school health and related services (shars)

School Health and Related Services (SHARS)

January 2012TEA | Division of Federal and State Education Policy

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TABLE OF CONTENTSIntroduction…………………………Slides 3- 5Overview….………………………….Slides 6-10Steps to Becoming a Provider…Slides 11-17Audit Review Documentation…Slides 18-27Documentation Reminders…….Slides 28-32Common Findings…………………Slides 33-34Related Information………………Slide 35-38Contact Information………………Slide 39


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INTRODUCTION


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The Texas Education Agency (TEA) and Health and Human Services Commission (HHSC) jointly developed the School Health and Related Services (SHARS) program to enable school districts in Texas to obtain federal Medicaid reimbursement for certain health-related services provided to Medicaid-eligible children with disabilities enrolled in special education.


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TEA is committed to ensuring school districts are adequately documenting health-related services provided to students who have IEPs that prescribe the needed services.

The purpose of this review is to provide information to assist school districts with SHARS compliance.

January 2012TEA | Division of Federal and State Education Policy 5

OVERVIEW


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The oversight of SHARS is a cooperative effort between the Texas Education Agency and Health and Human Services Commission. SHARS allows local school districts, including public charter schools, to obtain Medicaid reimbursement for certain health-related services documented in a student's Individualized Education Program (IEP).


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School districts receive federal Medicaid money for SHARS services provided to students who meet all three of the following requirements. These students must:


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•be Medicaid eligible,

•meet eligibility requirements for Special Education described in the Individuals with Disabilities Education Act (IDEA), and

•have Individual Educational Programs (IEPs) that prescribe the needed services.

Audiology and Hearing, including evaluations and therapy sessions;

Physician Services;Occupational Therapy, including evaluations and therapy sessions;

Physical Therapy, including evaluations and therapy sessions;

Psychological Services, including assessments and therapy sessions;

Speech and Language Services, including evaluations and therapy sessions;

Nursing Services, including routine medication administration services;

Counseling Services;Personal Care Services; andSpecialized Transportation.


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Current allowable SHARS services include:


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These services must be provided by qualified professionals under contract with or employed by the school district. Furthermore, the school district must be enrolled as a Medicaid provider and must meet all program and eligibility requirements in order to receive and retain reimbursement from Medicaid.

STEPS TO BECOMING A SHARS PROVIDER


Enrollment Random Moment Time Study (RMTS) Rates Billing Cost Report


Five Steps to Becoming a SHARS Provider

The district must enroll as an active Medicaid provider for SHARS. To enroll as a Medicaid provider, please complete the Texas Medicaid fee-for-service provider enrollment form on the Texas Medicaid and Healthcare Partnership (TMHP) website at: http://www.tmhp.com/Pages/ProviderEnrollment/PE_TX_Medicaid_New.aspx

EnrollmentJanuary 2012TEA | Division of Federal and State Education Policy 13

Enrollment

In order to participate in SHARS each district mustparticipate in RMTS, which includes attending trainingannually and submitting participant lists quarterly. Existingdistricts must begin participation with the first quarterwhich requires training attendance and participation listsubmission no later than September 15th annually. Non-compliance with RMTS requirements will make an ISDineligible to participate in SHARS for the entire federalfiscal year (October to September). Participation andtraining requirements related to RMTS may be found at:

http://www.hhsc.state.tx.us/rad/time-study/ts-isd.shtml


Random Moment Time Study (RMTS)

School districts providing SHARS are paid on an interim claiming basis using district-specific interim rates. After a district has completed the RMTS requirements and the enrollment process a district must contact the SHARS staff at (512) 491-1361 or [email protected] to have district-specific interim rates established.


Rates

According to Title 1 of the Texas Administrative Code (TAC) §354.1342 a district must bill. After items 1, 2, and 3 above have been completed, the district can begin billing through Texas Medicaid Healthcare Partnership (TMHP) for federal reimbursement. If a district fails to bill during a cost report period the district is not eligible to submit a SHARS Cost Report. Information regarding billing is available in the Texas Medicaid Provider Procedures Manual (TMPPM) located at: http://www.tmhp.com.


Billing

According to the Reimbursement Methodology rules forSHARS Title 1 of the TAC §355.8443 districts must submitan accurate and complete cost report each year in whichthe district actively participates in SHARS. Failure tosubmit a cost report is grounds for recoupment of allinterim federal funds received during the cost reportperiod in which the default occurs.

Additional training requirements and guidance documentsrelated to the SHARS Cost Report may be found at:http://www.hhsc.state.tx.us/rad/acute-care/shars/index.shtml.


Cost Report

AUDIT REVIEW DOCUMENTATION


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Provisions of a Memorandum of Understanding (MOU) between TEA and HHSC requires SHARS programs be monitored periodically. The TEA will conduct reviews to determine SHARS compliance.

Each school district selected for a SHARS program compliance review will receive a letter detailing instructions to facilitate the compliance review process.


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The following documentation may be reviewed during the compliance review process:

• Eligibility/Assessment• IEP• Prescription/Evaluation/Referral information for related services, as appropriate

• Licensure/certification of all providers• Session notes• PCS/Nursing services documentation• Transportation logs• Attendance records• Time study participant list• Cost report support documentation


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Full and Individual Evaluation ARD/IEP documents Attendance records Assessments/evaluations Provider qualifications (current licenses and certifications) Written agreements (contracts) Required prescriptions, evaluations, or referrals Supervision logs Session notes/service logs Personal care services documentation Delegated nursing services documentation Specialized transportation documentation (daily trip/maintenance

logs) Claims Submittal and Payment Histories Cost report documentation (invoices, salary information, time

study documentation, etc.)


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The following is a suggested list to be maintained for SHARS documentation; this is not an inclusive list:

• Type (name) of service

• Time, frequency and duration of service

• Medical condition related to service

• Rationale/ reason for service

• Description/ list of activities to be provided


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For SHARS purposes, the ARD/IEPs/Supplement forms should include the following:

• Speech therapy• Occupational therapy • Physical therapy • Counseling • Psychological • Audiology


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Services requiring session notes are:

• Student’s Medicaid number • Reference to medical necessity; IEP objective• Date of service• Time session begins/ends• Total billable minutes• Number of units• Service provided in a group or individual setting• Notation as to activity performed• Student observation• Signature/initials


Session notes must include:

Original signatures are required on the service logs and session notes which are required documentation for Medicaid services. The service log/session notes can be a printed copy from an “electronic documentation system” that lists the services delivered. This printed copy would need the signature/initials of the provider of the service.

If the documentation is kept on paper and summarized on a separate billing ticket, then a signature would not be needed on the separate billing ticket. But, if the billing ticket also serves the purpose of the service log and/or session notes, then original signatures are required.


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It is the district’s responsibility to maintain proper documentation for audit and review purposes. By maintaining the proper documentation, the district can avoid refunding SHARS Medicaid payments for lack of medical documentation during audits.


In accordance with the MOU, results of the compliance desk reviews and reports will be provided to HHSC for their review. If significant issues or discrepancies are discovered, a more in-depth review may be conducted.


DOCUMENTATION REMINDERS

When asked to provide documentation remember…


Include student’s Medicaid ID # on all documentation

Document all services provided in the ARD.

Related Services must be documented in the student’s IEP. Time, frequency and duration must be addressed.


When asked to provide documentation remember…

Personal Care Services (PCS) documentation must include:o The reason for PCS, such as medical necessityo Goals/objectiveso When/where services are needed; and,o Examples of PCS

Billable start/end time, total billable minutes and the type of PCS must be documented.


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Specialized transportation IEP documentation must include:

• the special adaptation required• the medical necessity• documentation of medical necessity for a SHARS medical service (such as PCS)


Specialized Transportation

Reimbursement for covered transportation services is calculated on a student one-way trip basis, as long as the student receives at least one direct medical service on the same day.

A specially adapted vehicle is one that has been physically modified (e.g. addition of a wheelchair lift, addition of seatbelts, or harnesses, addition of child protective seating, or addition of air conditioning).


COMMON FINDINGS


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Documentation does not support services rendered.

• Documentation does not include billable time.

• Documentation does not include session notes, start and stop times, total minutes, activity performed, student observation, or related IEP objective.

• Amount of time billed does not match amount of time documented.

• Student was absent on the date of service billed.

• Medical records requested were not submitted.

• Documentation does not support costs reported on cost report (IEP ratio, one-way trip ratio, time study, etc.)


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Common Audit Findings

LINKS TO RELATED INFORMATION


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SHARS:http://www.tea.state.tx.us/index2.aspx?id=4456

SHARS Compliance Review Guide SHARS Self Monitoring Tool SHARS Documentation Guidelines SHARS Frequently Asked Questions Subscribe to the SHARS Listserv Legislative Report - Maximizing Federal Reimbursement Billing Guidelines


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Additional detailed SHARS Participation, Training, Rates, Billing, Cost Reporting and other Published Guidance Documentation can be found on the following websites:

HHSC Rate Analysis SHARS website:http://www.hhsc.state.tx.us/rad/acute-care/shars/index.shtml

Fairbanks website: www.fairbanksllc.com

TMHP website: www.tmhp.com

Texas Medicaid Provider Procedures Manual (TMPPM)CHILDREN’S SERVICES HANDBOOK, Vol. 2, Section 3http://www.tmph.com/TMPPM/2011/Vol2 Children’s Services Handbook.pdf


Rules Effective October 1, 2011• The School Health and Related Services program rules are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter A, Division 25, Rules §1341-1342.

• Reimbursement rules applicable to School Health and Related Services are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 23, Rule §8443.


CONTACT INFORMATION If you have general questions, email at [email protected]

If you have questions regarding SHARS cost reporting or district specific interim rates, please call the Rate Analyst at (512) 491-1361 or email at [email protected]

If you have questions regarding SHARS payment/R & S issues, please call the TMHP Contact Center at 1-800-925-9126.


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school health and related services (shars)

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