What is School-Based Services?
Since the 1970s, the federal government has required schools to provide all children with disabilities appropriate services under the Individuals with Disabilities Education Act (IDEA). This includes health-related services such as occupational therapy, physical therapy, speech therapy, nursing services, counseling services, and audiology services. The IDEA requires students with disabilities to receive educational and related health services that will enable them to reach their educational goals as documented in their Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).
The School-Based Services (SBS) Program allows State Medicaid Agencies to reimburse local education agencies (LEAs) for providing these health related services to Medicaid eligible students in a school-based setting. By billing Medicaid for appropriate school-based services, LEAs can draw down federal Medicaid dollars for IDEA-required services provided to Medicaid eligible students. For LEAs to receive Medicaid payments for school-based services, schools must document the service in a student’s IEP or IFSP and meet the following criteria:
- 1. The service is authorized in Section 1905(a) of the Social Security Act, and the service is medically necessary.
- 2. Schools and service providers follow all state and federal regulations, including provider qualification requirements .
- 3. The state has included the service in the Medicaid State Plan, or the service is available under the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits.
Health care-related services included in the child’s IEP or IFSP are limited to: audiology services, mental health services, nursing/health services, occupational therapy services, physical therapy services, and speech-language therapy services.
Currently, the implementation of school-based services is still in its planning and development phase. The Wyoming Department of Health, in collaboration with the Department of Education, is engaging school districts, is preparing its Medicaid State Plan amendment, and is developing program and provider training materials. The SBS Program will go live in July 2022.
In order for school districts to bill Medicaid for school-based services, schools are required to obtain written consent from parents prior to the reimbursement occurring. Parents only need to sign the parental consent form once and then it follows the student through their school years and can move with the student if they transfer school districts (within the state of Wyoming). Parental consent is voluntary, and a parent may refuse or revoke their parental consent at any time. If a parent does not give consent or revokes consent, the school district must still provide all services included in the child’s IEP or IFSP service plan at no cost to the parent.
National Provider Identifier
The National Provider Identifier (NPI) is a 10-digit identification number that is assigned by the Centers for Medicare and Medicaid Services (CMS) to providers who are covered by the provision of HIPAA. Health plans, clearinghouses, and covered health care providers that submit claims or other information electronically are required to apply for and use an NPI. Providers apply for a single NPI that they will keep for the rest of their careers.
- Every Wyoming Medicaid provider that meets the definition of a healthcare provider (as defined by CMS) is required to obtain an NPI, regardless of whether they bill their claims electronically or on paper.
- Wyoming Medicaid requires its providers to use taxonomy codes in conjunction with their NPIs when billing claims electronically or on paper.
- FAQ Document: WY SBS FAQ
- Parental Consent Memo: Parental Consent Memo
- National Provider Identifier (NPI) Memo: NPI One Pager
- National Provider Identifier (NPI) Application: NPI Application
For more information about School-Based Services:
122 W 25th St., 4th Floor West
Cheyenne, WY 82001