School-based health care services (SBHS)

SBHS training webinars: Register for one or both of our upcoming webinars for returning school districts/ESDs or new school districts/ESDs. 

What is School-Based Health Care Services (SBHS) ?

The SBHS program reimburses school districts for Medicaid covered health care related services provided to 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 a licensed health care provider.

Client eligibility

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

Covered services

Evaluations: When the child is determined to have a disability, and is in need of special education and health care related services that result in an IEP or IFSP.

Reevaluations: To determine whether a child continues to need special education and health care related services.

Direct health care related services which are included in a child’s IEP or IFSP, including:

  • Audiology services
  • Counseling services
  • Nursing services
  • Occupational therapy services
  • Physical therapy services
  • Psychological assessments
  • Speech-language therapy services

Provider eligibility

School-based health care services must be delivered by health care providers who meet state licensure and certification requirements according to Washington State law (WAC 182-537-0350).

School districts can confirm provider qualifications on the Department of Health’s website. All providers must apply for a National Provider Identification (NPI) number through National Plan and Provider Enumeration System (NPPES). Providers must be enrolled as a servicing provider under the school district’s billing NPI number.

Reimbursement

The SBHS program is an optional Medicaid match program with a 50/50 state/federal match funding structure. Reimbursements are based on fee-for-service established rates, and are facilitated via an Intergovernmental Transfer (IGT) process. School districts must sign an inter-agency agreement with HCA and a core provider agreement with the provider enrollment unit in order to participate. When a fully executed contract is in place, the district can begin submitting claims for Medicaid covered services.

Resources

SBHS billing guide

SBHS fee schedule

SBHS fact sheet

SBHS contracted school districts

Intergovernmental Transfer (IGT) flowchart

SBHS trainings

Upcoming events

SBHS Annual Training for Returning School Districts/ESDs

Wednesday, August 30, 2017
2 p.m. to 3 p.m.

SBHS Annual Training for New School Districts/ESDs

Thursday, August 31, 2017
10 a.m. to 11:30 a.m.

Training videos and materials

2016 SBHS training webinar | 2016 YouTube training video

Billing for nursing services

Billing for behavioral health services

SBHS vs MAC

How to enroll as a billing provider

How to enroll servicing providers

Creating ProviderOne Users and Adding Profiles

Forms

Annual Provider Contact Update form PDF / Word

Sample signature log

SBHS contract

Sample SBHS contract

School Districts interested in contracting with the SBHS Program must complete a Contractor Intake form and a Substitute W-9 form via email to the SBHS program manager.

Program updates

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Contact

Shanna Muirhead
SBHS Program Specialist
Phone: 360-725-1153
Fax: 360-725-1152
Email: shanna.muirhead@hca.wa.gov