School Based Services (SBS)

Overview

School Based Services assist students with disabilities who benefit from Special Education and Related Services. Medicaid reimbursement, through the Michigan Department of Health and Human Services (MDHHS), provides funding for the medical service needs of students receiving Special Education and Related Services. The Social Security Act, as amended in 1988 by the Medicare Catastrophic Coverage Act, specifically provides for medical assistance (Medicaid) to cover "Related Services", which are specified in Federal Medicaid statute as medically necessary and included in the child's IEP (Individualized Education Plan) established pursuant to Part B of the IDEA or furnished to an infant or toddler with disabilities because such services are included in the child's IFSP (Individualized Family Service Plan), adopted pursuant to Part C (formerly called Part H) of the IDEA.

PDF Document Informational Brochure

PDF Document Parental Consent for Medicaid School Based Services Program

Quality Assurance

SBS Providers must have a written Quality Assurance Plan on file. SBS costs will be reviewed/audited by MDHHS for determination of medical necessity and to verify that all services were billed and paid appropriately. The purpose of the Quality Assurance Plan is to establish and maintain a process for monitoring and evaluating the quality and documentation of covered servicces, and the impact of Medicaid enrollment on the school environment.

An acceptable Quality Assurance Plan must address each of the following Quality Assurance Standards:

Covered services are medically necessary, as determined and documented through appropriate and objective testing, evaluation, and diagnosis
The IEP/IFSP treatment plan identifies which covered services are to be provided and the service frequency, duration, goals, and objectives
A Monitoring Program exists to ensure that services are appropriate, effective, and delivered in a cost effective manner consistent with the reduction of physical or mental disabilities and assisting the beneficiary to benefit from Special Education
Billings are reviewed for accuracy
Staff Qualifications meet current license, certification, and program requirements
Established coordination and collaboration exists to develop plans of care with all other providers (ie, Public Health, MDHHS, Community Mental Health Services Programs (CMHSPs), Medicaid Health Plans (MHPs), Hearing Centers, Outpatient Hospitals, etc.)
Parent/Guardian and beneficiary participation exists outside of the IEP/IFSP team process in evaluating the impact of the SBS program on the educational setting, service quality, and outcomes.

Quality Assurance Plan