School Health and Related Services

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
  • currently eligible for Medicaid
  • enrolled 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 prescribes the needed services.

Services covered by SHARS include:

  • audiology services
  • counseling
  • nursing services
  • occupational therapy
  • personal care services
  • physical therapy
  • physician services
  • psychological services, including assessments
  • speech therapy
  • specialized transportation as defined by the Health and Human Services Commission (HHSC)

*New SHARS Policy*

Major changes to the School Health and Related Services (SHARS) program will be effective on or after November 1, 2021. A new SHARS handbook will also be created for the Texas Medicaid Provider Procedures Manual.  These changes to medical benefits include:

  • New billable procedure codes for audiology evaluation and management services
  • Clarification for Occupational Therapy (OT), Physical Therapy (PT), Speech Therapy (ST), and Audiology Services
  • New documentation requirements for all SHARS services
  • New documentation requirements for special transportation

The new SHARS Handbook can be found at the HHSC website.

On October 13, 2021, HHSC held a webinar to discuss the new requirements for SHARS documentation. HHSC representatives reminded  the audience that the PowerPoint is not SHARS policy. It was used to help explain the new requirements. HHSC representatives stated that SHARS providers will be expected to: 
"-Refer to the newly created SHARS Handbook of the TMPPM (released and effective on November 1, 2021)
-Use critical thinking to comply with guidelines therein... It is (the LEA's) responsibility to review policy documentation regularly..."
TEA will continue to communicate policy changes as we become aware of it. The agency is available to provide support during this period of transition.

Provider Service Documentation - Individualized Logs

SHARS providers are required to document service through logs.  Guidance for this requirement comes from the Texas Medicaid Provider Procedures Manual (TMPPM). As clarification was requested in the past, the Health and Human Services Commission (HHSC) developed and distributed a Frequently Asked Questions (FAQ) document. The FAQ specifies, “Service log for PCS must include the signature of the individual that provided the PCS. In cases where more than one person provided PCS throughout the day, only one person needs to sign the service log.” TEA audits confirm that districts have implemented this guidance in self-contained classrooms.  One staff member is chosen to document PCS provided by the classroom staff throughout the day.

The FAQ expired on October 31, 2021. HHSC reminds us that the current guidance document is the November 2021 TMPPM SHARS Handbook. In subsection 2.4, it includes new language regarding documentation requirements:

The SHARS provider’s printed name, title, and original handwritten or electronic signature are required components of the service log for all SHARS services, including PCS.

Therefore, there is an expectation that all service providers, including staff in self-contained classrooms, must document their own service.  TEA will enforce this expectation for documents created on or after November 1, 2021, when the FAQ expired.

If providers are not able to meet this requirement, the service should not be billed for SHARS reimbursement. Medicaid has an expectation that once providers are aware of the need to modify local practices, those changes should be made. As always, TEA is available to support LEAs as they make this transition.


COVID-19: General Guidance

The HHSC provides guidance for the implementation of SHARS services during current school closures.

Certification of Funds: Letters to be Emailed to SHARS Providers

SHARS Services Provided Through Telehealth

Medicaid flexibilities (expanded telehealth) have been extended through January 31, 2022.


COVID-19: CARE Act Provider Relief Fund Reporting - UPDATE

The Provider Relief Fund supports healthcare providers in the battle against the COVID-19 pandemic. Through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the federal government has allocated funds to be distributed through the Provider Relief Fund (PRF).

Qualified providers of health care, services, and support may receive Provider Relief Fund payments for healthcare-related expenses or lost revenue due to COVID-19.  These distributions do not need to be repaid to the US government, assuming providers comply with the terms and conditions.

Reporting Requirements and Auditing

All recipients of Provider Relief Fund (PRF) payments are required to comply with the reporting requirements described in the Terms and Conditions and specified in future directions.

Provider Relief Fund reporting requirements (updated June 2021) are being issued in accordance with the Coronavirus Response and Relief Supplemental Appropriations Act of 2021.

Recipients of PRF payments exceeding $10,000 in aggregate must register in the Provider Relief Fund Reporting Portal. At present, there is no deadline for completing registration in the portal. Recipients will later receive a notification about when they should complete the second step of submitting reporting requirements information on the use of funds.

More information can be found on the US. Department of Health and Human Services (HHS) website.


Enrollment in SHARS 

A district must enroll as an active Medicaid provider for SHARS to become eligible to submit claims and receive reimbursement for SHARS Medicaid services.  Additional information about becoming a SHARS Medicaid provider is located on the Health and Human Services Commission website.


Parental Notice and Consent   

LEAs and SSAs are required to provide notification and obtain targeted parental consent before accessing a child’s or parent’s public benefits or insurance.

Written Notification 

LEAs and SSAs must provide written parental notification prior to requesting consent and accessing benefits for the first time and annually thereafter.  Minimally, it must include all of the following: 

1. A statement of the parental consent to access public benefits (34 CFR 300.154(d)(2)(iv)(A)-(B)) that

  •  specifies the personally identifiable information that may be disclosed (e.g., records or information about the services),
  •  describes the purpose of the disclosure (e.g., billing for specific IEP services), and
  •  identifies the agency to which the disclosure may be made (e.g., Medicaid).

2. A statement of the "no cost" provisions that states that states voluntary participation will not decrease lifetime benefit or incur out-of-pocket expense (34 CFR 300.154(d)(2)(I)-(iii)).

3. A statement that the parents have the right to withdraw their consent at any time (34 CFR 300.154 (d)(2)(v)(C)).

4. A statement that the withdrawal of consent or refusal to provide consent does not relieve the public agency of its responsibility to ensure that all required services are provided at no cost to the parents (34 CFR 300.154(d)(2)(v)(D)).

      The notification must be written in language understandable to the general public and in the native language of the parent or other mode of communication used by the parent, unless it is clearly not feasible to do so (34 CFR 300.154(d)(2)(v)(D) and 300.503(c)).

        One-Time Written Consent

        LEAs and SAAs  must obtain parental consent before releasing a child's personally identifiable information for billing purposes to a public benefits or insurance program for the first time.  Minimally, it must include the following:

        1. A statement of the parental consent to access public benefits (34 CFR 300.154(d)(2)(iv)(A)-(B)) that

        • specifies the personally identifiable information that may be disclosed (e.g., records or information about the services),
        • describes the purpose of the disclosure (e.g., billing for specific IEP services), and
        • identifies the agency to which the disclosure may be made (e.g., Medicaid).

          2. A statement indicating that the parent understands and agrees that the public agency may access the child’s or parent’s public benefits or insurance to pay for specific services identified in the child's IEP.

            Guidance Regarding Parental Consent for the Use of Public Benefits or Insurance


            Annual Cost Report Requirements

            Participating agencies are required to submit an annual cost report documenting the provider's Medicaid-allowable costs for all SHARS delivered during the federal fiscal year. This is used to reconcile interim payments to total Medicaid-allowable costs based on approved cost allocation methodology procedures. 

            TEA does not dictate this process. HHSC determines these procedures and has clarified the use of parental consent it relates to the cost report . Questions regarding this process can be directed to


            Texas Medicaid Policy: Third Party Liability (TPL) for SHARS Interim Billing

            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. 

            On October 1, 2017, a new policy was instituted.  After Medicaid reimburses districts for SHARS services, the state may seek recovery claims from a student's private insurance.  The HHSC began a lookback period on SHARS third party liability (TPL) claims on October 1, 2020.

            School districts have the responsibility to share the TPL policy with all families participating in the SHARS program. The following steps should be taken:

            • Share the policy with parents/adult students. Ensure that they understand their right to withdraw consent to participate in SHARS.

            • If parents produces 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. If it is an insurance bill, contact the Texas Medicaid Healthcare Partnership (TMHP) Contact Center at 1-800-925-9126.

            Information regarding TPL can be found on the TMHP website: Third Party Liability for SHARS Interim Claims.



            Implementation Guidance

            Oversight of SHARS is a cooperative effort between TEA and the HHSC. TEA monitor activities intended to ensure adherence to Medicaid standards and ensure the implementation of quality student services.

            TEA support includes:

            • monitoring compliance with documentation guidelines,
            • performing regular desk reviews and field audits,
            • providing policy clarifications to districts,
            • validating data submitted for SHARS billing,
            • working to minimize exposure to provider waste, program abuse, and fraud.

            The SHARS Self-Monitoring Tool is an instrument that can be used to assess a LEA's compliance with SHARS standards.  It is relevant to SHARS policy prior to November 2021.

            The SHARS Self-Monitoring Tool- Nov. 2021 is an updated instrument that can be used to assess compliance with the revised SHARS policy.


            Additional Resources and Training

            Texas Medicaid  Provider Procedures Manual-

            Personal Care Services: What It Is and What It Is NOT

            Payment Rates - Interim Billing

            SHARS Update: Electronic Bulletin Registration

            Office of Inspector General (US Department of Health and Human Services): Centers for Medicare and Medicaid Services (CMS)