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School Supportive Health Services Program
Preschool Supportive Health Services Program

The School Supportive Health Services Program and Preschool Supportive Health Services Program (collectively “SSHSP”) were developed jointly by the New York State Education Department (SED) and the New York State Department of Health (DOH). SED is responsible for administration of the SSHSP. DOH, as the single State agency responsible for administering New York’s Medicaid program, is responsible for setting Medicaid policy and reimbursement rates for SSHSP. The Office of the Medicaid Inspector General (OMIG) is responsible for auditing claims submitted for services under the SSHS Programs to ensure compliance with all applicable Medicaid requirements.

In 1988, an amendment to the Social Security Act provided statutory authority for SSHSP, also known as Medicaid in Education, by allowing Medicaid coverage of medical services included in the Individualized Education Programs (IEPs) of students with disabilities. The purpose of SSHSP is to provide Medicaid reimbursement to school districts, §4201 schools and counties for certain diagnostic and health support services provided to Medicaid-eligible students with disabilities. The SSHSP applies to students from age three years up to their 21st birthday.

Medicaid-reimbursable services under New York’s P/SSHS Program, for children with disabilities who are eligible for Medicaid, include:

Physical therapy services
Occupational therapy services
Speech therapy services
Psychological evaluations
Psychological counseling
Skilled nursing services
Medical evaluations
Medical specialist evaluations
Audiological evaluations
Special transportation services

In order to be reimbursable under the Medicaid program, school supportive health services must be:

Medically necessary and included in a Medicaid covered service category;
Included in the State’s Medicaid plan and/or available under Early and Periodic Screening, Diagnosis and Treatment (EPSDT) to children up to age 21;
Prescribed, ordered or referred by a practitioner acting within his or her scope of practice;
Included in the child’s Individualized Education Program (IEP);
Provided by qualified professionals under contract with or employed by a school district, a §4201 school; a county in the State or the City of New York; and,
Furnished in accordance with all requirements of the State Medicaid Program and other pertinent state and federal laws and regulations, including those regarding provider qualifications, comparability of services, freedom of choice and the amount, duration and scope provisions.

Additional clarification on compliance agreements related to the SSHSP as well as policies related to Medicaid covered preschool and school supportive health services, provider qualifications, documentation requirements to support billing, and special transportation services is available in a Q&A format.