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For children with disabilities, ages 0 through 20, receiving early intervention or special education services |
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School districts participating in the School-Based Health Care Services (SBHS) Program are required to complete Medicaid revalidation every five years. This year, over 100 school districts are due for revalidation!
What is Medicaid revalidation?
Federal regulations require state Medicaid agencies to revalidate the enrollment of Medicaid providers once every five years. During the provider revalidation process, your school district will need to update a few forms and may need to update information in ProviderOne. Revalidation is required for school districts (also known as "billing providers"). Servicing providers enrolled under a district's ProviderOne account do not have to complete revalidation.
Is my school district due for revalidation?
The district will be notified by mail when selected for revalidation. No action is required until the district receives the revalidation letter from the Health Care Authority (HCA). The revalidation notice will be sent to the mailing address listed in ProviderOne.
My school district received a revalidation letter. What is the district required to do?
The revalidation letter specifies the requirements needed to complete the
revalidation. Requirements are also summarized below.
School districts must complete the following steps:
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Login to the district's ProviderOne account via OneHealthPort. Once logged into ProviderOne, click on 'Manage Provider Information'. This link will take you to the Business Process Wizard (BPW) where you will need to review and update the district's information as needed.
- Upload a signed Core Provider Agreement, Debarment Statement, Internal Revenue Service (IRS) W-9 form, and a Trading Partner Agreement.
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Note: The forms must be signed by the person listed as a "Managing Employee" under Step 4: Ownership and Managing Controlling Interests in ProviderOne.
Questions?
For assistance with, or questions about the Medicaid revalidation process, please visit HCA's Revalidation webpage.
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In order to receive Medicaid reimbursement for IEP/IFSP health-related services, school districts must enroll providers (e.g., speech therapists, physical & occupational therapists, nurses, etc.) as "servicing providers" under the district's ProviderOne account:
How to enroll providers in ProviderOne
What to expect after submitting a provider application in ProviderOne:
- HCA strives to process applications within 30 days from when they are received.
- An application may take longer to process if it is:
- Out-of-state
- Requires program approval
- Is missing required information or documents. HCA will contact the district via the email address entered on the provider application if additional information is required.
- If the provider's enrollment application is approved, HCA will mail a welcome letter to the mailing address listed on the district's ProviderOne file.
Questions?
If you need assistance with enrolling providers in ProviderOne, please contact HCA's Office of Provider Enrollment:
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The SBHS Fee Schedule was updated on January 1, 2024. The rate for code 90791 (Psych Evaluation) was changed from $115.25 to $123.32.
This is a reminder that mental health & counseling services are reimbursable through the SBHS Program as long as they are prescribed by a Department of Health licensed provider per their scope of practice and they are included in the student's IEP or IFSP. More information about covered mental health services can be found in the SBHS Billing Guide.
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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).
Please feel free to share SBHS Program news with your colleagues! If you are not currently subscribed, sign up to receive SBHS Program updates.
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