TMPPM 2008 > Texas Medicaid Services > School Health and Related Services (SHARS) > Reimbursement and Certification of Funds

42.3 Reimbursement and Certification of Funds

42.3.1 Reimbursement

Effective for dates of service on or after September 1, 2006, SHARS providers are reimbursed on an interim basis for covered services at either the lesser of the provider's billed charges or the provider's district-specific interim rate. SHARS providers receive Medicaid payments equal to the federal share and fund the state matching share through certification of public expenditures. The federal share is the applicable federal Medicaid assistance percentage (FMAP) in accordance with guidelines from CMS.

CMS requires the implementation of annual cost reporting, cost reconciliation, and cost settlement processes for all such Medicaid services delivered by school districts. Recent changes from CMS require that school districts, as public entities, not be paid in excess of their Medicaid-allowable costs and that any overpayments be recouped through the cost reconciliation and cost settlement processes. In an effort to minimize any potential recoupments, HHSC has assigned district-specific interim rates that are as close as possible to each district's estimated Medicaid-allowable costs for providing each service. School districts can access their district-specific interim rates on the HHSC website at www.hhsc.state.tx.us/medicaid/programs/rad/
AcuteCare/Shars/Shars.html and click on the link titled Click Here To Access The Interim Rates Table.

Payments for services delivered by a nonschool SHARS provider are limited to either the lower of the nonschool SHARS provider's billed charges or the district-specific interim rate for the school district in which the student is enrolled and for the specific covered service provided. The school district with whom the nonschool SHARS provider is affiliated is required to pay HHSC the state portion of Medicaid payments made to the nonschool SHARS provider. Invoices for the state portion of Medicaid payments to nonschool SHARS providers are sent to the affiliated SHARS school districts on a quarterly basis.

Refer to: "Reimbursement" for more information about reimbursement and "Federal Financial Participation (FFP) Rate" .