School Health and Related Services (SHARS)

Overview

Medicaid services provided by school districts in Texas to Medicaid-eligible students are known as School Health and Related Services (SHARS). The oversight of SHARS is a cooperative effort between the Texas Education Agency (TEA) and Health and Human Services Commission (HHSC). SHARS allow 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).

Related Information

Department of State Health Services (DSHS) School Health Program

HHSC Contractor for SHARS Financial reporting

Medicaid Administrative Claiming (MAC) website

Texas Medicaid Providers Procedure Manual (Children's Services Handbook Section 3)

Texas Education Agency (TEA) website

HHSC SHARS TETN Presentation  (.pdf) (04/04/2018)

HHSC SHARS TETN Presentation  (.pdf) (12/12/2017)

Enrollment and Participation

In order to participate in SHARS as a Medicaid provider, school districts must complete a Texas Medicaid Provider Enrollment Application. 

Steps to becoming a SHARS Medicaid Provider

MAC & SHARS Participation Report (.pdf) (updated 09/21/18)

Frequently Asked Questions:

SHARS FAQ's (.pdf) (updated 07/24/17)

Guides / Manuals:

Cost Report Instructions (.pdf)

Cost Report Example (.pdf)

Appendix A (.pdf)

Methodology / Rules:

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.

The fee schedules and any periodic adjustment(s) to the fee schedules are published in banner messages contained in provider Remittance and Status (R&S) reports, Medicaid Bulletin articles, web postings, provider manual, fee schedules or other provider notification.

Notices:

View a list of important notices regarding School Health and Related Services.

Payment Rate Information:

2019 Payment Rate - effective October 1, 2018

INTERIM RATES - (Effective October 1, 2018)

School districts providing School Health and Related Services (SHARS) to Medicaid-eligible students are paid interim rates. The link below provides the federal fiscal year 2019 interim rates effective October 1, 2018. As services are delivered, SHARS districts are required to submit a claim and bill for these services as active providers in the SHARS program. Failure to bill for services in accordance with the Texas Medicaid Providers Procedure Manual will impact your school district's Medicaid funding. The current rates will remain in effect until adjusted by the Texas Health and Human Services Commission (HHSC).

The SHARS Interim Rates Table, which can be accessed from the link listed below, contains interim payment rates, procedure codes and modifiers for active SHARS participants. HHSC utilized actual 2015 cost report data submitted by districts to establish the interim rates for active participants. To verify your district’s current participation status, please refer to the MAC & SHARS Participation Report, which can also be found at the link listed below. If your district’s status reads “No,” HHSC does not currently recognize your district as an active participant in the SHARS program.

https://rad.hhs.texas.gov/acute-care/school-health-and-related-services-shars

If you have any questions regarding SHARS interim rates, cost report, cost reconciliation and settlement, please email the SHARS Rate Analyst at ra_shars@hhsc.state.tx.us

View the SHARS Interim Rates Table 

2018 Payment Rate - effective October 1, 2017

INTERIM RATES - (Effective October 1, 2017)

School districts providing School Health and Related Services (SHARS) to Medicaid-eligible students are paid interim rates. The link below provides the SHARS interim rates effective October 1, 2017. As services are delivered, the district is required to submit a claim and bill for these services as an active provider in the SHARS program. Failure to bill for services in accordance with the Texas Medicaid Providers Procedure Manual (TMPPM) will impact your school district's Medicaid funding. The rates will remain in effect until adjusted by Texas Health and Human Services Commission (HHSC).

The SHARS Interim Rates Table found below contains the interim payment rates, procedure codes and modifiers for active SHARS participants. HHSC utilized actual 2013 cost report data submitted by districts to establish the interim rates for active participants only. To verify your district’s current participation status, please refer to the MAC & SHARS Participation Report found at School Health and Related Services (SHARS).  If your district’s status reads “No,” HHSC does not currently recognize your district as an active participant in the SHARS program.

If you are interested in enrolling as a Medicaid SHARS provider or re-activating your SHARS Medicaid provider number, please contact your TMHP Provider Relations Representative at the number on the Contacts List or email Oversight_SHARS@hhsc.state.tx.us.

If you have any questions regarding SHARS interim rates, cost report, cost reconciliation and settlement, please email the SHARS Rate Analyst at ra_shars@hhsc.state.tx.us

View the SHARS Interim Rates Table - (updated 10/24/17)

2017 Payment Rate - effective October 1, 2016

INTERIM RATES - (Effective October 1, 2016)

School districts providing School Health and Related Services (SHARS) to Medicaid-eligible students are paid interim rates. The link below provides the SHARS interim rates effective October 1, 2016. As services are delivered, the district is required to submit a claim and bill for these services as an active provider in the SHARS program. Failure to bill for services in accordance with the Texas Medicaid Providers Procedure Manual (TMPPM) will impact your school district's Medicaid funding. The rates will remain in effect until adjusted by Texas Health and Human Services Commission (HHSC).

The SHARS Interim Rates Table found below contains the interim payment rates, procedure codes and modifiers for active SHARS participants. HHSC utilized actual 2013 cost report data submitted by districts to establish the interim rates for active participants only. To verify your district’s current participation status, please refer to the MAC & SHARS Participation Report found at School Health and Related Services (SHARS).  If your district’s status reads “No,” HHSC does not currently recognize your district as an active participant in the SHARS program.

If you are interested in enrolling as a Medicaid SHARS provider or re-activating your SHARS Medicaid provider number, please contact your TMHP Provider Relations Representative at the number on the Contacts List or email Oversight_SHARS@hhsc.state.tx.us.

If you have any questions regarding SHARS interim rates, cost report, cost reconciliation and settlement, please email the SHARS Rate Analyst at ra_shars@hhsc.state.tx.us

View the SHARS Interim Rates Table - updated 02/22/2016

2016 Payment Rate - effective October 1, 2015

INTERIM RATES - (Effective October 1, 2014)

School districts providing School Health and Related Services (SHARS) to Medicaid-eligible students are paid interim rates. The link below provides the SHARS interim rates effective October 1, 2015. As services are delivered, the district is required to submit a claim and bill for these services as an active provider in the SHARS program. Failure to bill for services in accordance with the Texas Medicaid Providers Procedure Manual (TMPPM) will impact your school district's Medicaid funding. The rates will remain in effect until adjusted by Texas Health and Human Services Commission (HHSC).

The table contains the interim payment rates, procedure codes and modifiers for active SHARS participants. HHSC utilized actual 2011 cost report data submitted by the districts to establish the interim rates on active participants only. To verify your district’s current participation status, please refer to the MAC & SHARS Participation Report.  If your district’s status reads “No,” HHSC does not currently recognize your district as an active participant in the SHARS program.

If you are interested in enrolling as a Medicaid SHARS provider or re-activating your SHARS Medicaid provider number, please contact your TMHP Provider Relations Representative at the number on the Contacts List or email Oversight_SHARS@hhsc.state.tx.us.

If you have any questions regarding SHARS interim rates, cost report, cost reconciliation and settlement, please email the SHARS Rate Analyst at ra_shars@hhsc.state.tx.us

View the SHARS Interim Rates Table - updated 10/01/2015

2015 Payment Rate - effective October 1, 2014

INTERIM RATES - (Effective October 1, 2014)

School districts providing School Health and Related Services (SHARS) to Medicaid-eligible students are paid district-specific interim rates. The link below provides the district-specific interim rates effective October 1, 2014. As services are delivered, the district is required to submit a claim and bill for these services as an active provider in the SHARS program. Failure to bill for services in accordance with the Texas Medicaid Providers Procedure Manual (TMPPM) will impact your school district's Medicaid funding. The rates will remain in effect until adjusted by Texas Health and Human Services Commission (HHSC).

The table contains the interim payment rates, procedure codes and modifiers for active SHARS participants. HHSC utilized actual 2011 cost report data submitted by the districts to establish the interim rates on active participants only. If you cannot locate your district-specific interim rates on the table, HHSC does not currently recognize your district as an active participant in the SHARS program.

If you are interested in enrolling as a Medicaid SHARS provider or re-activating your SHARS Medicaid provider number, please contact your TMHP Provider Relations Representative at the number on the Contacts List or email Oversight_SHARS@hhsc.state.tx.us.

If you have any questions regarding SHARS interim rates, cost report, cost reconciliation and settlement, please email the SHARS Rate Analyst at ra_shars@hhsc.state.tx.us

View the SHARS Interim Rates Table - updated 04/27/2015

2014 Payment Rate - effective October 1, 2013

INTERIM RATES - (Effective October 1, 2013)

School districts providing School Health and Related Services (SHARS) to Medicaid-eligible students are paid district-specific interim rates. The link below provides the district-specific interim rates effective October 1, 2013. As services are delivered, the district is required to submit a claim and bill for these services as an active provider in the SHARS program. Failure to bill for services in accordance with the Texas Medicaid Providers Procedure Manual (TMPPM) will impact your school district's Medicaid funding. The rates will remain in effect until adjusted by Texas Health and Human Services Commission (HHSC).

The table contains the interim payment rates, procedure codes and modifiers for active SHARS participants. HHSC utilized actual 2009 cost report data submitted by the districts to establish the interim rates on active participants only. If you cannot locate your district-specific interim rates on the table, HHSC does not currently recognize your district as an active participant in the SHARS program.

If you are interested in enrolling as a Medicaid SHARS provider or re-activating your SHARS Medicaid provider number, please contact your TMHP Provider Relations Representative at the number on the Contacts List or email Oversight_SHARS@hhsc.state.tx.us.

If you have any questions regarding SHARS interim rates, cost report, cost reconciliation and settlement, please email the SHARS Rate Analyst at ra_shars@hhsc.state.tx.us

View the SHARS Interim Rates Table - updated 05/09/14

2013 Payment Rate - effective October 1, 2012

INTERIM RATES - (Effective October 1, 2012)

School districts providing School Health and Related Services (SHARS) to Medicaid-eligible students are paid district-specific interim rates. The link below provides the district-specific interim rates effective October 1, 2012. As services are delivered, the district is required to submit a claim and bill for these services as an active provider in the SHARS program. Failure to bill for services in accordance with the Texas Medicaid Providers Procedure Manual (TMPPM) will impact your school district's Medicaid funding. The rates will remain in effect until adjusted by Texas Health and Human Services Commission (HHSC).

The table contains the interim payment rates, procedure codes and modifiers for active SHARS participants. HHSC utilized actual 2009 cost report data submitted by the districts to establish the interim rates on active participants only. If you cannot locate your district-specific interim rates on the table, HHSC does not currently recognize your district as an active participant in the SHARS program.

If you are interested in enrolling as a Medicaid SHARS provider or re-activating your SHARS Medicaid provider number, please contact your TMHP Provider Relations Representative at the number on the Contacts List or email Oversight_SHARS@hhsc.state.tx.us.

If you have any questions regarding SHARS interim rates, cost report, cost reconciliation and settlement, please email the SHARS Rate Analyst at ra_shars@hhsc.state.tx.us

View the SHARS Interim Rates Table - updated 05/02/13

2011 Payment Rate - effective October 1, 2010

INTERIM RATES - (Effective October 1, 2010)

School districts providing School Health and Related Services (SHARS) to Medicaid-eligible students are paid district-specific interim rates. The link below provides the district-specific interim rates effective for dates of service October 1, 2010, and after. The rates will remain in effect until adjusted by Texas Health and Human Services Commission (HHSC).

The table contains the interim payment rates, procedure codes and modifiers for active SHARS participants. HHSC utilized actual 2008 cost report data submitted by the districts to establish the interim rates on active participants only. If you cannot locate your district-specific interim rates on the table, HHSC does not currently recognize your district as an active participant in the SHARS program.

If you are interested in enrolling as a Medicaid SHARS provider or re-activating your SHARS Medicaid provider number, please contact your TMHP Provider Relations Representative at the number on the Contacts List or email Clarice Cefai, Senior Policy Analyst at clarice.cefai@hhsc.state.tx.us.

If you have any questions regarding SHARS interim rates, cost report, cost reconciliation and settlement questions, please email the SHARS Rate Analyst at ra_shars@hhsc.state.tx.us

View the SHARS Interim Rates Table - updated 05/23/2011.

2007 Payment Rate - effective September 1, 2006 - September 30, 2010

INTERIM RATES - effective September 1, 2006 - September 30, 2010

Effective for dates of service September 1, 2006, and after, school districts providing School Health and Related Services (SHARS) to Medicaid-eligible students will be paid district-specific interim rates. The rates will remain in effect through fiscal year 2008. The first annual cost report will cover fiscal year 2007 and this cost data will be used to adjust future interim rates.

The Centers for Medicare & Medicaid Services (CMS) requires that school districts, as public entities, may not be paid in excess of their Medicaid-allowable costs incurred for providing school-based services programs, known in Texas as SHARS. As a result, annual cost reporting, cost reconciliation, and cost settlement processes are being implemented beginning with the 2006-2007 school year (additional information about these processes will be provided at a later date). In an effort to minimize any potential recoupments, the Texas Health and Human Services Commission (HHSC) has assigned district-specific interim rates as close as possible to each school district’s estimated Medicaid-allowable costs for providing each service.

The district-specific interim rates, other than evaluation services, were calculated at approximately 55 percent of the state fiscal year 2006 statewide rates. Evaluation services were calculated at about 75 percent of the state fiscal year 2006 statewide rates because there is more pre/post-time required by the clinician to interpret testing and develop reports. Specialized transportation rates were calculated using Foundation School Program information. All other calculations were based on average payroll costs (i.e., salaries, payroll taxes, and employee benefits) multiplied by each district's unrestricted indirect cost rate. The average payroll costs added to the calculated indirect costs equal the interim rate. The interim rates assume that clinicians are paid 100% from state/local funds. If a district receives partial payment for SHARS services from IDEA and/or Medicaid Administrative Claiming (MAC) federal funds, that district should consider contacting HHSC (see below) so that its interim rates can be reduced so as to avoid the possibility of recoupment due to overpayment. Specialized transportation rates have been included in the web posting. In order to bill for specialized transportation the child requires transportation in a specially adapted vehicle and must be documented in the student’s Individualized Education Program (IEP).

If the district-specific interim rates are lower or higher than a district's Medicaid allowable costs, the resulting underpayment/overpayment will be addressed during the cost reconciliation and settlement processes.

The following table contains the interim payment rates, procedure codes and modifiers for all of the SHARS services for school districts that have participated in SHARS from 9/1/06 through 6/30/07.

If you cannot locate your district-specific interim rates on the table, or if you have any questions regarding the SHARS rates, please contact the HHSC Rate Analyst via e-mail at ra_shars@hhsc.state.tx.us.

View the SHARS Interim Rates Table - updated 09/07/2007

Cost Reporting Information:

SHARS Cost Report Information

Training Information for Cost Reporting:

Training Information for Cost Reporting

Time Study:

Learn more about time study for school districts