Under Governor Abbott’s Executive Order GA-14 dated March 31, 2020, “schools shall remain temporarily closed to in-person classroom attendance and shall not recommence before May 4, 2020.” However, schools may continue to provide instruction using alternative methods of delivery.
If a school that participates in the School and Health Related Services (SHARS) program provides instruction to a Medicaid-eligible student during this time, the school may seek Medicaid reimbursement for SHARS services delivered through telemedicine or telehealth, assuming all other SHARS program requirements are met.
HHSC will allow reimbursement for the following SHARS services to be delivered via telemedicine or telehealth when school districts have moved to virtual learning or any other educational model outside of the traditional school-based location:
- Audiology services
- Counseling services (psychologist or Master's level clinician delivered)
- Occupational therapy
- Physician services
- Physical therapy
- Speech therapy
Telehealth and telemedicine services must be billed using modifier 95.
HHSC does not require the Individualized Education Program (IEP) to be amended for remote delivery of SHARS services. However, districts are advised to follow all Texas Education Agency guidance regarding IEP requirements.
Distant site telemedicine and telehealth providers must obtain informed consent to treatment from the patient, patient's parent, or the patient's legal guardian prior to rendering a telemedicine or telehealth service. Consent may be written or verbal and must be documented in the student’s medical records.
Providers can refer to the Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook for additional information about Texas Medicaid telemedicine and telehealth services.
For more information, call the TMHP Contact Center at 800-925-9126.