SHARS Benefits to Change for Texas Medicaid October 1, 2022
Effective for dates of service on or after October 1, 2022, School Health and Related Services (SHARS) benefits will change for Texas Medicaid.
Overview of Benefit Changes
Major changes to this medical benefit include the following:
- Clarification relating to parental consent
- Audiology benefits for students under a Section 504 plan
- Updated information for telehealth services, including the addition of telemedicine services
- Clarification for other SHARS services
Clarification Relating to Parental Consent
In accordance with 34 Code of Federal Regulations (CFR) §300.154, 1 Texas Administrative Code (TAC) §354.1342, and the federal Family Educational Rights and Privacy Act (FERPA), local education agencies (LEAs) are required to obtain parental consent prior to disclosing personally identifiable student information maintained in a student’s education record; LEAs are also required to obtain parental consent for Medicaid-enrolled students prior to billing Medicaid for SHARS services prescribed in the Medicaid-enrolled student’s individualized education program or Section 504 Plan.
Audiology Services Provided Under Section 504 Plans
Note: Implementation is pending the Centers for Medicare & Medicaid Services (CMS) approval. The Texas Health and Human Services Commission (HHSC) is requesting an October 1, 2022, effective date. In the event of delayed CMS approval, HHSC will issue an updated notice to SHARS providers with additional information.
As approved by CMS, SHARS may include audiology evaluation and management services provided to eligible students under Section 504 of the Rehabilitation Act of 1973.
Medicaid-enrolled students must meet all eligibility requirements listed in the current Texas Medicaid Provider Procedures Manual (TMPPM), School Health and Related Services (SHARS) Handbook, and have one of the following:
- A written Section 504 plan, documenting disability and medical necessity
- A referral for audiology evaluation and management services
A Section 504 plan is mandated by 29 United States Code (U.S.C.) Section 794, regulated by 34 CFR §104, and developed by the school, in conjunction with the parents or guardians, teachers, and school administration. The plan must include evaluation data along with placement information regarding the type of services the student needs.
Evaluation under a Section 504 plan may be conducted using the same process to evaluate the needs of students under the Individuals with Disabilities Education Act (IDEA). If school districts choose to adopt a separate process for evaluating students under a Section 504 plan, 34 CFR §104.35 must be followed.
Refer to the current TMPPM, School Health and Related Services (SHARS) Handbook, subsection 2.4, “Documentation Requirements,” for additional information about service log documentation requirements for services prescribed in the student’s Section 504 Plan.
The SHARS program will not reimburse providers for services under a Section 504 plan beyond audiology evaluation and management services.
Telehealth and Telemedicine Services
Telemedicine and telehealth services have the meaning assigned by Texas Occupations Code §111.001 and must be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the service.
Schools that participate in the SHARS program may be reimbursed for telehealth or telemedicine physical therapy (PT), occupational therapy (OT), speech therapy (ST), counseling, psychological, or physician services delivered to children in school-based settings or while receiving remote instruction. Remote instruction is defined according to requirements set forth by the Texas Education Agency (TEA) and includes technology-based learning in home or community-based settings.
Services Provided Through Synchronous Audiovisual Technology
PT, OT, ST, Counseling, Psychological, or Physician Services provided by school districts through SHARS, using telehealth or telemedicine, can be delivered during school hours with synchronous audiovisual technologies. Synchronous audiovisual technology is an interactive, two-way audio and video telecommunications platform that meets the privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA).
Services Provided Through Synchronous Audio-Only Technology
Counseling or Psychological Services provided by school districts through SHARS, using telehealth or telemedicine, can also be delivered during school hours via synchronous telephone (audio-only) technologies. Synchronous telephone (audio-only) technology is an interactive, two-way audio telecommunications platform, including the use of telephonic communication that uses only sound and meets the privacy requirements of HIPAA.
Guidelines for Telehealth and Telemedicine Services
Reimbursement for providers is only available when the patient site is a school, home, or community-based setting, and the distant site is a school or office-based setting. A telehealth or telemedicine visit may not be conducted if the provider and student are both physically located at the same school at the time the services are rendered.
Providers must defer to the needs of the client receiving services, allowing the mode of service delivery (synchronous audiovisual, synchronous telephone [audio-only], or in-person) to be accessible. Providers should obtain informed consent for treatment from the client’s parent or legal guardian and the client before rendering a telehealth or telemedicine service. Verbal consent is permissible and should be documented in the client’s medical record.
Refer to the current Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook, for additional information about informed consent for telehealth and telemedicine services.
Services delivered by synchronous audiovisual or synchronous telephone (audio-only) technology may require the participation of a parent or caregiver to assist with the treatment.
All other reimbursement and billing guidelines that are applicable to in-person services will also apply when PT, OT, ST, Counseling, Psychological, or Physician Services are delivered as telehealth or telemedicine services.
Telehealth and telemedicine services must adhere to documentation, privacy, and security requirements as outlined in this article and the current Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook.
Note: During a declaration of a state of disaster, HHSC may issue direction to providers regarding the use of a telemedicine or telehealth service to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described in this article to the extent permitted by Texas law. A declaration of a state of disaster is when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.
Speech and Language Services
The following providers, who must be licensed in the state of Texas, may provide speech and language services:
- Qualified speech-language pathologist (SLP)
- Licensed SLP intern
- Licensed assistant in speech-language pathology acting under the supervision and direction of a licensed SLP
Personal Care Services
Personal care services must be medically necessary and must not be delivered solely for the purpose of education with classes such as Reading, English, Language Arts, Writing, Mathematics, Science, Social Studies, Physical Education, Functional Curriculum, or Electives.
For more information, contact your district’ s ONWARD Account Manager or contact the TMHP Contact Center at 800-925-9126.