School-based health care services (SBHS)

What is the School-Based Health Care Services (SBHS) program?

The SBHS program is an optional Medicaid program that provides reimbursement to public school districts, educational service districts, charter, and tribal schools for certain early intervention health-related services or special education health-related services.

These services are reimbursable when a student has Title XIX Medicaid (CNP/MNP) coverage and the services are included in the student's current Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).

Covered services

The SBHS program reimburses for evaluations, reevaluations. and direct health related services which are included in an eligible student's IEP or IFSP, including:

• Audiology services
• Mental health services (individual and group counseling)
• Nursing services
• Occupational therapy services
• Physical therapy services
• Speech-language therapy services

Provider eligibility

In order to receive Medicaid payment for IEP/IFSP health-related services through the SBHS program, the services must be prescribed or recommended by Department of Health (DOH) licensed providers and must be delivered by or under the direction of DOH licensed providers. A list of SBHS eligible providers can be found in the SBHS billing guide and in WAC 182-537-0350.

SBHS funding structure

The SBHS program is funded with federal and state funds and services are paid on a fee-for-service basis per the SBHS fee schedule.

• For services provided prior to July 1, 2022, SBHS was funded with 56.2% federal funds, 26.28% school district (local matching funds), and 17.52% state funds.
• For services provided July 1, 2022-May 10, 2023, SBHS was funded with 56.2% federal funds and 43.8% state funds.
• For services provided on or after May 11, 2023, SBHS is funded with 50% federal funds and 50% state funds.

How can I participate?

• School districts, ESDs, charter or tribal schools interested in participating in the SBHS program may download the SBHS checklist for interested/new school districts for next steps.

Additional information

• SBHS one-pager
• SBHS 101 training video | pdf
• SBHS billing guide
• SBHS checklist for interested/new school districts
• Sample SBHS contract
• Contractor intake form
• List of SBHS contracted school districts

Resources for SBHS coordinators and providers

SBHS coordinators

SBHS billing information and fee schedule	Trainings and webinars	Additional resources	Forms
SBHS billing guide	Annual training for SBHS coordinators: video | pdf	Annual checklist for SBHS coordinators	Provider and Contact update form (12-325)
SBHS fee schedule	SBHS 101-training: video | pdf	Checklist for new SBHS coordinators
	How to enroll servicing providers	Look up a provider's National Provider Identifier (NPI)
	How to end-date providers	Look up a provider's DOH license information
	How to submit SBHS claims (for self-billing districts)	Remittance advice claim denial remark codes
	Reading the remittance advice	Claim adjustment reason codes
	Checking Medicaid eligibility	OneHealthPort FAQ
		Accessing ProviderOne

Service providers

SBHS billing information and fee schedule	Trainings and webinars	Additional resources
SBHS billing guide	SBHS 101 training - video | pdf	Apply for a National Provider Identifier (NPI)
SBHS fee schedule	Billing for audiology services - video | pdf	NPI registry
	Billing for mental health services - video | pdf	Department of Health
	Billing for nursing services - video | pdf
	Billing for occupational therapy services - video | pdf
	Billing for physical therapy services - video | pdf
	Billing for speech-language therapy services - video | pdf

Program updates

SBHS sends updates via our email communications tool, GovDelivery. Sign up for SBHS email notifications. Recent bulletins are linked below, and older bulletins are available upon request.