Medicaid and SHARS Q&A

The School Health and Related Services (SHARS) program allows Texas school districts (LEAs) and/or shared service arrangements (SSAs) to request Medicaid reimbursement for certain health-related services. The Admission, Review, and Dismissal (ARD) committee determines SHARS services. Services must be medically necessary and reasonable to ensure that children with disabilities are able to participate in the educational program...

**School Health And Related Services** (SHARS) is a Medicaid financing program and is a joint effort of the Texas Education Agency (TEA) and the Texas Health & Human Services Commission (HHSC).

School Health and Related Services (SHARS)- Frequently Asked Questions- Updated September 2014!
Texas State Billing Services FAQ

(The following questions and answers are excerpts):
A7. 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.
B1. How long do SHARS providers need to keep their records?
SHARS records need to be retained for at least seven years because they are both Medicaid and educational records.
B3. What records should be maintained?
At a minimum, the following is a suggested checklist...!
B6. What information must be included in session notes? ...
B8. What documentation is required for assessments and related service evaluations?...
B10. Can an electronic signature or signature protected be used to meet the signature requirements for session notes and service logs documents? If so, what are the signature requirements for session notes and service logs documents?

C4. Does the student need to be seen by the medical practitioner (as listed in C1 and C2)?
Whether or not the authorized medical professional sees the student while reviewing records for writing a prescription is left up to the individual’s professional judgment. The medical practitioner is ultimately responsible for the services he/she prescribes; and therefore, the decision for the level of review must be left up to the medical practitioner.
C5. May a district bill Medicaid for therapy provided prior to the date of the signed referral/prescription?
No, the school district cannot bill Medicaid before the referral/prescription for the services is signed. However, the school district is required to deliver the service per the IEP requirements in accordance with IDEA.
C6. How often must a referral/prescription for physical therapy/occupational therapy or speech therapy services be obtained?
A prescription is required after the initial assessment and must be renewed at least every three years. If the prescription or referral has an end date, the prescription must be renewed prior to the end date. For example, some physicians will only write a prescription that is valid for one year. In addition, when there is a change in the plan of care, a new referral/prescription is needed.
C7. What type of change to the IEP would necessitate a new prescription or referral?
Determinations concerning the need for new prescriptions or referrals are decisions made by the student’s ARD committee. In addition, when there is a change in the plan of care, a new referral/prescription is needed. For example, if the duration time for treatment sessions change or the number of sessions per week change, a new prescription/referral is needed.
C8. If the goals/objectives change for an OT/PT student from year to year, but the frequency & duration of service does NOT change, is a "new" prescription required?
No. A new prescription is not required.

**Best Practices for School-Based Therapy Documentation** video discussing documentation and billing differences for school-based therapy

Carlynn Highie, OTR/L and School Therapy Consultant discusses how therapists can minimize risks in due process hearings and Medicaid audits. Presented at WCASS Conference, May 2011

obtaining parental consent requirements relating to accessing public benefits or insurance in 34 CFR §300.154

See "Documentation" Page for Session Note Forms