June 16, 2023

SBHS notification

The Washington State School-Based Health Care Services (SBHS) Program is administered by the Health Care Authority (HCA). HCA is the single state agency that oversees Apple Health (Medicaid). School districts participating in the SBHS Program may receive Medicaid reimbursement for providing health care-related services to Title XIX Medicaid-eligible students with Individualized Education Programs (IEPs) or Individualized Family Service Plans (IFSPs). 

Please feel free to share SBHS news with your colleagues!

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SBHS news and updates

Thank you to all school districts, educational service districts, and charter schools who participated in the SBHS Program during the 2022-23 school year! This notification provides SBHS Program news, updates, and reminders as well as federal news and updates related to school-based Medicaid. Have a great summer and we'll see you in September!

Fee schedule

A new SBHS Fee Schedule will be available July 1, 2023. HCA updates the SBHS Fee Schedule as CPT/HCPCS codes and rates are updated by the federal Centers for Medicare and Medicaid Services (CMS). These updates typically occur each July. 

Billing guide

A new SBHS Billing Guide will be available August 1, 2023. Changes to the guide include:

• Removal of signature log requirement
  • Providers are still required to sign treatment notes/service logs but districts will no longer be required to maintain a signature log starting July 1, 2023
• Updated language around electronic records and electronic signatures
• Telemedicine updates
• General clean-up and clarification

Links to the updated SBHS Fee Schedule and SBHS Billing Guide will be available on HCA's SBHS webpage.

SBHS reimbursement breakdown

For dates of service 7/1/2022-5/10/2023, the breakdown for SBHS Medicaid reimbursements was 56.2% federal funds and 43.8% state funds due to the federal public health emergency (PHE). The federal PHE ended on 5/10/2023 and, as a result, the current SBHS Medicaid reimbursement breakdown is 50% federal funds and 50% state funds for services provided on and after 5/11/2023. 

SBHS-participating districts, ESDs, and charter schools can track their Medicaid payments by viewing the remittance advices (RAs) in ProviderOne. Questions on how to access the RAs may be directed to HCA's SBHS Program Manager.

Information on how to report SBHS Medicaid reimbursements is outlined in OSPI's Accounting Manual. Questions on how to report SBHS Medicaid reimbursements may be directed to OSPI's apportionment team.

OneHealthPort registration

This is a reminder that school districts (SDs), educational service districts (ESDs), and charter schools who participate in the SBHS Program are required to register with OneHealthPort (OHP). 

Note: OHP is not replacing ProviderOne. SBHS-contracted SDs, ESDs, and charter schools will still have a ProviderOne account. The only thing that will change after OHP registration is how school staff (e.g., SBHS Coordinators or Business Managers) log in to ProviderOne. 

How do I register my organization with OHP?

Visit OneHealthPort's website, click on "Register", and follow the directions. Additional information about the registration process can be found in the OHP Registration Guide. 

I still have questions, who do I contact?

More information about OHP registration, how to access ProviderOne after registering, OHP contact information, and answers to other OHP frequently asked questions can be found in the SBHS Program: OneHealthPort & ProviderOne FAQ.  

Federal news and updates

Updated CMS school-based guidance

Last month, the Centers for Medicare & Medicaid Services (CMS) issued the Comprehensive Guide to Medicaid Services and Administrative Claiming. The guide clarifies, consolidates, and expands on how schools can receive payment for providing care for Medicaid enrolled students, and how state Medicaid agencies can ease the administrative burden on school-based health providers to promote their participation in Medicaid. CMS also issued an Informational Bulletin summarizing the new guidance. 

How does this new guidance impact HCA's SBHS Program?

The new CMS guidance offers new flexibilities and consolidates existing guidance, in an effort to make it easier for schools to receive Medicaid reimbursement. Upon initial review of the guidance, HCA has determined that the SBHS Program is in alliance with CMS rules and regulations. HCA continues to review the guide to identify additional flexibilities or changes that may be allowed for the SBHS Program.

More information

The new CMS guidance also provides information about how school districts can receive Medicaid reimbursement for administrative activities as well as for non-IEP health services through Medicaid Managed Care Organizations (MCOs). More information about the CMS guidance and the steps HCA is taking to explore the options outlined in the guide can be found in the attached HCA statement:

Proposed rule on parental consent

The US Department of Education (DOE) has proposed a rule change to amend the IDEA Part B regulations to remove the requirement for public agencies (i.e., local education agencies) to obtain parental consent prior to accessing for the first time a child's public benefits or insurance (i.e., Medicaid). If finalized, this proposed rule would simplify the process for schools to bill Medicaid while also retaining IDEA’s parental notification provisions and FERPA’s consent provisions. The proposed regulation is open for public comment through August 1. The US DOE invites your comments about this proposal!