School-Based Health Center Carve-In to Medicaid Managed Care

Note: Benefit Transition Date no sooner than April 1, 2024

Gap Report Frequently Asked Questions

  • FAQs also available in Portable Document Format (PDF)
  1. What is the gap report template?

    The gap report template is a document developed by the Department with the Quality Improvement and Care Coordination Sub–workgroup of the transition workgroup for the carve–in of School–Based Health Center (SBHC) services into Medicaid Managed Care (MMC), to allow exchange of information regarding preventive care and well–child services a student has not received. The gap report is a two–part document with an enrolled student roster portion to be filled out by SBHCs and a portion for gaps in care to be identified by Medicaid Managed Care Plans (MMCPs). This document is intended to facilitate children’s access to primary care services.
  2. Who is required to share gap reports?

    Gap reports are to be exchanged between all SBHCs, including School–Based Health Centers Dental (SBHC–Ds), and MMCPs that have contracts including data sharing agreements in place. Confidential information is not to be shared where an appropriate data sharing agreement is not already in place. Please see Transition of School Based Health Center Benefit and Population into Medicaid Managed Care for additional information about contracting requirements. This guidance can be found at: here.
  3. What information is exchanged in the gap report?

    The gap report includes identifying information for SBHC enrolled students such as: name, address, age, MMCP enrollment, and Medicaid client identification number. Also collected is information about the student’s health care services, including: gaps in care need to be addressed, the name of the Primary Care Physician (PCP), and the date of the last service with the PCP.
  4. How is the gap report filled out?

    The SBHC/SBHC–D initiates the information exchange using gap reports by filling in the information in the first two rows of the template as well as the columns highlighted in yellow. Upon completion, the gap report form will be shared with MMCPs (where data sharing agreement exists). Each MMCP should only receive the information for students enrolled in that plan. Upon receipt, the rest of the form with columns highlighted in green (area of service through last service by PCP) is to be completed by the MMCP. This will be returned to SBHCs/SBHC–Ds to provide the list of service gaps identified for each student, as appropriate.
  5. When are gap reports due?

    Gap reports are to be shared twice per school year. Initial gap reports are to be shared by SBHCs/SBHC–Ds to MMCPs by April 1, 2019. Plans must subsequently reply with the completed gap report by June 1, 2019. Gap reports are to be shared again by SBHCs/SBHC–Ds by October 1, 2019 and returned by MMCPs by December 1, 2019. Future data exchanges in following years will follow this April 1–June 1 and October 1–December 1 timeline.
  6. Is the exchange of gap reports mandatory?

    As noted above, gap reports must be shared between all SBHCs/SBHC–Ds and MMCPs where data sharing agreements exist.
  7. Is use of the Department issued template for gap reports mandatory?

    The use of the Department issued template is highly recommended, but modifications to this template or alternate templates may be used when mutually agreed upon by MMCPs and SBHCs/SBHC–Ds. Any template used must adequately address information exchange requirements MMCPs and SBHCs/SBHC–Ds are subject to revision pending the transition of SBHC/SBHC–D services into the MMCP Benefit Package.
  8. Are there instructions for the gap report template?

    A copy of the gap report template and instructions for use are being posted on the Department website.