A Beginner’s Guide to SHARS
How to get Medicaid reimbursements for services you’re probably already providing.
Is your district considering participating in SHARS or are you new to the program and looking to get a basic understanding? If the answer is yes, this article is for you.
Let’s get this out of the way: SHARS is complicated even by Medicaid standards. The good news is that it’s well worth the effort to recoup funds for your school district. In 2020, TASB Special Education Solutions helped schools gain over $206 million in revenue.
What Is SHARS?
First, let’s define SHARS.
Medicaid services provided by Texas school districts to Medicaid-eligible students are known as School Health and Related Services (SHARS). SHARS allows Texas school districts to get Medicaid reimbursement for certain health-related services documented in a student’s Individualized Education Program (IEP).
SHARS is overseen through a cooperative effort between the Texas Education Agency and Texas Health and Human Services Commission (THHSC).
Does Your District Qualify?
Probably. Currently, about 950 out of roughly 1,024 eligible school districts in Texas are enrolled in SHARS. Participation is voluntary, but why not recoup some of the funds for services your district is likely already providing?
What Are the Requirements?
SHARS reimbursement is provided for students who meet all the following criteria:
- Are 20 years old or younger
- Medicaid eligible
- Meet eligibility requirement for special education as described in the Individuals with Disabilities Education Act
- Have IEPs that prescribe the needed services
Students can access services based on a qualifying medical condition. The services must be provided by qualified or licensed personnel who are under contract with or employed by the school district. Services covered by SHARS include:
- Nursing services
- Medical services
- Occupational therapy
- Personal care services
- Physical therapy
- Psychological services
- Special transportation
- Speech therapy
How to Get Started
Step 1: Enroll as a SHARS Provider
Districts must enroll with the Texas Medicaid and Healthcare Partnership (TMHP) online. It can take between three to nine months to be approved. You must complete the enrollment process by September 15 to be eligible to participate in that fiscal year. (The federal fiscal year is October 1 to September 30.) If you follow all the program requirements, you only have to revalidate or re-enroll every five years.
Step 2: Document services
All SHARS services require some form of documentation to be reimbursable. Failure to adequately document can result in audits and ultimately recoupment of paid claims. THHSC provides a list of documents districts must maintain at a minimum for SHARS services and claims. SHARS records must be retained for at minimum seven years.
TASB tip: When in doubt, document! It will save you a lot of headaches later. The most frequently requested documents are parental consent forms, transportation logs, service notes, and session logs.
Step 3: Bill for Services
Districts must bill TMHP for services provided by eligible staff to be able to receive interim reimbursement and submit annual cost reports. You can only report costs for the service categories that you billed TMHP for throughout the year.
Billing for services enables districts to bring in a steady revenue stream throughout the year instead of waiting for the annual reimbursement that can take up to 17 months to get back. Claims must be submitted within 365 days from the date of service or no later than 95 days after the end of the federal fiscal year, whichever comes first.
Step 4: Participate in Random Moment Time Study
Once approved, you’ll be required to participate in three quarterly Random Moment Time Studies (RMTS). The purpose of the RMTS is to determine the amount of time spent providing SHARS services.
RMTS at the district level is overseen by trained staff. Each district must have a minimum of two RMTS staff contacts who attend training annually.
Your RTMS staff must certify a participant list for each of the three time-studied quarters. The list should include all the positions that provided SHARS on a weekly basis and meet the licensure requirements for that service, federally funded positions and vacant positions the district intends to fill that quarter.
Selected participants will be polled by THHSC at random intervals. They will receive an email with three simple questions and have five business days to respond. Participant responses are then coded and combined with statewide responses to determine the time study percentage. Although it’s called Random Moment Time Study, it’s not truly random as participants are notified three days in advance.
TASB tip: Make sure to include all positions providing eligible services! The participant list is very important as it determines your allowable costs. Remember this is a list of positions, not people, so it doesn’t matter if the staff member providing the service changes during the reporting period. Transportation staff are the only ones who don't need to be included.
Step 5: Submit Annual Cost Report
The annual cost report documents the providers’ costs for delivering SHARS and to reconcile the interim payments with actual total of Medicaid allowable costs.
Districts submit their annual cost reports online through THHSC’s web-based reporting system called the State of Texas Automated Information Reporting System (STAIRS). Stay vigilant! Failure to submit a cost report will result in the recoupment of all interim payments.
All cost reports are subject to audits and desk reviews. You can appeal if you disagree with the audit findings.
TASB tip: Assume you will be audited and prepare accordingly:
- Gather data and digitize records.
- Upload supporting documents to STAIRS.
- Consult other districts and your Medicaid vendor about what to expect.
- Make note of important deadlines.
- Answer only what is asked.
There you have it. You’ve now completed SHARS 101 and are ready to take the next step. Below is a list of additional resources. TASB Special Education Solutions can help you recoup the maximum amount of funding for your district.