The School-Based ACCESS Program (SBAP) allows school districts and intermediate units to receive federal Medicaid reimbursement for providing Individualized Education Plan (IEP) health-related services to Medical Assistance-eligible children as part of their IEP. SBAP is a cooperative effort between the Pennsylvania Department of Education (PDE), the Pennsylvania Department of Public Welfare, the federal Centers for Medicare and Medicaid Services, and PDE’s contractor Leader Services.
Reimbursable services include:
- Assistive devices
- IEP Meetings
- Interpreter services (limited)
- Nursing (RN, LPN)
- Occupational therapy
- Orientation and mobility
- Personal care assistants
- Physical therapy
- Social work
- Teacher of the hearing impaired
- Special transportation
- Vision (limited)
Parents and guardians must be notified of the intent to bill Medical Assistance for SBAP services. Participation in the SBAP is voluntary. Upon receipt of the notification, parents may give permission, deny permission, or elect not to reply at all. At any time, a parent or guardian may withdraw permission to bill. This request can be verbal or in writing.
Located within the Department of Welfare, the Office of Income Maintenance — through its County Assistance Offices — is responsible for determining eligibility for programs funded with federal dollars. Included are Medical Assistance, Cash Assistance, Food Stamps, Employment and Training, the Low Income Home Energy Assistance Program, and others. Each program has unique guidelines and requirements for eligibility. With regard to medical assistance eligibility for students, income limits may vary based on the age of the student and other factors. It is feasible that one student in a family qualifies for Medical Assistance, but his or her siblings do not qualify. A student receiving Social Security Income is automatically eligible for Medical Assistance.
Medical Assistance Loophole Provision
There are many advantages to enrolling students in Medical Assistance. Medical Assistance pays for wrap-around mental health services and other types of services that are not routinely covered under private insurance. Most families will not qualify for Medical Assistance or Social Security Income because the family income exceeds program limits.
For disabled students, there is a special eligibility vehicle, commonly referred to as the Medical Assistance Loophole. Under this provision, a student meeting the Social Security Administration’s disability standards may be eligible for Medical Assistance, based on meeting the standards and the income of the student, not the family.
There is an eligibility application for students. It is used to apply for Medical Assistance coverage or coverage through the Pennsylvania Child Health Insurance Program (CHIP). The name of the common application is Application for Health Care Coverage. Should the student be ineligible for one program, but feasibly eligible for enrollment in another program, the application is automatically referred. Only students enrolled in Medical Assistance are eligible for billing in the SBAP.
Parents can apply for Medical Assistance coverage through their local Assistance Office or by visiting the Compass website. Compass is an online application for Pennsylvanians to apply for many health and human service programs.
Regardless of the method used to determine eligibility, families must take action to ensure continued eligibility. Any changes in address, private insurance coverage, and other circumstances impacting current coverage should be referred to the case worker assigned to them. Notices to families from the County Assistance Office pertaining to eligibility continuation must be responded to, in order to ensure eligibility does not end.
Nursing services may be provided by a medical doctor (MD), doctor of osteopathy (DO), certified registered nurse practitioner (CRNP), registered nurse (RN), or licensed practical nurse (LPN).
Occupational Therapy Services
Occupational therapy evaluation services must be provided by a licensed occupational therapist. Occupational therapy treatment services must be provided by a licensed occupational therapist or a licensed occupational therapy assistant supervised by a licensed occupational therapist.
Orientation and Mobility Services
Orientation and mobility services must be provided by a an individual who possesses the following:
- Bachelor's degree or higher
- Pennsylvania Department of Education teaching certification in Visually Impaired
- Professional certification from the Association for the Certification of Vision Rehabilitation and Education Professionals (ACVREP)
Personal Care Assistant Services
A personal care assistant must be a high school graduate or have a GED. She/he must also have a current certification in first aid and CPR. These certifications must be maintained during employment
Physical Therapy Services
Physical therapy evaluation services must be provided by a licensed physical therapist. Physical therapy treatment services must be provided by a licensed physical therapist or a licensed physical therapist assistant supervised on-site by a licensed physical therapist. Direct supervision means the individual must be on the premises to provide assistance when needed.
Psychological services must be provided by a psychologist who meets one of the following credential requirements:
- License in Psychology as issued by the State Board of Psychology
- Pennsylvania Department of Education certified psychologist
Social Worker Services
Social work services must be provided by a licensed social worker or licensed professional counselor.
Speech, Language, and Hearing Services
If a speech/language pathologist does not possess a Certificate of Clinical Competence from the American Speech and Hearing Association or a license in speech pathology issued by the State Board of Examiners in Speech, Language, and Hearing, the service provider may participate in the SBAP if she or he meets all of the following:
- Possesses a master's degree in speech/language pathology or a master's equivalency with 36 credits, at least 30 of which are at the graduate level, from a university approved to offer graduate credits:
- At least six credits must be in speech disorders
- At least six credits must be in language disorders
- At least six credits must be in audiology
- The remaining 18 credits must be in speech/language courses
- Has documentation of 18 hours of direct on-site observation by her/his supervisor and documentation of 18 other contacts, such as telephone conversations, records reviews, IEP reviews, video observations of therapy, etc.
- Holds certification by the Pennsylvania Department of Education in speech/language pathology and has at least one year of supervised work experience in the field of speech/language pathology
Note: PDE-certified audiologists and speech pathologists who are working in the same building under the direct supervision of a qualified audiologist or a speech pathologist must obtain a supervisory signature on all their School-Based ACCESS Program Service Description Slips and Professional Services Logs.
Teacher of the Hearing Impaired Services
A qualified teacher of the hearing impaired may participate in the SBAP if she or he possesses any of the following:
- Pennsylvania license as a teacher of the hearing impaired
- Current professional certificate issued by the Council of Education of the Deaf (CED)
- Master’s degree, from an accredited college or university, with a major in teacher of the hearing impaired or a master's equivalency as indicated below:
- 39 graduate semester hours
- 12 hours in curriculum and instruction
- 12 hours in language and communication
- 3 hours in foundations
- 3 hours in speech science and audiology
- 9 hours among the above-listed areas or other course work related to teaching of the hearing impaired
- 1 year of supervised experience as a teacher of the hearing impaired
- 18 hours of direct, on-site supervision and at least 18 additional contacts related to the job IEP reviews, telephone conversations, etc.
Prior to placing a student in special education, an evaluation or assessment occurs. Usually, a psychologist completes an evaluation. Concerning psychological evaluations or assessments, if an evaluation or assessment does not lead to placement in special education and creation of an IEP, the evaluation or assessment is not billable. When an evaluation or assessment leads to determining a need for special education and creation of an IEP, the time spent completing the evaluation/assessment is billable. Time billed includes both direct and collateral activities. The maximum billable hours for any psychological evaluation/assessment is 20 hours. The date of the IEP is used as the service billing date.
Other Professional Evaluations/Assessments
Other therapists, as well as professional nurses, may complete evaluations/assessments to determine the need for medical/mental health-related services. As long as a student is determined to meet special education criteria, and an IEP is written which lists at least one medical/mental health-related direct service, the evaluation/assessment is billable.