Did you know School-Based Medicaid offers a platform for asking questions and seeking clarification?

The Clarifications section on the Idaho Training Clearinghouse School-Based Topic page provides answers to common questions submitted via the Medicaid SBS Clarification Form. Responses, developed by DHW and SDE staff, are organized by category and fully searchable. Before submitting a new question, please check the existing clarifications.

If you have new concerns or spot conflicting information, submit a Medicaid SBS Clarification Form. We’ll respond via email within two weeks, and your question will be added to the Clarifications page.

Clarification Pending on SLP and SLPA Billing for School-Based Medicaid>

We understand that many of you are seeking accurate information on who can bill School-Based Medicaid services as a Speech-Language Pathologist (SLP) or Speech-Language Pathologist Assistant (SLPA). Currently, we are still waiting for the Department of Health and Welfare (DHW) to provide clarification on the updated fee schedule and new licensing requirements.

As soon as we receive guidance from DHW, we will share the updated information to ensure compliance with Medicaid regulations. We appreciate your patience as we work to provide clear and accurate details. Stay tuned for further updates!

LEAs can bill Medicaid for SBS when services are outlined in a student's IEP or Service Plan (SP) for parentally placed private school students with disabilities, provided designated funds are available. Services billed must be medically necessary for the student to access their educational program and specifically identified in the student’s plan.

The plan must include:

• Type of service (individual/group), frequency, and duration.
• Provider title, including supervised staff.
• Measurable goals, when required.
• Location, if outside the school setting.

Educational services (those delivered during school hours in educational settings) are not reimbursable. However, Medicaid services that align with IEP goals, such as Positive Behavior Supports, may be billed if appropriately documented. (School Based Medicaid Reference Guide 2024-2025, pgs 38-39)

Update to the School-Based Medicaid Reference Guide: Speech-Language Pathology Services

The Speech-Language Pathology (SLP) section of the School-Based Medicaid Reference Guide has been updated to clarify qualifications, service provisions, and billing guidance for SLP services.

Speech-Language Pathologists (SLPs) must hold a master’s or doctoral degree in speech-language pathology, a Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association (ASHA), and licensure from the Idaho Division of Occupational and Professional Licenses (IDOPL). Alternatively, SLPs with a Pupil Personnel Certificate (PPC) must have earned a master’s degree in speech-language pathology from an accredited program approved by the Idaho State Board of Education. Both SLPs with IDOPL licensure and those with a PPC can bill Medicaid at the professional rate.

SLP Assistants are required to hold a bachelor’s degree or higher from a speech-language pathology assistant program and must pass the ASHA Assistant Certification Exam, although those licensed before July 1, 2024, are exempt from this requirement. SLP Assistants are reimbursed at the paraprofessional rate under Medicaid.

Effective July 1, 2024, highly qualified paraprofessionals will no longer be eligible to bill Medicaid for speech and language services. While they may continue assisting licensed SLPs, these services will not be Medicaid reimbursable.

Medicaid Resource Hub: Essential Tools for School-Based Service Providers

The Idaho Department of Health and Welfare provides a dedicated resource hub for Medicaid school-based service providers, offering essential training materials, guidelines, and forms. This platform supports schools and charter schools enrolled as Medicaid providers, ensuring they can effectively deliver Medicaid school-based services to students with disabilities. The website includes training modules, documentation tools, and procedural guidance to help providers navigate Medicaid regulations and improve service delivery.

In addition to training resources, the site offers key forms and compliance documents necessary for reimbursement and service authorization. Providers can access information on covered services, professional qualifications, and administrative procedures to streamline their work.

Medicaid Reimbursement for School-Based Services

Local Education Agencies (LEAs) seeking Medicaid reimbursement must ensure that services are medically necessary for a student to access their educational program. Each service billed must be listed in the student’s Individualized Education Program (IEP) but does not need to match Medicaid's service titles exactly—only align with them. For example, an IEP listing Positive Behavior Supports may correspond with Medicaid services like Behavioral Intervention or Habilitative Skill Building.

Key Requirements for Reimbursement:

• Name of Student;
• Name, title, and signature of the person providing the service;
• Date, time, and duration of service;
• Place of service, if provided in a location other than school;
• Category of service (also specifying individual or group);
• Brief description of the specific areas addressed (must correspond to the IEP goal); and
• Student’s response to the service when required for the service (must correspond to the IEP goal).