Oregon Health Plan (OHP) School-Based Health Services

About SBHS

Direct Services: K–12 provides reimbursement to school districts and Education Service Districts (ESDs) for covered health services provided in school settings, pursuant to an Individual Plan of Care (IPOC). There is no requirement for education agencies to bill for K–12 direct services.

Direct Services: EI/ECSE provides reimbursement to Early Intervention/Early Childhood Special Education (EI/ECSE) programs contracted with the Oregon Department of Education (ODE) for Medicaid-covered health services provided to children birth to five years old (pre-K), pursuant to an IPOC. ODE contractually requires EI/ECSE programs to bill Medicaid.

Medicaid Administrative Claiming (MAC) provides reimbursement to ESDs through a MAC intergovernmental agreement (IGA) with OHA and to school districts and ESDs under a MAC sub-agreement with ESDs who hold a MAC IGA for activities related to the administration of Medicaid  including referrals to and coordination and monitoring of Medicaid covered health services, assisting a student or family to enroll in the Oregon Health Plan (OHP), and planning, assessment, and policy development of health services programs.

Services for Children and Young Adults

Children and young adults include individuals from birth until their 21^st birthday. School Based Health Services Oregon Administrative Rules (OARs) allow school districts, ESDs, and EI/ECSE programs to bill Medicaid for covered health services when the following conditions are met:

• The child or young adult is an actively enrolled Medicaid recipient.
• The education agency is an enrolled School Medical Provider.
• The services are identified in an IPOC.
• The services are included in Oregon's Medicaid State Plan.
• The services are provided by a medically qualified individual within the scope and practice of their licensure.
• The services are not claimed or reimbursed to another provider.
  

Getting Started

Start here if your education agency is interested in implementing an SBHS (School Medicaid) program. Here you will find essential steps and resources to support School Medicaid billing, including training videos and frequently asked questions.

Oregon Department of Education (ODE) - School Medicaid: Guide to Getting Started

SBHS Learning Opportunities

Technical Guidance

SBHS Provider Enrollment 

Medicaid Leveraging Process 

• Leverage Claims Payable - Not Paid Remittance Advice Information
• Oregon Medicaid Local Match Rates 

Individual Plan of Care Guide 

Billing Codes and Instructions 

MMIS Provider Portal  

• MMIS Provider Portal Resources 
  
• MMIS Provider Portal Guides 
• MMIS Provider Portal Instruction 
• HERC Prioritized List on the Provider Portal 
• Oregon Medicaid Eligibility on the Provider Portal

Occupational Therapy in Oregon Schools  

Physical Therapy in Oregon Schools 

Nursing Staffing in Oregon Schools 

MAC Resources

MAC Program Support for ESDs and School Districts

Automated Clearing House Setup for SBHS and MAC Payments