SBHS notification

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School-based health care services (SBHS) notification

July 12, 2022

Updated SBHS billing guide and fee schedule

HCA has updated the School-Based Health Care Services (SBHS) billing guide and SBHS fee schedule:

  • SBHS billing guide (July 1, 2022-present)
    • Review the What has changed? table in the guide for a summary of changes
  • SBHS fee schedule (July 1, 2022-present)
    • Please note that rates for most codes have changed!

Any questions about the SBHS billing guide and SBHS fee schedule should be directed to HCA's SBHS program manager.

Medicaid payment for school-based mental and behavioral health services

Mental health services included in an IEP/IFSP

The SBHS program provides Medicaid payment to contracted school districts and educational service districts for mental health services (e.g., individual and group counseling) when services meet the following criteria: 

  • Prescribed by a Department of Health (DOH)-licensed provider within their scope-of-practice
  • Provided by or under the direction of a DOH-licensed provider within their scope-of-practice
  • Included in a Medicaid-eligible student's individualized education program (IEP) or individualized family service plan (IFSP)

More information on how to bill for IEP/IFSP counseling/mental health services through the SBHS program can be found in the SBHS billing guide.

Medicaid School-Based BH Toolkit

Mental/behavioral health services not included in an IEP/IFSP

Because the SBHS program is limited to providing Medicaid reimbursement for IEP/IFSP services only, HCA has created guidance for school districts (SDs) and educational service districts (ESDs) who may be interested in exploring other Medicaid reimbursement options for non-IEP/IFSP mental/behavioral health services provided in the school setting.

The Medicaid School-Based Behavioral Health Services and Billing Toolkit provides guidance and best practices about how to access Medicaid funding for behavioral health services your ESD or SD may already be providing, how to partner with behavioral health providers in your area, and other topics including:

  • Avenues to provide behavioral health services and billing Medicaid for  these services
  • Requirements to become licensed as a behavioral health agency (BHA) with the Department of Health (DOH) 
  • Best practices for partnering with and contracting with the Medicaid managed care organizations (MCOs) to receive Medicaid reimbursement for non-IEP behavioral health services
  • Additional behavioral health resources and supports

ESDs and SDs who utilize the MCO contacts in Appendix B of the toolkit and encounter obstacles in contracting with the MCOs to receive reimbursement for behavioral health services and need assistance, may email their concerns or questions to with reference to Issue #26779.

News from outside HCA

OSPI accounting manual updates

The Office of Superintendent of Public Instruction (OSPI) issued the following information in their June 23, 2022 GovDelivery notification:

The purpose of this communication is to advise school districts of the first addendum to the Accounting Manual for Public School Districts in the State of Washington (Accounting Manual). 


Chapter 7–General Journal Entries

On page 7-58, the Special Education Medicaid Reimbursement Entries are being deleted from the Accounting Manual.


The Health Care Authority (HCA) is pleased to announce that effective 7/1/2022, School-Based Health Care Services (SBHS)-contracted school districts will no longer be required to submit local match to HCA for IEP/IFSP health-related service claims.


For services provided prior to 7/1/2022, HCA will continue to invoice school districts for local match and school districts will continue to follow the Special Education Medicaid Reimbursement Entries described and illustrated in the 2022 School District Accounting Manual, Chapter 7, Page 7-58 and 7-59. Per the Intergovernmental Transfer (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.


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.


If you have any questions please contact Paul Stone, School District and ESD Accounting Supervisor at

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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