COVID-19 SHARS and MAC Program FAQs
TASB Special Education Solutions has fielded many calls concerning SHARS and MAC over the last couple of weeks. We’ve done our best to address the various questions that have come up on a case-by-case basis. We have reached out to Texas Education Agency (TEA) and Texas Health and Human Services (HHSC) along the way for clarification as well. For many of these inquiries, we are awaiting additional information.
We will work to keep these FAQs as updated as possible as we get more information in.
Contact shars@tasb.org for questions.
SHARS overall
What dates are billable for teletherapy through SHARS during the COVID-19 pandemic? (Updated)
Do I have flexibility to change my SHARS/MAC program because of recent changes due to COVID-19?
You may have seen guidance from various sources that indicates telehealth is approved, random moment time study has been changed, SHARS cannot be billed, additional flexibility exists, etc. Please read such guidance carefully to determine if it applies to the SHARS or MAC programs in Texas. Guidance is coming for multiple sources that do not include these programs. If you are unsure, please reach out to us at shars@tasb.org. We are here to help you decipher the flood of information you are receiving.
Updated March 25, 2020
Can I continue to bill for SHARS while my school is delivering alternative instruction?
Per guidance issued by HHSC on April 9, 2020 (pdf), districts may seek Medicaid reimbursement for teleservices for six areas during the COVID 19 pandemic. Districts must meet all other SHARS program requirements. Service areas include:
- Audiology services
- Counseling services (Psychologist or Master's level clinician delivered)
- Occupational therapy
- Physician services
- Physical therapy
- Speech therapy
For those who are billing with TASB in SMART, new functionality will be available shortly that allows your provider to mark a session as teleservices and certify with the submission of their session that remote delivery of the service is clinically appropriate per the treating provider's professional judgment in accordance with guidelines from HHSC. In addition, documented sessions may be held at the district level rather than processed for payment until further clarification has been received on the other SHARS services not listed above. We have created a new hide reason called COVID-19 Time Period for this purpose. We continue to submit claims on a daily basis as you process them so be aware that processed claims will be sent to TMHP.
Updated April 22, 2020
We have heard that providing services, supports, or therapy virtually is in violation of FERPA or HIPPA.
Since there is guidance from the federal level that indicates a priority toward delivery of services virtually, may we bill for all areas of SHARS?
Per guidance issued by HHSC on April 9, 2020, (pdf) districts may seek Medicaid reimbursement for teleservices for six areas during the COVID 19 pandemic. Districts must meet all other SHARS program requirements. Service areas at this time include:
- Audiology services
- Counseling services (Psychologist or Master's level clinician delivered)
- Occupational therapy
- Physician services
- Physical therapy
- Speech therapy
No other services are reimbursable through SHARS when delivered virtually. TASB remains in communication with both HHSC and TEA on this subject and will issue updates as they become available.
Updated April 22, 2020
Given that there is national support for teletherapy during the current crisis, may we deliver and bill for physical therapy (APTA), counseling (ACA & ASCA), assessment (APA), psychological services (APA), nursing (NASN), occupational therapy (AOTA), speech services (ASHA), etc..?
Per guidance issued by HHSC on April 9, 2020, (pdf) districts may seek Medicaid reimbursement for teleservices for six areas during the COVID-19 pandemic. Districts must meet all other SHARS program requirements. Service areas include:
- Audiology services
- Counseling services (Psychologist or Master's level clinician delivered)
- Occupational therapy
- Physician services
- Physical therapy
- Speech therapy
No other services are reimbursable through SHARS when delivered virtually. We have sent inquires about other SHARS approved areas and have received no response at this time. TASB remains in communication with both HHSC and TEA on this subject and will issue updates as they become available.
Updated April 22, 2020
As a school district, are we eligible to apply for the Provider Relief Fund? (Updated)
On September 10, 2021, the U.S. Department of Health and Human Services (HHS) announced a fourth phase of the Provider Relief Fund. HHS has allocated $17 billion for this round of funding. As in Phases 2 and 3 of the program, Medicaid providers are considered eligible providers so long as they meet all other requirements. School districts that participate in their state’s school-based Medicaid program are considered Medicaid providers. Therefore, SHARS participating districts in Texas may be eligible for this funding. The application deadline is October 26, 2021.
Additional information on these funds may be found on the HRSA Fact Sheet and FAQs related to the Medicaid and CHIP Distribution.If your district is interested in applying you can download the Medicaid Provider Distribution Instructions and Medicaid Provider Distribution Application Form from hhs.gov/providerrelief. We recommend that you work with your finance department and school lawyers to determine if these funds apply to your district and any potential implications attached to applying and receiving said funds. For additional information, please call the provider support line at 866.569.3522.
Updated October 1, 2021
If we receive a payment from the Provider Relief Fund, how should it be coded in our accounting records?
Per TEA, districts and charters are to use revenue object code 5849, fund code 289, with a local option code to be chosen by the district/charter.
Added August 26, 2020
SHARS service areas
May we bill for teleservice for speech and occupational therapy?
May we provide supervision for our Speech Therapy, Occupational Therapy and Physical Therapy Assistants virtually?
May our Speech Therapy, Occupational Therapy, Physical Therapy, and Audiology Therapy Assistants deliver services virtually and seek reimbursement through SHARS?
May we evaluate or assess students virtually and bill SHARS during this time?
Per guidance issued by HHSC on April 14, 2020, districts may seek Medicaid reimbursement for occupational therapy, physical therapy, and speech therapy evaluations and reevaluations. Evaluation, re-evaluation, and treatment may be delivered via teleservices as determined clinically appropriate by the rendering therapist and in compliance with each discipline’s rules. Evaluation Considerations During COVID-19 were provided by TEA on April 2, 2020. No guidance has been issued at this time regarding this topic in relation to the expanded teleservices services (audiology services, counseling services, and physician services). Further clarification on this matter has been sought. TASB remains in communication with both HHSC and TEA on this subject and will issue updates as they become available.
Updated April 22, 2020
During the COVID-19 pandemic, should Psychologists and LSSPs bill for counseling as a related service under Counseling or Psychological Services?
Per guidance issued by HHSC on April 9, 2020 (pdf), districts may seek Medicaid reimbursement for teleservices under counseling services for Psychologist or Master's level clinicians. We have sought clarification due to the conflict with billing information changes previously and have not received a response at this time. TASB remains in communication with both HHSC and TEA on this subject and will issue updates as they become available.
Updated April 22, 2020
May we bill for personal care services if our staff are providing services virtually?
This question has been posed. No response has been provided at this time.
Updated March 25, 2020
Billing specifics
What is required or typical activity for a billable telehealth session?
Per guidance issued by HHSC on April 9, 2020 (pdf), districts may seek Medicaid reimbursement for teleservices for six areas during the COVID-19 pandemic. Each procedure area has clinicians who have been given guidance from their licensing board on service delivery via teletherapy. It is recommended that you rely on your clinician for what is deemed appropriate for delivery via teletherapy. HHSC has not provided guidance on what types of activity they are seeking for each area thus far. TEA does have general guidance for most service areas on what is best practice in Texas. This may be found on TEA’s website.
Updated May 5, 2020
We are working with a contractor to deliver services virtually. May we bill for services delivered via a contractor?
Service delivery models have not changed related to delivery via direct staff or contracted service providers. According to question B5 in the SHARS FAQ (pdf), it is allowable to use either to bill as long as they are paid by the district (or SSA). You may collect documentation directly from the contractor to support your SHARS billing. It is recommended that you review billing documentation requirements in section B in the SHARS FAQ (pdf) to confirm all documentation points are in place.
For those billing through TASB, districts may set up contractors to document directly in SMART. For direct delivery of service in a virtual platform that collects the required documentation for the district, an import of session details is possible. We are currently working with several such providers. If you are working with a teleservices company for delivery, we are happy to reach out to them on your behalf. Please contact us at shars@tasb.org for additional information.
Updated April 22, 2020
May we bill for services that are provided and include the parent or caregiver to assist?
Per guidance from HHSC on April 14, 2020 (pdf), teleservice therapy “may require participation of a parent or caregiver to assist with the treatment” that is provided directly to the student by the district service provider.
Updated April 22, 2020
May we deliver service via the telephone and seek reimbursement through SHARS? (Updated)
HHSC has communicated in guidance issued on April 9, 2020 (pdf), additional information about teleservices. In its Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook (pdf), Section 3.3.8 on Telehealth Service Delivery Modalities, it is indicated that synchronous audiovisual interaction and asynchronous store and forward technology used with synchronous interaction may be used. Staff and student interaction is necessary for billing. This section does not allow for audio only telephone consultation, text only email messages, or facsimile transmissions.
Updated October 1, 2021
Due to confidentiality issues, must teleservices for counseling be face to face, or can the sessions be conducted by phone as this allows for some level of confidentiality? (Updated)
Consent
Do you need informed consent for each service or one for a student and all services they are receiving?
There is no clear guidance on consent by service or student. It would seem prudent that to have informed consent the parent would need to know what services were being provided and documented. We are recommending that for informed consent it is necessary that parents understand what services their children are receiving. More specifics may be found in the Telecommunication Services Handbook.
Updated May 5, 2020
Must we get a new consent to deliver services virtually?
According to guidance from TEA in COVID-19 FAQ: Special Education in Texas, additional consent for virtual delivery is required for SHARS. Question number 10 indicates that if the district intends to bill Medicaid through the SHARS program for these sessions, consent is required for this delivery model. According to guidance issued by HHSC on April 9, 2020, (pdf) “distant site [teleservices] providers must obtain informed consent to treatment from the patient, patient's parent, or the patient's legal guardian prior to rendering a [teleservices]. Consent may be written or verbal and must be documented in the student’s ... records.”
This could be done in several ways including (a) in the deliberations of the ARD should you have one planned, (b) as a part of the SHARS log/note the district creates and retains or (c) as a consent retained in the district’s student file. We recommend that the district consider one format so that this documentation is easy to produce for future audits. Including this information in the delibrations or the SHARS log/note may be easy to locate in the future. For documentation of verbal authorization, a single sign off form for your staff to complete that indicates student information, the parent or guardian’s information, the service approved for teleservice, the staff member’s verification that verbal authorization was given, and the date would be a strong starting point. For documentation of written authorization, the district may wish to create a form for collection of signatures. However, guidance does not require written authorization. Districts may wish to seek guidance from their legal counsel on this issue.
Note that this consent is not the same as the IDEA Parental Consent or Notification requirement for SHARS services. IDEA Parental Consent and Notification has not changed.
Updated April 22, 2020
May we attain parental consent for SHARS virtually?
TEA has indicated that “Rules for consent and notice have not changed at all. Consent can be sent home. Electronic signature only works if [the school districts] have an acknowledgment form signed by the parent giving permission to use their signature.” If a district chooses to pursue consent at this time, which may not be the case with all districts, they could send the form home, have parents sign and then scan or photograph the form and return electronically. Please be aware that the signature needs to be an actual signature and not a facsimile (i.e. signature font in a word processing program).
Updated March 25, 2020
May we document parental notification of SHARS billing virtually?
Like with parental consent, notification rules have not changed. It is recommended that if you choose to give notice at this time, which may not be the case with all districts, documenting when, how, and who provided the notice is important for verification purposes.
Updated March 25, 2020
Documentation
If the Annual is not due until November, does our staff need to have an amendment change of placement to document that they have received informed consent from the parent for telehealth services?
Per guidance issued by HHSC on April 9, 2020 (pdf), as long as you are delivering services outlined in your IEP then no IEP amendment is needed for SHARS to move to teletherapy. However, the district should review TEA guidelines on IEP amendments (pdf) overall as that would speak to the broader need for an amendment. Documentation of consent need not be in an amendment unless the district chooses to handle it in that manner.
Updated May 5, 2020
If your IEP states you get physical therapy (or any other therapy) one time a month for 30 minutes but you are now doing teletherapy once a month for only 15 minutes, does an ARD need to be held to adjust the minutes to be able to bill?
Per guidance issued by HHSC on April 9, 2020 (pdf), as long as you are delivering services outlined in your IEP then no IEP amendment is needed for SHARS to move to teletherapy. As you are delivering less, you may be responsible for compensatory services, but that is not a SHARS issue. TEA has indicated information on that is forthcoming. However, the district should review TEA guidelines on IEP amendments (pdf) overall as that would speak to the broader need for an amendment.
Updated May 5, 2020
How can school staff document that they are providing services through teleservices for SHARS billing purposes?
When creating SHARS notes or logs, it is recommended that teleservice delivery be clearly indicated. In addition, a statement that such services were clinically appropriate in the providers judgment would be in alignment with standards established thus far.
For those billing with TASB, a new SMART patch will be released shortly that will allow your staff to mark any session as delivered via a teleservice. In addition, when creating the session, providers will verify that “If the service is delivered via [teleservice], I certify that services are clinically appropriate in my professional judgment” in alignment with guidance from HHSC. An additional notice will be sent out to billing districts when this functionality is available.
Per billing guidelines from HHSC, services delivered virtually that are not on the currently approved billing list should not be billed. Information that these services were delivered will be retained. We encourage you to consider carefully before billing any sessions as virtual during this time period (pdf). Documented sessions may be held at the district level rather than processed for payment until further clarification has been received on the other SHARS services not listed above. We have created a new hide reason called COVID-19 Time Period for this purpose. We will reach out individually to districts with sessions processed with a date of service after March 16, 2020, to discuss how to handle those sessions for adequate back-up documentation.
Updated April 22, 2020
Should we change a student's IEP to outline services being delivered during the current crisis?
Per guidance issued on April 9, 2020, HHSC does not require IEPs be amended for remote delivery of SHARS services. However, districts are advised to meet all TEA guidance regarding IEP requirements during this time. Districts may wish to seek guidance from their legal counsel on this issue.
Updated April 22, 2020
We have decided that our staff will continue to document for SHARS. Is there something else we should do in that documentation to support billing SHARS?
For those who are billing with TASB in SMART, districts may continue to document in our system in the same manner they have previously. We are not aware of any rule changes for the SHARS program. Therefore, to bill for SHARS, the medical necessity and specific services delivered must be outlined in the IEP. If you are unsure of what those requirements are, please feel free to reach out to us at shars@tasb.org. We are happy to walk through the SHARS FAQ (pdf) with you to review them. It is unclear if the current educational arrangements meet the definition of delivery in a school-based setting. Inquiries have resulted in no clear guidance from HHSC on this matter at this time. Should you choose to bill services delivered during the current crisis prior to receiving additional guidance on this issue from HHSC, we recommend you clearly indicate in the notes section of your documentation specifics about the delivery of virtual services, such as how they were provided and anything unusual about the session that might support this methodology.
Updated March 25, 2020
Regulatory requirements
How should we address moments when staff have been chosen to respond for the random moment time study (RMTS) requirement?
On April 9, 2020, HHSC’s Random Moment Time Study division provided guidance via email from Fairbanks LLC, the state's RMTS contractor. This guidance indicates that, “Although many Texas schools and facilities buildings are closed, we recognize that most staff continue to work remotely and are still providing educational as well as health-related services. For any staff that are continuing to work (regardless of location), if they have been sampled for a moment, they should respond to the moment with what they were doing within the five-business day response period. For any staff that are not working or have been furloughed, [districts] should still answer their moments with the appropriate 'Not Working'/'Paid or Unpaid Leave' responses.”
Updated April 22, 2020
We have been given approval to virtually sign our FY 2019 Cost Report. However, the document does not have a place for us to execute this online. How do we meet this requirement?
Additional information on acceptable virtual signatures may be found in the Rate Analysis Digital Signature Policy. According to this guidance, “A digital signature will be accepted by HHSC if the signature is derived using software that creates a digital signature logo with a system-generated date and time stamp or includes the logo of the digital software used.” A photocopy of a handwritten signature, an ink stamp or a typed signature without a digital stamp will not be accepted. Additional information on the sample is provided on the Adobe website. Other methods may also be acceptable. We recommend speaking with your technology staff to determine what is available in your district.
Updated April 22, 2020
Our community is under a stay-at-home order. How can we complete the Certification of Funds (COF) requirement during this time as the letter is mailed to our district offices and no one is reporting on site? (Updated)
Per guidance from HHSC on November 20, 2020, requirements for COF requirements have been modified to meet the current pandemic circumstances. Providers who have not already completed their COF, will receive an email with instructions and their letter to complete it electronically. The notary requirement for COF letters is waived through the 2020-2021 school year.
Updated December 3, 2020
I have heard that the federal government has approved a different FMAP for services provided during this time. Does this impact SHARS or MAC?
Per guidance from HHSC on April 20, 2020 (pdf), SHARS will be impacted by these new eFMAP rates. According to the announcement from HHSC, “The Families First Coronavirus Response Act, which became federal law on March 18, 2020, authorized an increase of 6.2 percentage points to the Federal medical assistance percentage (FMAP) determined for each state for each calendar quarter occurring during the emergency period.” SHARS will be impacted in the FY 2020 and “when the cost settlement is issued in March 2022, the payment will be paid using an allocation method to apply the blended FMAP (pdf).” Specifics on how this will be calculated have not been issued. MAC will not be impacted.
Updated April 22, 2020
Our provider enrollment revalidation is due, but we are focused on serving students. What can we do? (Updated)
Per guidance from HHSC on November 25, 2020 (pdf), reenrollments for March through December of 2020, have been extended to December 31, 2020. Districts who bill with TASB Special Education Solutions should expect a contact from us approximately 120 days before your reenrollment date. Reenrollment dates may be found on your account with TMHP. Should you need assistance with your reenrollment, TASB Special Education Solutions staff are here to assist you. Please reach out to us at shars@tasb.org.
Updated December 3, 2020
We are unable to bill during this time due to various limitations. Will HHSC inactivate our TPI resulting in our removal from the SHARS or MAC program?
TMHP applies payment denial codes and/or vendor holds on provider accounts for various reasons. For example, according to the Texas Medicaid Providers Procedure Manual – Volume 1, Section 1.3 Provider Deactivation/Disenrollment (pdf), a payment denial code is applied to a TPI that has had no claim activity for a period of 24 months or more. The codes are typically entered with future effective dates. They are automatically implemented if action is not taken by the effective date. We have sought clarification on this issue and have not received a response at this time. TASB remains in communication with both HHSC and TEA on this subject and will issue updates as they become available. Should your district have received a letter informing you of pending holds on your provider account, please reach out to us at shars@tasb.org. We are happy to help you with this issue.
Updated April 22, 2020
Our community is under a stay-at-home order. How can we complete the required notary requirement for documentation?
Governor Abbott temporarily suspended certain statues to allow for appearance before a notary public via videoconference. Specifics of this requirements may be found on the Office of the Texas Governor website.
Updated April 22, 2020
If you have additional questions, we are here to help. Please reach out to us at shars@tasb.org. We will do our best to assist all Texas school districts.