tool - 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: 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