Information on School Health and Related Services (SHARS)
Texas school districts can get reimbursed for some of the special education services they provide by participating in the School Health and Related Services (SHARS) program. Federal reimbursement for schools is provided through Medicaid for designated services delivered to special education students.
The SHARS program consists of three components:
- Participating in three quarterly Random Moment Time Studies
- Filing interim claims and receiving payments throughout the year
- Completing an annual cost report
Which children qualify for SHARS reimbursement?
The child must:
- Be enrolled in a public school’s special education program
- Be between the ages of 3-20 years
- Have an Admission, Review, and 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
What services qualify for SHARS reimbursement?
Students can access services based on a qualifying medical condition. Services are reimbursed based on meeting specified requirements. Services covered by SHARS include the following:
- Assessments
- Audiology
- Counseling
- Nursing services
- Medical services
- Occupational therapy
- Personal care services
- Physical therapy
- Psychological services
- Special transportation
- Speech therapy
Does billing under SHARS impact a child's Medicaid benefits outside of school?
Receiving SHARS services at school doesn’t compromise a child’s eligibility for Medicaid services outside the school setting. The Medicaid services the child receives at school also do not affect the type or amount of Medicaid services the child receives outside the school. There is no lifetime benefit cap for Medicaid services to children 3–20 years of age.
How much revenue are we eligible to receive from SHARS reimbursements?
The amounts individual schools are eligible for varies. The Health and Human Services Commission (HHSC) and the Texas Education Agency (TEA) are part of the process of establishing how much SHARS reimbursement a school can get. HHSC’s Rate Analysis Department (RAD) establishes the SHARS interim rates. They base the rates on the actual costs reported and certified as correct by the district in the cost report. HHSC gets the total salary information from the cost report data for all allowable SHARS direct services and transportation. TEA is responsible for setting the unrestricted indirect cost rate (UIDCR).
If your school is not yet participating in SHARS or if you would just like a third-party analysis of your program, TASB Special Education Solutions can help. We can work with you to analyze your current students and services to identify the range of revenue your school is eligible for.
How can a school spend funds generated from SHARS?
The Medicaid funding that schools receive for delivering SHARS services to special education students is considered a vendor payment and does not require separate accountability for audit purposes. Because the funding is not considered federal money at the school district level and is not subject to the Single Audit Act under OMB A-133, these dollars may be deposited to the General Revenue Fund.
What documentation is a school required to keep to participate in SHARS?
At a minimum, the following is a suggested checklist of documents related to SHARS direct services that should be collected and maintained for SHARS documentation, this is not an exhaustive list:
- ARD/IEP documents (medical necessity; examples of SHARS services)
- Attendance records
- Assessment/evaluations
- Provider qualifications (current licenses and certifications)
- Written agreements (contract) for contracted service providers
- Required prescriptions or referrals for services
- Supervision logs
- Session notes or service logs
- Transportation documentation (daily trip logs; maintenance logs/records; bus documentation; documentation for cost report)
- Claims Submittal and Payment Histories (R&S Reports and General Ledger)
- Copies of signed/notarized quarterly Certification of Funds (COF) letters and supporting documentation, including quarterly COF Reports
- Non-school SHARS provider affiliation letter and attachments (if applicable)
- Cost Report and supporting documentation
- Parent notification and consent as required by Section 300.154(d) of the reauthorized IDEA 2004.
How long should a school keep SHARS documentation?
SHARS records need to be retained for at least seven years because they are both Medicaid and educational records. The SHARS provider is the school district. It is up to the school district to determine where to store the documents.
Who do I put on my SHARS Participant List (PL)?
The PL should include all providers that deliver direct medical services (SHARS) and Medicaid Administrative Claiming services (MAC only). When creating or updating the PL for SHARS, be sure to only include providers that perform SHARS activities on a regular basis. The list is maintained so a district can participate in the Random Moment Time Study. The study is used to determine the percentage of time a participant spends assisting individuals with direct medical services.
SHARS Direct Medical Categories:
- Registered Nurse (RN)
- Licensed Vocational Nurse (LVN)
- Advanced Practical Nurse (APN)
- Delegated Nursing Services
- Physicians (MDs and Dos)
- Licensed Audiologist
- Licensed Assistant in Audiology
- Licensed Occupational Therapist (OT)
- Certified Occupational Therapy Assistant (COTA)
- Licensed Physical Therapist (PT)
- Certified Physical Therapy Assistant (LPTA)
- Licensed Psychological Associate
- Licensed Psychologist
- Licensed Specialist in School Psychology (LSSP)
- Licensed Psychiatrist
- ASHA – Equivalent Speech Language Pathologist (SLP) with Texas license and master’s degree
- ASHA SLPs with Texas license
- Grandfathered SLP with Texas License and no master’s degree
- TEA or SBEC Certified Speech Therapists
- Licensed Assistant in SLP
- Licensed SLP Intern
- Licensed Professional Counselor (LPC)
- Licensed Marriage and Family Therapist (LMFT)
- Licensed Clinical Social Worker (LCSW)
- Personal Care Providers
All-inclusive list of SHARS providers approved by Center for Medicaid & Medicaid Services (CMS)
MAC only categories:
- Behavioral counselor
- Interpreter/translator/bilingual specialist
- Licensed Bachelor of Social Work (LSW)
- Licensed Master of Social Work (LMSW)
- Physician assistant
- Pregnancy, Education and Parenting Program personnel
- Psychology intern
- Orientation and mobility specialist
- Outreach workers
- Service coordinators/case managers
How can we help your district with SHARS issues?
Special Education Solutions can help your district:
- Determine the benefits of SHARS participation
- Review your current program to determine if it’s in compliance and audit-ready
- Analyze current revenue generated to ensure the maximum amount is being generated
We even offer partnerships with the district for participating in SHARS. For additional information, don’t hesitate to email us at shars.tasb.orgor call 888.630.6606.