What is School-Based Health Care Services?
School-Based Health Care Service (SBHS) is a program run by the Health Care Authority (HCA) which reimburses school districts for Medicaid covered health care related services provided to Medicaid eligible children. The services must be included in the student’s current Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) and must be provided by a licensed health care provider.
By default, reimbursement for SBHS services are split between the school, state government, and federal government: 30% school, 20% state, 50% Federal.
What is required to add ABA under SBHS?
Adding ABA to SBHS requires a minimum of four changes:
- Amending WAC 182-537-0350 (Provider qualifications) to add BCBAs and CBTs to the list of SBHS providers.
- Amending WAC 182-537-0500 (Noncovered services) to remove ABA from the list of noncovered services.
- Amending Medicaid State Plan to add BCBAs and CBTs to the provider list found in State Plan Attachment 3.1-A(4b)(7)(1)(a) (Provider qualifications for EPSDT SBHS).
- Amending Medicaid State Plan to add ABA to the list of covered therapies found in State Plan Attachment 3.1-A(4b)(7)(1)(a) (Covered services).
What is required to amend the WACs?
The Washington Administrative Codes (WACs) are regulations issued by executive branch agencies under the authority of statutes. The SBHS WAC Title 182 Chapter 537 is administered by the HCA, who can amend it by proposing an updated rule and completing the public comment process.
What is required to amend the Medicaid State Plan?
The Washington Medicaid State Plan is managed by the HCA and approved by the Center for Medicare and Medicaid Services (CMS). Changes to the State Plan are accomplished via State Plan Amendments (SPAs), which are created by the HCA and sent to CMS for review and approval. CMS has 90 days after receiving a SPA to review respond, either by approving, denying, or requesting additional information. As required by Title XIX, the HCA is advised on the State Plan by the Medicaid Title XIX Advisory Committee. The Advisory Committee includes representatives from physicians and consumer groups and meets every two months.