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 a key setting to provide 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 a multitude of advantages.

  1. 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.
  2. 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.
  3. Technology Integration: We ensure that your processes are efficient and positioned for future advancements in healthcare and administrative practices.
  4. Proactive Regulatory Guidance: We stay abreast of evolving guidelines, providing you with an informed and proactive approach to compliance and regulatory changes.
  5. Dedicated Client Support: Our team is committed to understanding your unique challenges, and we work 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 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.

  1. 1

    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.
  2. 2

    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.
  3. 3

    Random Moment Time Studies: Implement statistically valid cost allocation tools like RMTS to quantify staff time for Medicaid-reimbursable activities.
  4. 4

    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

  1. 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.
  2. 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.
  3. 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.