TMPPM 2008 > Texas Medicaid Services > School Health and Related Services (SHARS) > School Enrollment

42.2.3 Medicaid Managed Care Enrollment

SHARS providers do not enroll with the Medicaid Managed Care health plans. SHARS providers deliver services to all eligible Medicaid SHARS clients, including clients of the Medicaid Managed Care health plans. SHARS services are not covered by the Medicaid Managed Care health plans. SHARS services that are rendered to clients of Medicaid Managed Care are covered and reimbursed by TMHP. Students who are under 21 years of age and on a Medicaid 1915(c) waiver program are covered and reimbursed by TMHP.

SHARS providers should use program code 200 to bill for Primary Care Case Management (PCCM). SHARS providers should use program code 100 to bill for fee-for-service.

Important: All providers are required to read and comply with Section 1, Provider Enrollment and Responsibilities. In addition to required compliance with all requirements specific to the Texas Medicaid Program, it is a violation of Texas Medicaid Program rules when a provider fails to provide health-care services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371.1617(a)(6)(A). Accordingly, in addition to being subject to sanctions for failure to comply with the requirements that are specific to the Texas Medicaid Program, providers can also be subject to Texas Medicaid Program sanctions for failure, at all times, to deliver health-care items and services to Medicaid clients in full accordance with all applicable licensure and certification requirements including, without limitation, those related to documentation and record maintenance.

Refer to: "Provider Enrollment and Responsibilities" for more information about enrollment procedures.