MedicaidDocumentationHigh impact
Additional School-Based Services ChangesOctober 7, 2026: This Update has been revised since its original publication. Clarifying information about specialized transportation requirements has been added. Revised information appears in red text on page 5.
Wisconsin Medicaid (ForwardHealth)·WI · Occupational Therapy, Physical Therapy, Speech Therapy +1 more·Medical Policy
Effective date
Jul 1, 2026
We identified it
Oct 8, 2026
Summary
Effective July 1, 2026, school-based services (SBS) claims for nursing, occupational therapy, physical therapy, speech-language pathology, and attendant care must include the individual NPI (Type 1) of the prescribing, referring, or ordering provider enrolled with Wisconsin Medicaid. Additionally, CMS has narrowed the definition of specialized transportation to require a physically modified vehicle with specific documentation in the IEP; regular vehicles with only an aide present will no longer be covered as specialized transportation. Random Moment Time Study procedures are also changing, with reduced notice periods and expanded August/September participation.
Action Required
Previously due July 1, 2026 (date passed; verify current applicability): (1) Billing team must update claims submission workflows to require individual Type 1 NPIs for prescribing/referring/ordering providers on SBS claims for nursing services, occupational therapy, physical therapy, speech-language pathology services, and attendant care services. Claims without the required individual NPI will be denied. (2) Verify that all ordering/prescribing providers are enrolled with Wisconsin Medicaid as prescribing/referring/ordering providers through the ForwardHealth Portal. (3) Coordinate with school districts to implement one of three options: hire/contract Medicaid-enrolled clinicians to refer services, establish systems for families' primary care providers to sign off on treatment plans, or have school providers (PT/OT/SLP/nurses) obtain individual NPIs and enroll with Wisconsin Medicaid. (4) Update transportation billing policies to reflect the narrowed definition of specialized transportation—only physically modified vehicles (wheelchair lifts, ramps, special harnesses) with specific IEP documentation qualify. Transportation in regular vehicles with only an aide present is no longer coverable. (5) Communicate revised time study procedures to school districts: notice will decrease from 5 days to 2 days; reporting window decreases from 5 days to 2 school days; time studies now include August/September; structure changes to two semesters (Semester 1: staff return date through December 31; Semester 2: January 1 through June 30).