A. GENERAL QUESTIONS


A1. What criteria must a child meet in order for the district to bill Medicaid under the SHARS program?

The child must:

  • Be enrolled in a public school’s special education program;
  • Be 20 years of age or younger;
  • Have an Admission, Review, & Dismissal (ARD)/Individual Education Plan (IEP) documenting the medical necessity for services [Documentation requirements can be found in the current Texas Medicaid Provider Procedures Manual (TMPPM), in the Provider Enrollment and Responsibilities Section and in the SHARS Section];
  • Have a disability or chronic medical condition;
  • Be Medicaid eligible.

A2. Is it required to obtain parental consent in order for the district to bill Medicaid under the SHARS program?

As per the guidelines provided by the Texas Education Agency (TEA), schools should obtain informed parental consent to bill Medicaid for the specific services and the frequency as outlined in the child’s current ARD/IEP.

A3. If a child receives Medicaid billable services at school under the SHARS program, are they also able to receive the same service through Medicaid outside of the regular school hours? 

Yes, the child’s eligibility for Medicaid services outside the school setting is not compromised by receiving SHARS services at school. The services provided at school are so the child may receive a free and appropriate public education. Due to medical necessity, the child may need additional services outside of school. For example, a school may provide and bill for SHARS speech therapy for a student who also receives Medicaid Children’s Services -Comprehensive Care Program (Medicaid Children’s Services CCP) speech therapy outside the school.

A4.  Could billing SHARS cause a child to exceed any “cap” or lifetime maximum on their Medicaid benefits?

There is no lifetime benefit cap for Medicaid services to children 20 years of age or younger. SHARS is a program under the EPSDT (Early and Periodic Screening, Diagnosis and Treatment) program. Under EPSDT, there are no set limitations or cap on Medicaid services to clients 20 years of age or younger, so long as the service is medically necessary. The Medicaid services the child receives at school do not affect the type or amount of Medicaid services the child receives outside the school.

A5. Will the services received under SHARS impact other Medicaid services prescribed by my primary physician?

The Medicaid services the child receives at school do not affect the type or amount of Medicaid services the child receives outside the school.

A6. What revenue code should be used to account for Medicaid reimbursement (SHARS) in the Financial Accountability System?

School districts should use the revenue code: 5931 “School Health and Related Services (SHARS).” (TEA Financial Accountability System Resource Guide, 15.0) – Financial Accounting and Reporting § 1.4.8 Revenue Object Codes). Medicaid reimbursement received by school districts for SHARS services is considered “vendor” payments and do not require separate accountability for audit purposes. These dollars may be deposited to the General Revenue Fund.

TEA Financial Accountability System Resource Guide: http://tea.texas.gov/Finance_and_Grants/Financial_Accountability/Financial__Acco untability_System_Resource_Guide/

A7. Are there any guidelines in place on how the received funding must be spent?

No, the Medicaid funding that schools receive for delivering SHARS services to special education students is not considered federal money at the school district level and is not subject to the Single Audit Act under OMB A-133. A general guideline is that the money should be spent on services or items to better benefit the program.

A8. Can a SHARS provider provide services beyond the IEP requirements?

No, the IEP authorizes the maximum services that can be provided and billed. Under the Individuals with Disabilities Education Act (IDEA), districts are required to follow the IEP requirements. Any services billed to Medicaid in excess of those stated in the IEP could be subject to recoupment.

A9. Can a federally funded position bill for direct medical services as long as all of the SHARS program requirements have been met?

Providers that deliver SHARS services to a Medicaid client are required to bill for services. In order to bill for the provider, the position will need to be reported on the district’s participant list (PL). In some cases, the provider may be fully or partially federally funded. If the district intends to report any costs associated with delivering the SHARS services, including other allowable costs (such as Appendix A items or specialized transportation) the district is required to bill for those services, regardless of the funding received for the position. The original cost must be claimed through Medicaid in order for any subsequent allowable costs to be 4 reimbursable. When the cost report is prepared, the district will need to report the provider’s federally funded amount in order to offset his/her costs from the total Medicaid allowable costs.

If the district intends to report no other costs associated with the original, federally funded provider’s services it is not necessary to bill for the services delivered to Medicaid clients, nor is it required to include the position on the cost report. However, for RMTS requirements, the position may still need to be included on the PL.

A10. How many days from the date of service does a school have to bill for SHARS reimbursement? 

A school district must file all claims within 365 days of the date of service or 95 days after the end Federal Fiscal Year (September 30), whichever comes first. A district cannot bill for services delivered before its SHARS provider enrollment date. For example, for dates of service covering October 1 through September 30, all claims must be submitted no later than 365 days from the date of service or January 3 of the following year, whichever comes first.

A11. Can a provider’s travel time be billed? 

No, travel time for providers may not be billed separately under the SHARS program. This indirect time (i.e., when the client is not present) is built into a school district's SHARS interim rate and is an allowable cost on the SHARS cost report. So, while travel time is not separately billable, it is reimbursed. 

A12. Where can I get information on the new ICD codes as it relates to SHARS?

TMHP maintains a Code Updates webpage with ICD-10 information and resources. The site can be accessed from the link listed below.

http://www.tmhp.com/Pages/CodeUpdates/ICD-10.aspx

For further assistance with ICD-10 codes, please contact the TMHP Contact Center at 1-800-925-9126.

A13. How do I update my district’s direct deposit account for the SHARS program?

To update your district’s direct deposit account for the SHARS program, you will need to complete an Electronic Funds Transfer (EFT) Information form. The form can be accessed from the link provided below. Instructions for completing the form are included in the document.

http://www.tmhp.com/Provider_Forms/EFT%20Authorization.pdf