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SHARS/Medicaid Reimbursement

The School Health and Related Services (SHARS) program allows Texas local educational agencies (LEAs) and shared service arrangements (SSAs) to request reimbursement for Medicaid 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.

SHARS reimbursement is available for children who meet all of the following requirements:

      • 20 years of age and younger;
      • current eligible for Medicaid;
      • enrollment in a public school's special education program;
      • meet requirements for special education described in the Individuals with Disabilities Education Act (IDEA);
      • current Individualized Education Program (IEP) that prescribe the needed services.

 

Services covered by SHARS include:

      • Audiology services
      • Counseling
      • Nursing services
      • Occupational therapy
      • Personal care services
      • Physical therapy
      • Physician services
      • Psychological services, including assessments
      • Speech therapy
      • Specialized transportation as defined by the Texas Health and Human Services Commission (THHSC)
 

Parental Notice and Consent   

School are required to provide notification and obtain targeted parental consent before accessing a child’s or parent’s public benefits or insurance.
 

Written Notification 

School must provide written parental notification prior to requesting consent and accessing benefits for the first time and annually thereafter.  Minimally, it must include: 

1. A statement of the parental consent to access public benefits {34 CFR 300.154(d)(2)(iv)(A)-(B)]:

          • specify the personally identifiable information that may be disclosed (e.g., records or information about the services),
          • describe the purpose of the disclosure (e.g., billing for specific IEP services),
          • identify the agency to which the disclosure may be made (e.g., Medicaid).

2. A statement of the "no cost" provisions: voluntary participation will not decrease lifetime benefit or incur out-of-pocket expense [34 CFR 300.154(d)(2)(I)-(iii)];

3. A statement that the parents have the right to withdraw their consent at any time (34 CFR part 99 and part 300); and

4. A statement that the withdrawal of consent or refusal to provide consent does not relieve the public agency of its responsibility to ensure that all required services are provided at no cost to the parents [34 CFR 300.154(d)(2)(v)].

 

The notification must be written in language understandable to the general public and in the native language of the parent or other mode of communication used by the parent, unless it is clearly not feasible to do so [34 CFR 300.503(c)].

 

One-Time Written Consent

Schools must obtain parental consent before releasing a child's personally identifiable information for billing purposes to a public benefits or insurance program for the first time.  Minimally, it must include:

1. A statement of the parental consent to access public benefits [34 CFR 300.154(d)(2)(iv)(A)-(B)]:

          • specify the personally identifiable information that may be disclosed (e.g., records or information about the services),
          • describe the purpose of the disclosure (e.g., billing for specific IEP services),
          • identify the agency to which the disclosure may be made (e.g., Medicaid).

2. A statement indicating that the parent understands and agrees that the public agency may access the child’s or parent’s public benefits or insurance to pay for specific services identified in the child's IEP.

Guidance Regarding Parental Consent for the Use of Public Benefits or Insurance

 

Texas Medicaid Policy- Third Party Liability (TPL) for SHARS Interim Billing

Enrollment in SHARS is optional for districts and parents.  Participation does not preclude the district's responsibility to provide a free and appropriate public education to all students with disabilities.   Parents/adult students cannot be charged for special education services provided to students with disabilities. 

 

Beginning on October 1, 2017, a new policy was instituted.  After Medicaid reimburses districts for SHARS services, the state may seek recovery claims from a student's private insurance.  The THHSC has decided to begin a lookback period on SHARS TPL claims on October 1, 2020.

School districts have the responsibility to share the TPL policy with all families participating in the SHARS program:

  1. Share the policy with parents/adult students. Ensure that they understand their right to withdraw consent to participate in SHARS.

  2. If parents produce a document they believe is an insurance bill:

    • verify whether the document is a bill;  Some documents may include an Explanation of Benefits (EOB) that may or may not indicate that money is owed; and

    • if it is an insurance bill, contact the TMHP Contact Center at 1-800-925-9126

 
Additional Resources:
 
 

 

RMTS Time Study Training Presentation - https://rad.hhs.texas.gov/sites/rad/files/documents/time-study/2021/2021-rmts-isd-tsparticipants.pdf 

 

Appendix A: Reimbursable Items https://rad.hhs.texas.gov/sites/rad/files/documents/acute-care/shars-cr-ins-appa.pdf