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Pennsylvania Medicaid Reimbursement programs

In Pennsylvania, Leader Services administers, as the selected vendor for the Pennsylvania Department of Education (PDE), the School-Based ACCESS Program and the Administrative Time Study program, both of which facilitate Medicaid reimbursement to Pennsylvania LEAs.

School-Based ACCESS Program, or SBAP

The School-Based ACCESS Program, or SBAP, allows Pennsylvania LEAs to receive federal Medicaid reimbursement for providing IEP health-related services to Medical Assistance-eligible children as part of their Individualized Education Program (IEP). SBAP is a cooperative efforts between the Pennsylvania Department of Education (PDE), the Pennsylvania Department of Public Welfare (DPW), the federal Centers for Medicare and Medicaid Services (CMS), and PDE's contractor, Leader Services.

Reimburseable services include:

• Assistive Devices
• Audiology
• IEP Meetings
• Interpreter Services - limited
• Nursing (RN, LPN)
• Occupational Therapy
• Orientation and Mobility
• Personal Care Assistants
• Physical Therapy
• Physician
• Psychiatry
• Psychology
• Social Work
• Speech/Language/Hearing
• Teacher of the Hearing Impaired
• Special Transportation
• Vision - limited

For Pennsylvania LEAs, Leader maintains a number of resources, including web-based data capture and reporting. Please refer to the links to the left to access these resources.

The Administrative Claiming Program

LEAs have a responsibility to identify, evaluate, and accommodate the physical and mental health needs of all of their students who may be at risk for poor school outcomes. To this end, LEAs often spend time reaching out to children and families to inform, encourage, and assist them in accessing needed health care services. The Administrative Claiming Program (ACP) allows LEAs to claim Medicaid reimbursement for performing certain eligible outreach services as they relate to Medicaid.

Quarterly one-week time studies of staff activities are conducted three times a year to identify the costs of allowable administrative activities. During a predetermined five-day period, each participant identifies the tasks he/she performed and the time spent on those tasks (in 15-minute increments). The participant fills out this information on a timesheet form, using the Code Sheet as a guide.

Leader processes the captured data and calculates the claim based on allowable activities as recorded on the timesheet forms. PDE submits a claim to DPW for the claiming amount. Leader notifies the LEA of the check amount for the quarter. The LEA receives the check 6-8 weeks after the quarter ends. The check for the fourth quarter is based on the average claiming amount calculated from the previous quarters; no time study is required for the 4th quarter. More >.

For more information on either of these programs, please contact an SBAP Account Manager today, or fill out the form on our contact page.