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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 3. School Health and Related Services (SHARS) : 3.5 Claims Filing and Reimbursement : 3.5.3 Reimbursement

3.5.3
Providers are reimbursed for medical and transportation services provided under the SHARS Program on a cost basis using federally mandated allocation methodologies in accordance with 1 TAC §355.8443.
In order to accommodate participating SHARS districts that require interim cash flow to offset the financial burden of providing for students, an interim fee-for-service claiming system still exists for SHARS. The interim claims are based on district-specific interim rates but are provisional in nature.
The provider’s final reimbursement amount is arrived at by a cost report, cost reconciliation, and cost settlement process. The provider’s total costs for both direct medical and transportation services as reported in the cost report are adjusted using the federally mandated allocation methodologies.
If a provider's interim payments exceed the provider’s federal portion of the total certified Medicaid allowable costs, HHSC will recoup the federal share of the overpayment.
If the provider’s federal portion of the total certified Medicaid allowable costs exceeds the interim Medicaid payments, HHSC will pay the federal share of the difference to the provider in accordance with the final actual certification agreement.
Submittal of a SHARS cost report is mandatory for each provider that requests and receives interim payments. Failure to file a SHARS cost report will result in sanctions, to include recoupment of all interim payments for the cost report period in which the default occurs.
School districts can access district-specific interim rates and published cost report guidance documents, on the HHSC website at www.hhsc.state.tx.us/rad/acute-care/shars/index.shtml.
For additional information SHARS providers can contact a SHARS Rate Analyst via email at ra_shars@hhsc.state.tx.us or by telephone at (512) 491-1361.
Refer to:
Subsection 2.2, “Fee-for-Service Reimbursement Methodology” in Section 2, “Texas Medicaid Fee-for-Service Reimbursement” (Vol. 1, General Information) for more information.
Subsection 2.7, “Federal Medical Assistance Percentage (FMAP)” in Section 2, “Texas Medicaid Fee-for-Service Reimbursement” (Vol. 1, General Information).

Texas Medicaid & Healthcare Partnership
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