Q: What is School Health and Related Services (SHARS)?
Frequently Asked Questions
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Q: How much paperwork is involved?
ervices (SHARS) is a Medicaid financing program and is a joint effort of the Texas Education Agency (TEA) and the Texas Health & Human Services Commission (HHSC). SHARS allows local school districts, cooperatives, and SSA special education programs to obtain Medicaid reimbursement for certain health-related services provided to children in special education. Using existing state and local special education allocations as the state match, SHARS providers are reimbursed the federal share or approximately 59% of the established billing rate.
School districts/cooperatives receive federal Medicaid money for services provided to children who meet all four of the following requirements. These children must:
- Be Medicaid eligible
- Be under age 21
- Be enrolled in Special Education for one or more disabilities
- Have Individual Educational Plans (IEPs) that prescribe the needed services.
The services include: assessment, audiology, counseling, nursing services, physician services, occupational therapy, physical therapy, psychological services, personal attendant care service, speech therapy, and transportation in a school setting. These services must be provided by qualified professionals under contract with or employed by the school district/cooperative. Furthermore, the school district/cooperatives must be enrolled as Medicaid providers in order to bill Medicaid.
A: Texas State Billing Services unique offerings are based upon 12 years experience in Texas with a sole business focus on SHARS. We have worked closely with school administrators and practitioners to design and refine our forms to ensure the best data collection with the least amount of time spent filling out our forms. We share your commitment to children and ensure that, as much as possible, your providers' time is spent with children and not paperwork. However, as with any program there is required documentation; Medicaid is no exception. Our clients have found that our procedures and forms are easy to use and require the least amount of time possible. Using our procedures, your providers will need to spend roughly 5-10 minutes every two weeks updating service records for our data processing purposes.
As with any Federal program, there are startup efforts that cannot be avoided. However, we have found that once we have your program operational, it becomes fairly transparent to the Special Education Director, and the burden of the administration of the program is minimal. No additional district staff will be necessary, TSBS will process all forms.
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Q: How do we know which children are Medicaid eligible?
A: Part of our job as your billing agency is to identify your Medicaid eligible population. TSBS does this through interface with the Texas Medicaid & Healthcare Partnership (TMHP). TSBS can submit the names of your special education students to TDH monthly in order to establish the "match" of Medicaid eligible students. We triple-check for student eligibility by using not just the data provided by the districts but by using internal systems that submit truncation and alternate spellings of children's names as well as international birth date lookups. Although somewhat laborious, we have been successful at uncovering nearly 100% of the existing population.
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Q: How do we keep abreast of Texas' school-based Medicaid program?
A: A commitment of the TSBS network is the keeping in close contact with Texas Medicaid & Healthcare Partnership (TMHP), Texas Health & Human Services Commission (HHSC), The Centers for Medicare and Medicaid (CMS), and the Texas Education Agency (TEA) on behalf of the districts we serve. Our practice for the past decade has been to establish a working relationship with state offices to ensure clear and dependable dissemination of information to our districts. Part of our contractual responsibility is to act as a liaison between state and federal offices and the local school district. In short, TSBS stays abreast of Medicaid for you. We provide a quarterly newsletter with Medicaid information updates or changing policies and procedures. When immediate dissemination of information is required, the news is passed along to the SPED Director and Staff via phone calls and emails. We will keep you informed.
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Q: Do I have to become a Medicaid "expert"?
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Q: What if we are audited?
No, that is our role! Texas State Billing Services, Inc. has been established with a leadership team of Medicaid Consultants who are in their twelfth year of successfully providing administrative services to school districts in Texas. TSBS provides a strong blend of the two most important experiential levels required for quality school Medicaid administration:
- A solid multi-state exposure to the many applications of federal Medicaid legislation and regulations
- An in-depth record of success and trust whereby school boards and local school administrators have seen legal claims maximized with energies of district personnel minimized.
A: One of the foremost concerns among school districts is the eventuality of an audit. Our successful experience in this arena has proven invaluable to school districts. The personnel of Texas State Billing Services have consistently and successfully (to the point of no exception) prepared for and completed audit evaluations for state and federal auditors on behalf of hundreds of school districts over the past ten years. Our audit experience guides the claims process throughout, and prepares each school district in such a way that no surprises or failures to comply are ever realized. We see audit-proof performance not as an "add-on" service at the end, but rather as a condition of readiness that is achieved throughout the TSBS SHARS process.