School-Based Health Care Services (SBHS) notification
March 29, 2022
**Attention SBHS coordinators--please share this notification with the school district's accounting staff**
SBHS funding structure update
The Health Care Authority (HCA) is pleased to announce that effective 7/1/2022, SBHS-contracted school districts will no longer be required to submit local match to HCA for IEP/IFSP health-related service claims.
Background
The intergovernmental transfer (IGT) process was implemented in 2012 due to a budget shortfall. The IGT process requires SBHS-contracted school districts to first provide local match (30% of the claim amount) to HCA before HCA can reimburse school districts for IEP/IFSP health related services provided to Title XIX Medicaid-eligible students. The IGT process has proven to be administratively burdensome and is a major barrier for school districts to access Medicaid funding. Since 2015, HCA has attempted to eliminate the IGT process by requesting additional state funds from the Legislature. During the 2022-23 supplemental budget session, HCA's request was finally approved!
How will this update impact SBHS claims?
Services provided prior to 7/1/2022
For services provided prior to 7/1/2022, HCA will continue to invoice school districts for local match. For example, a student receives IEP speech services on 5/1/2022 but the school district doesn't enter the claim into ProviderOne until 7/20/2022. Because the date of service is prior to 7/1/2022, the claim will suspend in ProviderOne and HCA will invoice the school district for local match. Per the IGT process, school districts have 120 days from the invoice date to submit local match to HCA. Once local match is received, HCA will release the claims for payment.
Services provided on and after 7/1/2022
For services provided on and after 7/1/2022, eligible SBHS claims will automatically pay on a weekly basis. HCA will not invoice the school district for local match for any claims with dates of service on and after 7/1/2022. School districts can review the weekly remittance advice (which is available in ProviderOne) each Friday to review a list of paid and denied claims. More information about the claims payment cycle will be added to the next SBHS Billing Guide update.
Next steps
Contract amendment
HCA is in the process of removing IGT language from the SBHS contract. Within the next few weeks, HCA will email a SBHS contract amendment to the school district's primary signatory and the SBHS coordinator. School districts who wish to continue participating in the SBHS program must review and electronically sign the contract amendment (per HCA's DocuSign process) as soon as possible in order to avoid disruption in Medicaid payments.
Additional updates
Over the next few months HCA will be working on updating SBHS WAC 182-537-0600, the SBHS Billing Guide, and SBHS trainings and resources to reflect the new funding structure. HCA will notify SBHS-contracted school districts via GovDelivery as updated documents and resources are available.
Questions?
Any questions regarding this notification and the new SBHS funding structure should be directed to the SBHS program manager. Thank you for your continued participation in the SBHS program!
About the SBHS program
The Washington State School-Based Health Care Services (SBHS) program is administered by the Health Care Authority (HCA). School districts participating in the SBHS program may receive reimbursement for providing health care-related services to Title XIX Medicaid-eligible students with Individualized Education Programs (IEPs) or Individualized Family Service Plans (IFSPs). Visit the SBHS webpage for more information.
Please feel free to share SBHS news with your colleagues!
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