Medicaid/ School Based Services (SBS) - Key topics in Special Education

• School-based services (SBS) is a program that allows public school districts to bill Wisconsin Medicaid for medically necessary services provided to Medicaid-eligible children provided by qualified personnel in Wisconsin public schools. The majority of the funds go directly back to the school districts providing the service. In addition, Wisconsin’s general fund receives federal reimbursement for medical services performed as required by students' Individualized Education Programs (IEPs).
• Wisconsin’s SBS program was created as Act 27 of the 1995-97 State Budget. It has brought approximately $950 million of federal dollars to Wisconsin since 2000.
• DPI believes public benefits and insurance are important resources for local educational agencies (LEAs) and other public agencies to access, when appropriate, to assist in meeting their obligation to make a free appropriate public education (FAPE) available to all students who are eligible to receive services. If a student is Medicaid-eligible, and there is no cost to the family or the student and the service is included in a students’ IEP, the LEA is encouraged to use the public benefits or insurance to the extent possible.

Bulletin 14.01: Wisconsin Medicaid

This bulletin explains how Wisconsin’s Medicaid program interfaces with the Individuals with Disabilities Education Act (IDEA) and state special education law including Medicaid funding for certain medically-related services provided under the IDEA, including School-Based Services (SBS) and Medicaid Administrative Claiming (MAC); and information regarding parental consent for the use of Medicaid to pay for services under the IDEA.

Increased Financial Resources to Support Students with Disabilities

This PowerPoint presentation was originally jointly presented between DPI and DHS in 2011 and has some introductory information on Medicaid, the School-Based program, and the history in Wisconsin. It was updated in November of 2021.

Providing Related Services via Teleservice

One way of providing SBS is through telehealth. This website, developed by DPI, gives guidance in a number of areas on teleservices, which include telehealth provided in the schools and billed for through SBS.

Teleservice Considerations for Related Services During the Current Public Health Emergency

This document was created during the 2020 public health emergency and revised prior to the start of the 2020-2021 school year in order to address the provision of speech-language and related services via teleservice due to school building closure as a result of COVID-19 and includes information on Medicaid billing under SBS.

Parental consent to bill Medicaid

There are two requirements in effect related to parental consent for LEAs to bill Medicaid:

1. The LEA must notify parents in writing of a number of safeguards to protect their rights before the LEA accesses Wisconsin Medicaid to pay for special education or related services under the IDEA for the first time, and annually thereafter. 34 CFR 300.154(d)(2)(v).
2. The LEA must obtain from the parent, a one-time written consent that meets the requirements of FERPA, 34 CFR 99.30, and the IDEA, 34 CFR 300.622, and also specifies the parent understands and agrees that the LEA may access the student’s or parent’s Wisconsin Medicaid to pay for special education or related services under IDEA. 34 CFR 300.154(d)(2)(iv).

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   DPI has developed a sample parent notification of their safeguards to meet the requirement to notify parents of safeguards in writing.

• English

• Spanish

• Hmong 

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  DPI has also developed a model form, the Consent to Bill Wisconsin Medicaid for Medically-related Special Education and/or Related Services (DPI Model Form M-5), and guidance for how to complete that form that LEAs can use to obtain consent from the parent to bill Medicaid.

• English

• Spanish 

• Hmong

• Guidance to completing the M-5 form

• The Department of Health Services provides guidance regarding requirements for the billing of SBS. This is documented in the ForwardHealth Online Handbook.

• Navigating Forwardhealth Online Handbook This video walks through the navigation to the Wisconsin Medicaid Online Handbook for providers to assist them in finding various Medicaid requirements. Specific tips are given for speech language providers but the navigation applies for any user. The video also gives various search tips for finding different requirements.

• DHS publishes updates, called ForwardHealth updates, to inform the field of changes to the Wisconsin Medicaid program. These updates can provide helpful information about SBS to school providers.

  • ForwardHealth Updates 2020-15 (March 2020) was released at the beginning of the COVID-19 public health emergency to allow telehealth for SBS. This is the temporary telehealth policy, which remains in place until the public health emergency is over.

  • ForwardHealth Update 2022-02. Permanent Teleheath Policy for School-Based Services (January 2022) clarifies what is billable under telehealth, updates allowable services, defines "functionally equivalent," provides information about the supervision of IT and PTAs, and clarifies reimbursement of OT, PT, and SLP evaluations and treatment (and "coaching"), among other pieces of information. The permanent policy will officially become active on the first day of the first month after the public health emergency expires.