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Pennsylvania Medicaid (DHS)Medicaid · Administrative · Provider Bulletin · PA · Pediatrics, Audiology, Occupational Therapy +3 moreMedium impact

MAB2024091601

Effective date
Sep 16, 2024
Identified
Jun 20, 2026

Summary

The Pennsylvania Department of Human Services issued an updated School-Based ACCESS Program (SBAP) provider handbook dated September 2024, which governs how local education agencies (LEAs) enrolled in MA bill for health-related services defined in a student's IEP, including assistive devices, audiology, nursing, therapy, psychiatric, psychological, social work, personal care and specialized transportation services. The handbook amends language and updates format to highlight program requirements and provider qualifications and services. It sets requirements for practitioner authorization, parental consent, provider logs, timely filing, record keeping, exclusion screening, cost reporting and staff pool participation.

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What to do

Action · 7 steps
01Already effective September 16, 2024: Billing team should follow the updated SBAP provider handbook dated September 2024 for participation requirements and billing procedures.
02Enroll as a PT 35 Public School provider on a paper application, and revalidate enrollment every five years, submitting revalidation applications at least 60 days before the revalidation dates.
03Before billing, make sure the practitioner's prescription or Medical Practitioner Authorization Form for SBAP Services has a signature date on or before the date of service, because services before that date are not compensable; obtain these at least annually or whenever the IEP changes.
04Obtain the one-time parental consent before accessing MA for the student and send the annual parental notification, because services delivered before the consent date are not compensable.
05Keep provider logs with exact start and end times, do not round up service minutes, and do not bill overlapping minutes.
06Submit compensable direct service claims through the DHS contractor's system within 180 days of the date of service, and retain records for at least four years.
07Screen employees and contractors against the Pennsylvania Medicheck list, the LEIE and SAM before hire and monthly after, and self-report any discovered exclusion immediately to the Bureau of Program Integrity.
If missed: Failure to participate in each program component may result in a lower or no reimbursement, and claims with incomplete compliance information are not submitted to PROMISe.

Codes mentioned

T1999T1003T1002T1502T1023T1019A0434H2027H0046H0031925079250892523S915297530971689753399172971109716490832908539079196156F84.0H91.3H54.7F98.9H91.90R41.9F82F79M95.9R68.89F81.89F80.9S09.8XXSR62.50

Original notice

MAB2024091601
pa.gov · Always check the source before changing claims.
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Related changes

See all Pennsylvania Medicaid (DHS) changes →
MAB2020092201MediumEffective Sep 22, 2020 · Provider BulletinMAB2022091501MediumEffective Sep 15, 2022 · Provider BulletinMAB2025111801MediumEffective Nov 18, 2025 · Provider Bulletin351702 Merge attachmentMediumEffective Nov 22, 2017 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list

Related policy hubs

Pennsylvania Medicaid (DHS) policiesPA policy changesPediatricsAudiologyOccupational TherapyPhysical TherapySpeech TherapyPsychiatryCode T1999Code T1003Code T1002Code T1502Code T1023Code T1019Code A0434Code H2027Code H0046Code H0031Code 92507Code 92508Code 92523Code S9152Code 97530Code 97168Code 97533Code 99172Code 97110Code 97164Code 90832Code 90853Code 90791Code 96156Code F84.0Code H91.3Code H54.7Code F98.9Code H91.90Code R41.9Code F82Code F79Code M95.9Code R68.89Code F81.89Code F80.9Code S09.8XXSCode R62.50

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