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Increasing Revenue: SBAP Funding Procedures

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Increasing revenue sbap funding procedures

Increasing Revenue:

SBAP Funding Procedures


Looking for revenues

Looking for Revenues?


You’re in the right place!


Increasing revenue sbap funding procedures



Increasing revenue sbap funding procedures

Carlisle Recently Jump Started their SBAP Billing ProgramMay 2010Added 1 FTE – Dedicated Access Billing CoordinatorUpdated Leader Services Software SetupBilling Form/File ManagementJune 2011Revenues increased > $100,000Year 1


14 buildings 4 800 students general fund budget 64m

14 Buildings4,800 StudentsGeneral Fund Budget: $64m

Carlisle Area School District

Special Ed – 15.5% population

of that: 32.2 % MA Eligible

30% Free & Reduced Lunch

Spec Ed Budget $7m

+ Pupil Health $5m


Increasing revenue sbap funding procedures

How did we do it?

  • Billed by Service Category:

  • IEP’s and Transportation

  • Speech, OT, PT, and Psych Svc

  • And various smaller categories

  • Year 2-3: need to add:

  • PCA Services

  • Social Work Services

YEAR 3 GOAL: $300,000


School based access program sbap

School-Based ACCESS Program (SBAP)

Sbap direct services overview

SBAP-Direct Services overview

SBAP affords schools the opportunity to receive federal Medicaid funds for providing certain health-related services to special education students who are enrolled in the MA Program.

The program began in 1992 and is jointly operated by the PA Department of Education (PDE) and Department of Public Welfare (DPW).

Eligible schools

Eligible schools

  • School Districts

  • Intermediate Units

  • MAWAs

  • Charter Schools

  • Approved Private Schools

    Currently, over 600 schools participate.

Covered services

Covered services

Assistive Devices


IEP Development

Nursing (RN)

Nursing (LPN)

Occupational Therapy

Orientation and Mobility

Personal Care Assistant

Physical Therapy




Social Work


Teacher of Hearing Impaired

Special Transportation

Reimbursements by specialty

Reimbursements by specialty

For the 2010-2011 school year:

Total = $145,233,580


Speech, Language$28,274,559



IEP Development$15,132,210

Physical Therapy$8,596,718


RN Nursing$5,191,279

Teacher of HI$2,925,027

Social Work$1,870,712

LPN Nursing$1,533,872



Asst. Devices$151,314



Increasing revenue sbap funding procedures

Considerations for participation

  • Do you have:

  • Sufficient staff and resources?

  • Accessibility of records?

  • Ability to maintain internal compliance programs?

  • Commitment to keep current on program regulations?

  • Commitment to training and conducting self-audits?

Reimbursement factors

Reimbursement factors

  • Special education population

  • MA population

  • Health-related services provided by school staff and/or contracted services

  • Number of MA-qualified service providers

  • Number of parents providing consent

  • Level of management

Increasing revenue sbap funding procedures

Eligible students

  • Student must:

  • Be entitled to services under IDEA.

  • Be three years of age and under 21.

  • Be enrolled in MA.

  • Have an IEP that defines the MA-covered service.

Increasing revenue sbap funding procedures

Eligible students

  • Student must:

  • Have written Parental Consent.

  • Have Medical Authorization.

  • Receive the MA-covered service by a school employee or contractor who meets MA Provider qualifications.



  • Must be maintained for six years.

  • Must fully disclose the nature and extent of the service rendered.

  • Must be legible.

  • Must be readily available for an audit.



  • Reimbursements are made to PDE’s Comptroller’s Office and deposited into an LEA-restricted account.

  • Leader provides monthly Financial Reports.

  • LEAs must ensure the availability of funds prior to making a withdrawal request.

  • Funds must be used for special education programs and services.

Administrative claiming program acp

Administrative Claiming Program (ACP)

Acp overview

ACP overview

In meeting students’ educational needs, LEA staff members often find themselves delivering services that help ensure students are healthy and ready and able to learn.

The school setting provides an opportunity to enroll potentially eligible children in the MA Program or to assist children and their families who are already enrolled to access the MA services that are available to them.

Acp overview1

ACP overview

ACP allows LEAs to receive federal Medicaid funds in addition to the School-Based ACCESS Program(direct services revenue).

Federal matching funds are available for certain administrative activities that are in support of the state’s Medicaid program.

Eligible schools1

Eligible schools

  • School districts

  • IUs

  • Charter schools

  • Approved Private Schools

    Participating LEAs must also participate in the Direct Services Program.

    Currently, over 150 schools participate.

Acp time studies

ACP time studies

One-week quarterly time studies held three times per year capture staff time.

The time study must:

  • represent tasks as they relate to the participants’ job descriptions.

  • capture 100 percent of participants’ time.

Acp claimable activities

ACP claimable activities

Examples of administrative claimable activities:

  • Informing individuals about the MA Program.

  • Assisting individuals with the MA-application process.

  • Monitoring, referring, or coordinating MA-covered services.

Reimbursements by quarter

Reimbursements by quarter

  • For the 2010-2011 fiscal year:

  • July-Sept. 2010$3,979,820

  • Oct.-Dec. 2010$3,753,608

  • Jan.-March 2011$4,016,334

  • April-June 2011$4,104,988

Total = $15,854,750



  • LEAs receive a check from DPW.

  • Reimbursement is calculated at the Federal Financial Participation rate of 50 percent.

  • DPW retains 50 percent of the reimbursement.

  • Funds should be spent within health-care services.

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