Only health-related services identified in an IEP/IFSP and delivered to students who are actively enrolled as Medical Assistance beneficiaries may be reimbursed as SBAP services.
A student may be eligible for the MA Program if they meet certain income requirements or special needs. For more information about eligibility, refer to the Office of Income Maintenance webpage and the following resources:
Assisting families with the application process or advising families about the benefits of MA enrollment are MA-allowable administrative activities which may be reimbursed through the quarterly Medicaid Administrative Claiming (MAC) process. When LEA staff perform these activities, evaluate whether they should be included in your Administrative Cost Pool for the Random Moment Time Study (RMTS).
The Family Educational Rights and Privacy requires parental consent to disclose a student’s personally identifiable information to the State Medicaid Agency for purposes of billing and reimbursement.
By signing the Parental Consent form, the parent or guardian is granting permission for the LEA to access their public insurance (MA) and share with the State Medicaid Agency the information necessary to bill the MA program for services delivered to their child.
While the parent/guardian does not need to sign a new parental consent each year, the LEA is required to provide an annual notification to serve as a reminder that they previously granted that access.
PA Annual Notice of Parental Consent for Medical Assistance Billing:
- Yes, a parent/guardian may revoke consent at any time.
- If consent is revoked, the LEA may not submit any services from that date forward for reimbursement.
- The LEA should reach out to the SBAP contractor to ensure appropriate updates are made in the contractor’s system to ensure services are not submitted after consent is revoked.