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    Introduction

    The school-based ACCESS program (SBAP) was created in 1965 through Title XIX of the Social Security Act. Medicaid is the state and federal government program that provides health care coverage for eligible individuals, including low-income individuals and individuals with disabilities. The Medicare Catastrophic Coverage Act has amended Title XIX, by providing that payment through the Medicaid program is not prohibited because such “services are included in the child’s individualized education program established pursuant to Part B of the Individuals with Disabilities Act." (Social Security Act § 1903c [42 U.S.C. 1396b(c)]).

    The SBAP permits a Local Education Agency (LEA) to receive reimbursement for health-related services, provided to Medical Assistance enrolled children, under 21 years of age, as documented in an Individual Education Program (IEP).

    Reimbursement Procedures

    Funds that are reimbursed from the federal Medicaid School-Based ACCESS Program for direct health related services are kept in LEA specific accounts at the Pennsylvania Department of Education (PDE). Each LEA is able to verify its ACCESS fund balance by accessing the Financial Accounting Information (FAI) System.

    To receive these funds, each LEA must request the funds by completing a digital copy of

    PDE-352 form and submitting it to the Bureau of Special Education (BSE) electronically by email to RA-EDSBAPFUNDING@pa.gov. The PDE-352 form may be accessed at the following link: School Based ACCESS Program (PDF).

    Completed forms can be submitted by email to: RA-EDSBAPFUNDING@pa.gov.

    The chief administrative officer must sign the PDE-352 form. The form is a request for reimbursement dollars for direct service claiming, which may be used to support the education of any special education student, not only those who are Medicaid eligible.

    A general description of the items or services purchased, and their effect on the special education program, should be included in a cover letter, or the narrative section of the PDE-352. The name and contact information of the individual, who is completing the PDE-352, should be included on the form. Copies of invoices or purchase orders should not be included with the PDE-352 form. BSE personnel recommend the submission of PDE-352 forms on a quarterly or monthly basis to maintain the balance of the LEAs ACCESS account below $500,000.00. After the PDE-352 form has been received and approved by BSE personnel, the PDE-352 is sent to the Comptroller's office for processing. Funds are transferred electronically to the LEAs local bank account approximately two months after the request is received by BSE.

    Ineligible School-Based ACCESS Expenditures (examples, not an exhaustive list)

      1. general education expenses.
      2. supplanting of professional positions that the LEA has been supporting in the past.
      3. expenses outside the scope of the special education program.
      4. capital improvement expenses.
      5. real estate expenses.
      6. administrative expenses which are outside the realm of special education.

    Eligible School-Based ACCESS Expenditures (examples, not an exhaustive list)

    1. new, professional, special education positions (teachers, therapists, etc.); salaries and benefits.
    2. special Education classroom instructional aides; salaries, and benefits.
    3. personal Care aides; salaries, and benefits.
    4. school Based Access Program coordinators; salaries, and benefits.
    5. nurses; salaries and benefits, for the percentage of time spent with special education students.
    6. clerical support staff; for ACCESS record keeping, salaries, and benefits.
    7. clerical support staff; for the special education program, related to the time spent in direct student support (typing, filing, mailing of IEPs, evaluation reports, Invitations to IEP meetings, etc.), salaries and benefits.
    8. substitute teacher expenses, for special education classes, due to the special education teacher’s attendance at IEP meetings or professional development sessions.

    1. copiers.
    2. computers.
    3. paper supplies.
    4. equipment maintenance.
    5. FAX equipment and supplies.
    6. printer equipment and supplies.
    7. filing cabinets.
    8. Internet access, for purposes of accessing vendor program services; e.g., SBAP billing program and IEP writer program, etc.

    1. CPR and first aid training for special education personnel.
    2. conferences and workshops for special education personnel and administrators.
    3. inclusion conferences and workshops for general education personnel.
    4. parent training for special education purposes.
    5. Manuals, or other materials, required for professional development sessions or training programs

    1. Student computers - When computer or other technology items are outdated and sold by an LEA, there is no regulatory language requiring an LEA to return funds received from the sale. The LEA should keep the proceeds from the sale. When technology items are sold, the LEA should: keep a record of the vendor to which the items were sold or received credit, keep a record of the dollar amount received, and record the date of the transaction. This documentation should be maintained for a period of seven years.
    2. instructional personnel computers, which are used for writing IEPs, evaluation reports, lesson or treatment plans, record keeping, or other special education functions.
    3. specialized furniture for special education students.
    4. treatment room furniture.
    5. furniture needed for computer use.
    6. televisions and related technology devices.
    7. assistive technology equipment and supplies.
    8. portable stair climbers.
    9. wheel chairs.
    10. computer networking hardware and software.
    11. swimming pool lifts.
    12. therapy equipment.

    1. psychological testing.
    2. specialized transportation outside the general education school transportation system.
    3. professional development and training for instructional personnel and aides.
    4. community based program costs.
    5. maintenance contracts on computers, copiers, etc.
    6. tuition for students who have placements outside of the LEA.

    1. modification of specialized buses with car seats, seat belts, wheelchair adaptations, lifts, etc.
    2. specialized buses for special education transportation.
    3. expenses for contracted transportation services.

    1. personal care supplies for special education students.
    2. health room supplies for special education students.
    3. paper, computer, and printer supplies for School Based ACCESS Program, IEPs, evaluation reports, and other student specific documents.

    1. curriculum based field trips.
    2. guest speakers and enrichment programs.
    3. programs provided, e.g., swimming lessons, community-based programs, transition related programs, etc.
    4. tests and other assessment instruments.
    5. books and other resource materials, including service animal expenses.
    6. software.
    7. workbooks and other ancillary curriculum products.
    8. adaptive feeding equipment and other health related products.
    9. IEP writing programs/software and professional development needed for implementation and performance.
    10. instructional materials.
    11. teacher manuals and related instructional materials.
    12. tuition which is the result of a settlement agreement.

    FAQs – Approved Private Schools

    No. The LEA may only include contracted health services and contracted tuition costs for students who are receiving a direct medical service as listed in their IEPs.

    Yes. Contracted health services and contracted tuition costs are subjected to the LEA's IEP ratio to determine Medicaid Allowable (MA) costs, so it is appropriate to include costs for both MA- and non-MA-eligible students. It is also important that any students for which costs are reported should be included in the IEP ratio, with the total of all students with a health-related service in their IEP included in the denominator and total number of MA-eligible students with a health-related service in their IEP included in the numerator.

    First, the LEA must confirm whether the student enrolled in the APS is in a PDE partially funded slot or whether the LEA is responsible for paying the full tuition for the student. For example, the LEA sends Student A and Student B to an APS with an annual tuition rate of $75,000. Student A is in a PDE partially funded slot, with PDE paying for 60 percent of the tuition and the LEA paying 40 percent. Student B is funded 100 percent by the LEA. The LEA would claim $105,000 of tuition on its annual cost report ($30,000 for Student A and $75,000 for Student B).

    Since APSs are no longer eligible to participate as MA providers in the SBAP as of January 1, 2015, they cannot receive direct reimbursement. However, a funding agreement may be established between the LEA and APS.

    No. Cost reports are used to determine Medicaid allowable costs for direct medical services only.

    Yes, if the LEA provides payments to an APS for both tuition and separate health-related service(s) for the same student, the LEA may include both tuition and contracted costs on their cost report. As in Question #3, the LEA must first determine whether the student is in a PDE partially funded slot or not.

    If an LEA plans to claim contracted health services, it must include contracted staff members who perform direct health-related services. LEAs would need to work with APSs to identify those direct service staff.

    On July 17, 2014, Centers for Medicare and Medicaid Services (CMS) sent the Pennsylvania Department of Human Services (DHS) the final report, for school-based services in fiscal year 2012. The report included the following: "CMS has determined that the approved private schools are not a government unit for Medicaid reimbursement purposes, and a certified public funding mechanism cannot be used." Therefore, only "government unit" LEAs can participate as providers in the School-Based ACCESS Program and can claim the costs of providing or purchasing school-based medical services.

    Questions

    Questions, regarding ACCESS, should be directed to:

    Carla Alfieri
    717-346-0724
    calfieri@pa.gov​

    Or, to the resource account at: RA-EDSBAPFUNDING@pa.gov