The Kentucky Department of Education allows local education agencies to enroll as a Medicaid Health service provider for beneficiaries who are eligible under the Medicaid program and under the Individuals with Disabilities Education Act (IDEA). They must also be enrolled with the Managed Care Organization (MCO) of any beneficiary they wish to treat. SBHS are evaluative, diagnostic, preventive and treatment services provided for the maximum reduction of physical or intellectual disability, to allow for functioning of the beneficiary to their best possible level, to prevent loss of current functional level, or to correct any defects or conditions.
SBHS Services must be listed in the child's Individual Education Plan (IEP). They must meet the coverage provisions and requirements set forth in 907 KAR 1:715 . All services must be performed within the scope of practice for any provider.
- Children from age three to 21 who are eligible under the Individuals with Disabilities Education Act (IDEA) and who have an IEP are eligible for School-Based Health Services.
- Parents must be advised annually that the school intends to bill Medicaid for a child's services. A parent may refuse to allow the school to bill.
- Speech therapy, occupational therapy, physical therapy and mental health services may be provided in an individual or group setting.
- Children who receive School-Based Health Services are not prohibited from receiving services through the EPSDT program. When medically necessary, services may be covered through both programs.
Some services may require a prior authorization in order to be covered. Just because a service is listed in the administrative regulation does not guarantee payment of the service. Providers must follow the regulations and must follow requirements of the MCO for which they participate.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions -
DXC - (800) 807-1232
Provider Questions - (855) 824-5615
Policy Questions - (502) 564-6890
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth.net assistance -
DXC - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071