Note: This is an updated version of ForHealth Consulting School-Based Claiming Services Helps with New CMS Guidance, posted on January 31, 2024.
In June 2024, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced up to $2.5M in grant awards to 18 states for the implementation, enhancement, and expansion of Medicaid and CHIP School-Based Services.
School districts or local education agencies (LEAs) provide health-related services that support students’ ability to achieve educational goals. While CMS allows states to seek federal reimbursement for public expenditures by LEAs for the cost of providing health-related services, there is still untapped potential for federal reimbursement for direct services and Medicaid administrative activities provided at schools, such as physical and occupational therapy, psychological and counseling services, health-related screenings, nursing, speech/hearing/language services, Medicaid outreach, and care coordination.
New CMS guidance issued in May 2023 poses new options and requirements for schools to participate in federal reimbursement. Most importantly, it encourages states to design effective CMS reimbursement programs. The new guidance created new grant funding and programmatic flexibility, which will enable more states to better meet the health-related needs of children in school.
With three decades of experience in school-based Medicaid programs, ForHealth Consulting’s industry-leading experts can design reimbursement models and programs that can support states in the design, implementation, and ongoing administration phases of their programs. Our consultants’ experience can help states understand the new guidance and how the states can create and operate programs to maximize this funding opportunity to better support their children and youth in school.
ForHealth Consulting offers a robust, comprehensive suite of school-based claiming services, along with our expert guidance. Learn more about how we can help you.
School Based Services (SBS) Claiming
School Based Services (SBS) claiming is the process of securing Medicaid reimbursement for eligible services provided in a school setting. Local educational agencies (LEAs) provide medically necessary health services and various administrative activities that contribute to the well-being of students eligible for federal reimbursement. State Medicaid and education agencies, in partnership with health departments, help LEAs access critical funding to sustain or expand the delivery of essential services and improve the overall health and educational outcomes for students.
What Challenges You
Schools are key settings for providing health access and equity but often lack the infrastructure, resources, and specialized knowledge needed to successfully obtain Medicaid funding. The recently published CMS guidance, “Delivering Service in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming,” poses new options and requirements for states to enhance participation in federal reimbursement. Most importantly, it encourages states to evaluate and potentially re-design their reimbursement programs to expand access to services.
Why Choose Us
Choosing ForHealth Consulting is not just a business decision; it’s a strategic partnership that empowers your organization with numerous advantages.
- Comprehensive Service Portfolio: ForHealth Consulting offers a wide-ranging suite of services, covering everything from cost-based reimbursement to program training and help desk support.
- Deep Expertise: We bring over two decades of specialized expertise and knowledge in SBS claiming services to provide unparalleled guidance and transformative results for our clients.
- Technology Integration: We ensure that your processes are efficient and positioned for future advancements in healthcare and administrative practices.
- Proactive Regulatory Guidance: We stay abreast of evolving guidelines, providing you with an informed and proactive approach to compliance and regulatory changes.
- Dedicated Client Support: Our team is committed to understanding your unique challenges and working collaboratively to address them. Your success is our priority, and our responsive support ensures you’re never alone in your journey.
ForHealth Consulting School-Based Claiming Services ensures a WIN-WIN-WIN ForHealth Consulting School-Based Claiming Services ensures a WIN-WIN-WIN for all involved.
- Children and families receive medically necessary services at their school, ensuring quality care in an accessible, convenient setting.
- State and local governments and LEAs secure federal Medicaid reimbursement, helping improve the financing of critical health and other related services to students and families.
- Schools and programs are audit-ready by participating in a reimbursement program that is fully compliant with the new CMS guidance—minimizing risk.
Announcing Our Latest Offering: ForHealth Consulting’s CMS Guidance Support
ForHealth Consulting can help you navigate the complexities of the new CMS guidance. We can help states take advantage of newly offered flexibilities and other administrative simplifications and most importantly, ensure access to necessary care and services to children while advancing educational goals.
How We Can Help
ForHealth Consulting is more than a service provider; we’re your dedicated partner in achieving impactful outcomes for your organization’s health and education endeavors. Our subject matter experts can help design reimbursement models and programs to support the design, implementation, and ongoing administration phases of your state’s SBS program.
- Cost-Based Reimbursement and Methodologies: Unlock the full potential of reimbursement dollars through meticulously designed cost-based strategies. Navigate complex financial landscapes with our expert guidance, software solutions, training, and operational support for cost settlements.
- Medicaid Administrative Activity Claiming: Maximize reimbursement opportunities through efficient claiming of Medicaid administrative activities and ensure your organization receives due reimbursement for the full scope of services provided.
- Random Moment Time Studies: Implement statistically valid cost allocation tools like RMTS to quantify staff time for Medicaid-reimbursable activities.
- Program Design and Consulting: Provide your program even more support with our additional services, including cost settlements, program training and help desk support, and reimbursement methodology and design.
Our Impact
- ForHealth Consulting has been actively involved in operating School Based Services (SBS) and Medicaid programs, assisting state and local governments in securing over $250 million in federal Medicaid reimbursement annually. By successfully securing funding for health services, we play a pivotal role in fostering an environment where students can thrive academically.
- During the COVID-19 crisis, ForHealth Consulting recommended and implemented strategic time study activity changes, tailored for remote and hybrid learning as well as the rise of telehealth. These measures were instrumental in minimizing revenue impacts for our clients.
- Through our proactive partnership and sustained engagement with the Commonwealth’s Medicaid program, Massachusetts became the inaugural state to secure CMS approval for the expansive “free care expansion,” granting students access to an extended range of covered services. We are committed to advancing healthcare accessibility and driving policy changes that directly benefit communities and their educational institutions.
Better means all of us.
We are committed to diversity and inclusion in every aspect of what we do—in the people and communities we serve, in our partnerships, and in how we measure outcomes and define success. A better healthcare experience is one that delivers for—and respects—everyone.