• This page, School-Based Medicaid Program (SBMP) Resource Center, is offered by
  • MassHealth

School-Based Medicaid Program (SBMP) Resource Center

The Resource Center is where most guidance, forms, and other resources for successful participation in the SBMP lives. Chances are, if you have a question about the SBMP, you can find the answer here.

Please note it is important we have current contact information for all participating LEA’s. See the forms section for updating any and all contact information.

Table of Contents

General Program Information

This section of the Resource Center includes more general information and resources that cuts across the entire School-Based Medicaid Program. If you’re new to the SBMP, we recommend you start by reading the Program Guide found in this section.

  • Enrolling as a contracted SBMP Provider: after learning about the SBMP and reviewing the Provider Contract in the Resource Center, LEAs must reach out to the MassHealth Provider Enrollment Center to initiate the contracting process. Please see Need Help With the SBMP? for contact information.
  • SBMP Provider Contract: All LEAs have executed this contract and are responsible for compliance with the requirements. Review this contract at least annually as part of your compliance strategy. PDF | Word
  • SBMP Program Guide for Local Education Agencies: Everyone who works on the School-Based Medicaid Program, from superintendents to physical therapists should review this guide. PDF | Word
  • Dates & Deadlines FY23 PDF | XLS
  • Top 5 Things Providers Need to Know PDF | Word
  • For more general program information, please see School-Based Medicaid Program (SBMP) Trainings. Specifically, review SBMP 101 Modules 1 (Introduction) and 2 (SBMP for LEA Administrators).

Random Moment Time Study (RMTS)

The RMTS is the key to reimbursement in the SBMP. These resources will help you understand and implement the RMTS in your district. For Step-by-Step manuals or help with accessing the RMTS website, see Need Help With the SBMP?.

  • LEA Coordinator Guide for Random Moment Time Study (RMTS) PDF | Word
  • SBMP Covered Services and Qualified Practitioners PDF | Word
  • New! Information Sessions for RMTS Coordinators – September 2021  YouTube | PowerPoint
  • For more RMTS information, please see School-Based Medicaid Program (SBMP) Trainings. Specifically, review SBMP 101 Module 3 (For LEA RMTS Coordinators), Module 7 (For LEA Technology Leadership), 8 (For LEA Direct Service Providers) and 9 (For LEA RMTS – Participants performing Medicaid Administrative Activities).

Administrative Activities Claiming (AAC)

AAC reimbursement can be claimed for staff costs in both the direct service and administrative only RMTS pools, as well as for other allowable administrative costs. For Step-by-Step manuals, please see Need Help With the SBMP?.

  • LEA Instruction Guide for Administrative Activity Claiming (AAC) PDF | Word
  • For more AAC information, please see School-Based Medicaid Program (SBMP) Trainings. Specifically review SBMP 101 Module 5 (For LEA Financial Leadership), Module 7 (For LEA Technology Leadershipand Module 9 (For LEA RMTS – Participants performing Medicaid Administrative Activities).

Direct Service Claiming Resources

DSC Reimbursement can be claimed for staff and other costs associated with the provision of reimbursable services. Interim claims are submitted throughout the year and are reconciled with the annual cost report that is filed following the close of the fiscal year. Information about reimbursable services and interim claims, as well as the annual cost report can be found in this section.  For further assistance see Need Help With the SBMP?.

  • SBMP Direct Service Claiming (DSC) Guide PDF | Word
  • LEA Instruction Guide for the Direct Service Cost Report PDF | Word
  • New!  Information Sessions on the Direct Service Cost Report updates – October 2021  YouTube | PowerPoint
  • Top 5 Things Providers Need to Know PDF | Word
  • SBMP Covered Services and Qualified Practitioners PDF | Word
  • SBMP Billable Procedure Codes and Maximum Fees PDF | Word
  • Q&A For Services Provided via Telehealth during the COVID-19 Public Health Emergency (PHE): This guidance will be in place for 90 days, following the end of the PHE. PDF
  • The Provider Online Service Center (POSC) is a crucial tool for participating in the DSC claiming. For example, on the POSC you can:
    • Track remittance advices
    • Inquire about student/member eligibility (individual lookups)
    • Maintain your LEA’s primary account holder/contact
    • Maintain electronic payment/banking information
    • Designate a billing vendor for electronic claims transactions
  • Medicaid 101 series, particularly Modules 4 (For LEA Clinical Leadership) and 8 (For LEA Direct Service Providers), found on the Trainings page.

Forms

  • School District Contact Information Form: At least annually, LEAs must update this form so that MassHealth can get in touch with important, time-sensitive information. If you are unsure who your LEA’s current contacts are, please reach out to the SBMP help desk per the contact form. Word
  • SBMP Authorized Designee Information Form Word
  • DESE Form for Out of District Service Documentation: Per DESE Administrative Advisory SPED 2019-3, this out of district billing form is mandated, unless a different format for submitting information for reimbursement is mutually agreed upon and contains all required elements. Please review the DESE Administrative Advisory SPED 2019-3 for the advisory and form. If you have any direct questions to DESE, please see Need Help With the SBMP?.
  • DESE Parental Consent Form: The Department of Elementary and Secondary Education has determined that one-time parental consent and annual notification is required to comply with the Federal Education and Rights Privacy Act (FERPA). Please see DESE Administrative Advisory SPED 2013-1 (Updated) for information and the form (including multiple translations). Note, this is not a Medicaid/MassHealth requirement and questions should be directed to DESE (see Need Help With the SBMP?). Please also review SBMP Bulletin #32: Parental Consent for Local Education Agencies to Bill MassHealth Does Not Change MassHealth Benefits Outside of School.
Last updated: August 3, 2022
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