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

MAB2020092201

Effective date
Sep 22, 2020
Identified
Jun 20, 2026

Summary

The Pennsylvania Department of Human Services issued an updated School-Based ACCESS Program provider handbook, dated September 2020, for local education agencies enrolled in Medical Assistance that bill health-related services documented in students' IEPs. The updated handbook clarifies some provisions and program requirements, and it covers covered services by provider type, medical authorization, provider logs, eligibility, documentation, cost reporting and the random moment time study. A prescription or Medical Practitioner Authorization Form signed by an eligible practitioner is required before a service is billable.

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What to do

Action · 8 steps
01Already effective September 22, 2020: Billing teams for LEAs in the School-Based ACCESS Program must follow the handbook dated September 2020 for participation requirements and billing procedures.
02Obtain a signed prescription or Medical Practitioner Authorization Form before the service date, because services provided before the practitioner's authorization are not compensable and will not be billed to the MA Program.
03Obtain one-time parental consent before or on the date of an evaluation, because services delivered before the consent date are not compensable.
04Record exact start and end times in provider logs, since rounding up service minutes is prohibited.
05Submit direct service and special transportation claims within 180 days from the date of service, and make sure resubmitted claims and adjustments are fully adjudicated within 365 days from the date of service.
06Keep required records for at least four years, and screen employees and contractors against the Pennsylvania Medicheck list, the LEIE and SAM before hire and monthly thereafter.
07Failure to document services and maintain records may result in recoupment of MA reimbursement or termination of the written provider agreement.
08Check the current applicability of this 2020 handbook on the Department's website before relying on it.

Codes mentioned

925079250892523S91529716697168975309753397110971629716499172T1999T1019T1002T1003T1502T1023A0434907919083290853H2027H0031H004696156

Original notice

MAB2020092201
pa.gov · Always check the source before changing claims.
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