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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 3. School Health and Related Services (SHARS) : 3.2 Enrollment : 3.2.2 Nonschool SHARS Provider Enrollment

3.2.2
A nonschool SHARS provider must have either a current provider identifier as a Texas Medicaid provider of the IEP service or meet all of the eligibility requirements to obtain a provider identifier as a Texas Medicaid provider of the IEP service. For example, a nonschool SHARS provider of speech therapy must meet all provider criteria to provide Texas Medicaid fee-for-service speech therapy and cannot hold only a state education certificate as a speech therapist.
To be enrolled in Texas Medicaid as a nonschool SHARS provider, the enrollment packet must contain an affiliation letter that:
Contains assurances that the school district will reimburse the state share to HHSC for any Texas Medicaid payments made to the nonschool SHARS provider for the listed student and service
Maintain and submit all records and reports required by the school district to ensure compliance with the IEP and compliance with IEP documentation and billing requirements
A separate affiliation letter is required for each Texas Medicaid client to be served by the nonschool SHARS provider. A nonschool SHARS provider is required to have a separate two-digit suffix for each school district with which it is affiliated. For example, if a nonschool SHARS provider has written agreements with Anywhere Independent School District (ISD) for two students and with Somewhere ISD for one student, then the nonschool SHARS provider would submit its claims for the two students from Anywhere ISD under provider identifier 1234567‑01 and associated National Provider Identifier (NPI) number if submitting a paper claim. The SHARS provider would submit its claims for the one student from Somewhere ISD under provider identifier 1234567‑02 and associated NPI number if submitting a paper claim. The nonschool SHARS provider would submit two affiliation letters from Anywhere ISD to TMHP Provider Enrollment (one for each student served) and one affiliation letter from Somewhere ISD.
Since nonschool SHARS providers are private, nonpublic entities, they should select “private entity” on the enrollment application.
Nonschool SHARS services include audiology services, counseling services, nursing services, OT, PT, ST services, and psychological services delivered in an individual setting. Nonschool SHARS services do not include evaluation/assessment, physician services, personal care services, or transportation.

Texas Medicaid & Healthcare Partnership
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