Summary
The Pennsylvania Department of Human Services updated its School-Based ACCESS Program (SBAP) provider handbook for local education agencies enrolled in Medical Assistance that provide school-based services. The handbook sets participation requirements, covered services with their procedure codes, billing and documentation rules, random moment time study requirements, and cost reporting and cost settlement requirements. The updated sections are highlighted in the handbook.
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What to do
Action · 9 steps
01Already effective September 15, 2022: Follow the SBAP provider handbook for participation requirements and billing procedures for Medical Assistance payment for SBAP services.
02Before billing a service, obtain a prescription or Medical Practitioner Authorization Form signed by an appropriate licensed practitioner, because services delivered before that signature date are not compensable.
03Obtain the one-time parental consent before the service is delivered, and send the annual parental notification after that.
04Document each service in a provider log with exact start and end times, with the student's first and last name on every page, the student's date of birth, the provider's name and title, the diagnosis, the date of service, the treatment code, and the required signatures.
05Submit direct service and special transportation claims within 180 days from the date the service was rendered, and complete resubmitted claims and adjustments within 365 days from the date of service.
06Screen employees and contractors monthly against the Pennsylvania Medicheck list, the List of Excluded Individuals/Entities and the System for Award Management.
07Keep medical and fiscal records for at least four years.
08Revalidate Medical Assistance enrollment of each service location every 5 years, submitting applications at least 60 days before the revalidation date.
09Check current applicability of these requirements before acting, because this guidance was issued in 2022.
Codes mentioned
907919083290853925079250892523961569711097162971649716697168975309753399172A0434H0031H0046H2027S9152T1002T1003T1019T1023T1502T1999
Original notice
MAB2022091501
pa.gov · Always check the source before changing claims.
Related changes
See all Pennsylvania Medicaid (DHS) changes →MAB2020092201MediumEffective Sep 22, 2020 · Provider Bulletin351702 Merge attachmentMediumEffective Nov 22, 2017 · Provider BulletinMAB2024091601MediumEffective Sep 16, 2024 · Provider BulletinMAB2025111801MediumEffective Nov 18, 2025 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list
Related policy hubs
Pennsylvania Medicaid (DHS) policiesPA policy changesAudiologyOccupational TherapyPhysical TherapySpeech TherapyPediatricsPsychiatryCode 90791Code 90832Code 90853Code 92507Code 92508Code 92523Code 96156Code 97110Code 97162Code 97164Code 97166Code 97168Code 97530Code 97533Code 99172Code A0434Code H0031Code H0046Code H2027Code S9152Code T1002Code T1003Code T1019Code T1023Code T1502Code T1999