SHARS: Billing and Training Updates

Texas Education Agency sent this bulletin at 03/15/2019 07:00 AM CDT

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School Health and
Related Services (SHARS)

March 18, 2019

Health and Human Service Commission (HHSC) Billing Policy: Third Party Billing

As shared on previous bulletins, the Texas Medicaid Healthcare Partnership (TMHP) posted a provider notice regarding Third Party Liability (TPL) for SHARS interim claims. As outlined in the bulletin, Texas Medicaid instituted TPL policy requirements using a "pay and recover later" method for SHARS providers on October 1, 2017. Using the pay and recover TPL process for SHARS means that Medicaid pays the school district for services before third party reimbursement is sought (e.g., private insurance held by the parents of a student with a disability).

Expectation for District/ Charter School Providers:

Share the information with parents and adult students. Ensure that parents/adult students understand that they have the right to refuse to participate in SHARS.
Public schools are responsible for ensuring that students with disabilities receive a free and appropriate public education (FAPE). Parents/adult students cannot, therefore, be charged by a public school for special education services provided to students with disabilities. If parents produce a document they believe is an insurance bill,

- verify whether the document is a bill. Some documents may include an Explanation of Benefits (EOB) that may or may not indicate that money is owed; and

- if it is an insurance bill, contact the TMHP Contact Center at 1-800-925-9126.

To assist in the communicate of the policy to families, HHSC has developed "parent friendly language" that may be used in discussion with SHARS families:

Texas Medicaid is a “payer of last resort.” That means that everyone who is legally responsible for paying for your health-care services must pay what they owe before Texas Medicaid will pay. For example, if you have other health insurance, that insurance company must pay its share before Texas Medicaid will pay. Anyone who is legally responsible for paying is called a “third party” and the responsibility to pay is called “third-party liability.”

It can be hard for you to work with all of the third parties who are responsible for paying for your health-care services. To make it easier for you, Texas Medicaid pays your claims and then goes to the third parties for their share of the costs. This way of handling payment is called “pay and recover.”

On October 1, 2017, Texas Medicaid began using the pay-and-recover method for the School Health and Related Services (SHARS) program. This new way of getting payments will have very little impact on you. You will not have to pay anything, because Texas Medicaid pays your insurance co-payments and deductibles. However, your lifetime benefits for your private insurance might be affected. It will depend on your insurance company and policy. You should read your policy and call your insurance company if you have any questions.

The Individuals with Disabilities Education Act (IDEA) entitles children to a free and appropriate public education. If you think this change might cost you money, you should talk with your school district.

Psychological Testing Evaluation Service Code
Frequenctly Asked Questions Clarification
Upcoming Training Opportunities

Additional Information:

TEA Program: SHARS

TEA Financial: SHARS/ MOE

HHSC Rate Analysis: HHSC Rate Analysis - Acute Care

TMHP Website: Tx Medicaid

Contacts:

HHSC - SHARS Help Line
(512) 730-7400
ra_shars@hhsc.state.tx.us

TEA - Angela Foote Financial Compliance Division
(SHARS Program)
(512) 463-6639
angela.foote@tea.texas.gov

TEA - Federal Fiscal Compliance and Reporting Division
(IDEA_B MOE)
(512) 463-9127
compliance@tea.texas.gov

Psychological Testing Evaluation Service Code

Reminder:

Beginning January 1, 2019, 96101 was replaced by the codes below:

96130 - Psychological Testing Evaluation Services: first hour by qualified professional.

96131 - Psychological Testing Evaluation Services: additional hours by qualified professional

Frequenctly Asked Questions Clarification

The following is intended to clarify, not replace the HHSC FAQ (July 2017) document.

If parents or adult students ask for SHARS documentation, does the district have to provide it?

Student-specific records that are required for SHARS become part of the student’s educational record. Under FERPA, a school must provide a parent with an opportunity to inspect and review his or her child's education records within 45 days following its receipt of a request. A school is required to provide a parent with copies of education records, or make other arrangements, if a failure to do so would effectively prevent the parent from obtaining access to the records. A case in point would be a situation in which the parent does not live within commuting distance of the school.

(Texas Medicaid Manual Procedures Manual September 2018,3.4.1)

(U.S. Department of Education (Department). 20 U.S.C. § 1232g; 34 CFR Part 99.)

Is a physician order required prior to billing for occupational and physical therapy evaluations?

HHSC has revised guidance provided in the December 17, 2018 bulletin:

For the purpose of SHARS billing, a physician order is not required prior to an initial occupational and/ or physical therapy evaluation. Please see the Texas Medicaid Provider Procedures Manual Volume 2: Children's Services Handbook, Sections 3.3.5 and 3.3.7, for additional information.