SBHS Program Telehealth Updates

Washington State Health Care Authority sent this bulletin at 10/13/2023 03:35 PM PDT

October 13, 2023

Telemedicine updates to School-Based Health Care Services (SBHS) Program

Attention SBHS Medicaid coordinators and school-based providers!

Over the summer, the SBHS Program informed contracted school districts about a policy change that would limit payment for speech-language teletherapy and would discontinue payment for occupational/physical teletherapy. Due to feedback from concerned providers and stakeholders, the Health Care Authority (HCA) has decided to change this policy as outlined below.

Retroactive to dates of service on and after October 1, 2023, the SBHS Program will continue to pay for occupational, physical, and speech-language therapy services (as well as mental health & nursing services) when provided through HIPAA-compliant audio/visual telemedicine platforms.

HCA updated both the Telemedicine Section and the Coverage Tables in the SBHS Program Billing Guide to clarify which services HCA pays for when provided via telemedicine:

SBHS Program Billing Guide

Note: Payment for services provided through HIPAA-compliant telemedicine platforms is limited to certain codes as outlined in the SBHS Program Billing Guide. In addition, some speech-language therapy services and mental health services are also reimbursable when provided through audio-only telemedicine platforms.

Questions?

Email HCA's SBHS Program Manager for any questions related to this policy.

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 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).

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Learn more about the SBHS Program

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.