For reimbursement of SHARS benefits, SHARS providers should adhere to documentation requirements and privacy standards set forth by professional licensure requirements, medical practice standards, the Texas Medicaid Provider Procedures Manual (TMPPM), the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, and any applicable federal and state laws.
Subsection 2.4, “Documentation Requirements,” of the TMPPM SHARS Handbook states, “Documentation of services must occur within 1 week (7 days) of the time the service is rendered.”
SHARS providers must document services provided in the student’s medical record (i.e., service log, session note, or evaluation) within one week, or seven calendar days, from the date the service was rendered, regardless of whether in paper or electronic form.
Per the TMPPM: Session notes are required for therapy. Session notes must include the billable start time, billable stop time, total billable minutes, activity performed during the session, student observation, and the related IEP objective.
Per the TMPPM: Session notes for evaluations are not required; however, documentation must include the billable start time, billable stop time, and total billable minutes with a notation of the activity performed (e.g., audiology evaluation, speech therapy evaluation).
Supplemental documentation, such as completed evaluations, may be added at a later date. Please refer to Subsection 2.4 of the TMPPM SHARS Handbook for additional session note requirements.
A list of service log documentation requirements for all SHARS services, including PCS and Nursing, can be located in Subsection 2.4 of the TMPPM SHARS Handbook. This list of requirements includes student observation and activity performed, among others.
Student observation should be documented anytime an activity is performed, whether it is a new activity or a repeat activity. The purpose of this documentation requirement is to provide support for reimbursement of SHARS services through Texas Medicaid.
Subsection 220.127.116.11 of the TMPPM SHARS Handbook states, “Trip logs must be maintained daily to record one-way specialized transportation trips.” Trip logs must be documented daily, per each one-way trip.
The Texas Health and Human Services Commission (HHSC) cannot provide guidance specific to the documentation and billing platforms and software utilized by districts and vendors. The TMPPM SHARS Handbook does not dictate the exact layout of the forms school districts use to document SHARS services. The TMPPM SHARS Handbook describes what information must be included in the forms, and it is the responsibility of the school district to draft the forms accordingly. Any potential auditing that may occur would likely include a review of the documentation, to include a review of the dated signature, either in electronic or paper form.
Claims Filing and Reimbursement
For SHARS specific claims filing and reimbursement information, please refer to Subsection 2.7 of the current TMPPM SHARS Handbook, “Claims Filing and Reimbursement.”
- Interim claiming or cost reporting does not need to occur within 1 week (7 days) from the date the service was rendered.
- Subsection 2.7.1, “Claims Information,” of the TMPPM SHARS Handbook states, “Claims must be submitted within 365 days from the date of service, or no later than 95 days after the end of the Federal Fiscal Year (i.e., January 3), whichever comes first.”
- Subsection 18.104.22.168, “Cost Reconciliation and Cost Settlement,” of the TMPPM SHARS Handbook states, “Each SHARS provider is required to complete an annual cost report for all SHARS that were delivered during the previous federal fiscal year (October 1 through September 30). The cost report is due on or before April 1 of the year following the reporting period.”
Supervision and Prescriptions/Referrals
Please refer to respective professional licensing boards and professional organizations for questions relating to supervision of interns or assistants as it is expected that providers of SHARS physical therapy (PT), occupational therapy (OT), speech therapy (OT), or audiology services follow their respective licensing board requirements. Professional licensing boards and professional organizations may also provide resources to help SHARS providers with understanding the fundamental components of and process to obtain a medical prescription or referral.
National Provider Identifier (NPI):
Effective November 1, 2021, the HHSC and Texas Medicaid Healthcare Partnership (TMHP) is offering a one-year grace period, for dates of service on or after November 1, 2021, to allow SHARS providers adequate time to come into compliance with the claims submission requirements for the referring or prescribing provider NPI number for SHARS PT, OT, ST, or audiology services.
November 1, 2022 will be the first date of service in which claims will deny for missing the referring or prescribing provider NPI number, for dates of service on or after November 1, 2022.
OT and PT Prescriptions:
Prescriptions for OT and PT services do not need to include a maximum billable amount. However, if the prescription does specify an amount, services in excess of that amount are not billable to the SHARS program.