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June 2022
This is a reminder that the SBHS funding structure will be changing July 1, 2022!
Dates of service on and after July 1, 2022:
For services provided on and after July 1, 2022, school districts will no longer be required to submit local match (30% of the claim amount) to HCA per the intergovernmental transfer (IGT) process. After claims are entered into the ProviderOne system, the school district should receive payment for valid claims within a week.
Dates of service before July 1, 2022:
For services provided prior to July 1, 2022, HCA will continue to invoice school districts for local match. School districts have 120 days from the invoice date to submit local match to HCA.
More information about this can be found in the March 29, 2022 SBHS GovDelivery notification.
This is a reminder of upcoming telemedicine changes!
Effective for dates of service on and after 7/1/2022, there is a new place of service (POS 10) and a new modifier (Modifier 93) that must be used when billing for services provided through telemedicine.
Telemedicine place of service (POS):
POS 02: Use when providing telehealth services and student is located somewhere other than the home.
POS 10 (New!): Use when providing telehealth services and student is located in the home.
Telemedicine modifiers:
Mod 95: Use when providing services through HIPAA-compliant audio/visual telemedicine.
Mod 93 (New!): Use when providing services through audio-only telemedicine.
More information about this can be found in the SBHS COVID-19 FAQ and in the April 7, 2022 SBHS GovDelivery notification.
HCA is in the process of updating the SBHS billing guide to reflect the upcoming telehealth changes and the SBHS funding change (both changes highlighted above).
The updated guide will be available on HCA's SBHS webpage on or around July 1, 2022. HCA will notify districts via GovDelivery when the updated billing guide is available. If you are not signed up to receive SBHS GovDelivery notifications, you can sign up here.
HCA emailed SBHS contract amendments to currently contracted school districts and ESDs last month. If you haven't already, please sign and return your SBHS contract amendment ASAP!
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.
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