The School Health and Related Services (SHARS) program allows Texas local educational agencies (LEAs) and shared service arrangements (SSAs) to request reimbursement for Medicaid health-related services. The Admission, Review, and Dismissal (ARD) committee determines SHARS services. Services must be medically necessary and reasonable to ensure that children with disabilities are able to participate in the educational program.
SHARS reimbursement is available for children who meet all of the following requirements:
- 20 years of age and younger;
- current eligible for Medicaid;
- enrollment in a public school's special education program;
- meet requirements for special education described in the Individuals with Disabilities Education Act (IDEA);
- current Individualized Education Program (IEP) that prescribe the needed services.
Services covered by SHARS include:
- Audiology services
- Nursing services
- Occupational therapy
- Personal care services
- Physical therapy
- Physician services
- Psychological services, including assessments
- Speech therapy
- Specialized transportation as defined by the Texas Health and Human Services Commission (THHSC)
Springtown ISD must priovide notification and obtain targeted parental consent before accessing a students' public benefits or insurance. The district provides written parental notification prior to requesting consent and accesing benefits for the first time and annually thereafter. The district will obtain parental consent before releasiong a child's perdonally identifiable information for billing purposes to a public benefits or insurance program for the first time.
Enrollment in SHARS is optional for districts and parents. Participation does not preclude the district's responsibility to provide a free and appropriate public education to all students with disabilities. Parents/adult students cannot be charged for special education services provided to students with disabilities.
After Medicaid reimburses districts for SHARS services, the state may seek recovery claims from a student's private insurance. School districts have the responsibility to share the TPL policy with all families participating in the SHARS program:
Share the policy with parents/adult students. Ensure that they understand their right to withdraw consent to participate in SHARS.
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.