pa-56-24-843: School-Based ACCESS Program payment methodology updates

Summary

The Department of Human Services (Department) is announcing updates to Pennsylvania's Medicaid State Plan for the School-Based ACCESS Program (SBAP) services to ensure compliance with guidance from the Centers for Medicare & Medicaid Services (CMS). The SBAP has operated in this Commonwealth since 1991, allowing Local Education Agencies to receive reimbursement for health-related services provided to Medical Assistance (MA) enrolled children who are under 21 years of age when those services are documented in the child's Individualized Education Plan. On July 25, 2022, the Bipartisan Safer Communities Act (Pub.L. No. 117-159, § 11003, 136 Stat. 1313, 1320 (2022)) was signed into law, requiring CMS to provide guidance to State Medicaid agencies to support the delivery of health services to MA beneficiaries in school-based settings. On May 18, 2023, CMS released ''Delivering Service in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming.'' School-based services are reimbursed on a cost-based rate methodology. The Department is updating Attachment 4.19B of the Medicaid State Plan to include additional details on the specific data sources, processes and timeframes for the payment methodology used for the SBAP. The Department is not otherwise changing the payment methodology for the SBAP, only providing additional clarification and detail to meet the requirements set forth in the guidance issued by CMS. Fiscal Impact There is no fiscal...

The agency’s own summary, as published.