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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

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SHARS Benefits for Texas Medicaid Will Change on October 1, 2024

Last updated on 8/16/2024

Effective for dates of service on or after October 1, 2024, School Health and Related Services (SHARS) benefits will change for Texas Medicaid.

Overview of Benefit Changes

Changes to this medical benefit include the following:

Clarification of nurse-delegated tasks
A procedure code update for physician services
Clarification of speech therapy referrals
Updated benefit information for personal care services (PCS) for the following:
- Defined areas of required provider competency, with documentation requirement effective October 1, 2025
- Clarified that PCS may be provided in a group setting, but the time that the provider assists one student must not overlap with the time that the provider works with another student
- Removed group PCS modifier UD
- Clarified definition of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)
- Added descriptions of specific activities included in ADLs and IADLs
- Added requirement to record the total billable minutes per day for each ADL and IADL provided
Revised reimbursement guidelines and requirements to align with Texas Administrative Code (TAC) Title 1 §355.8443

Nursing Services

Nurse-delegated tasks must meet the professional standards of the Texas Board of Nursing and be provided in accordance with 22 TAC §225.4 and 22 TAC §225.10.

Physician Services

The procedure code for physician services will change from procedure code 99499 to procedure code T1023.

Procedure code T1023 will be limited to one service per day.

Speech and Language Services

A speech evaluation that documents the medical necessity for speech therapy may serve as the referral.

Personal Care Services

Personal care services (PCS) are medical support services that are provided to students who require assistance with ADLs and IADLs because of a physical, functional, cognitive, or behavioral limitation related to a student’s disability or chronic health condition.

Personal care services are medically necessary only when the student’s physical, functional, cognitive, or behavioral limitation related to the student’s disability or chronic health condition inhibits the student’s ability to accomplish ADLs or IADLs.

PCS are not educational in nature and may not be reimbursed for activities that teach the student academic or functional skills.

The following group PCS procedure codes will no longer be benefits:

Procedure code T1019 with modifiers U5 and UD
Procedure code T1019 with modifiers U6 and UD

A provider may perform PCS for more than one student per day as long as each student’s care is based on their individualized education program (IEP) and needs. PCS may be provided in a group setting, but the time that the provider assists one student must not overlap with the time that the provider works with another student. PCS must be provided to one student at a time but may be provided to multiple students one after the other.

PCS may be provided at the same time as another SHARS-eligible service if the student is receiving assistance with ADLs and IADLs from a PCS provider while receiving the SHARS-eligible service from another provider. PCS may not be billed for activities that are included in the other SHARS-eligible service that is performed by the same provider.

Only the time spent on authorized PCS tasks for each student is eligible for reimbursement.

Service logs for PCS must include all elements of a SHARS service log and both:

A description of the specific PCS task.
A record of the total billable minutes for each ADL and IADL provided. The total billable minutes for PCS are determined by combining the total billable minutes for each ADL and IADL performed.
Note: The total billable minutes for PCS that are performed by a PCS provider cannot exceed the PCS provider’s total number of hours at the place of service.

PCS Provider Requirements

All PCS providers must:

Be employed by or contracted with the local education agency (LEA).
Meet the requirements of 42 CFR § 440.167.
Have demonstrated the understanding and competence necessary to perform the eligible PCS tasks required by the student, including written documentation procedures.

The understanding and competence needed to provide PCS includes but is not limited to the following two competence areas:

Appropriate techniques for assisting with ADLs and IADLs, including basic body mechanics, mobility, and techniques for transferring students
The needs of students with disabilities, including appropriate techniques for managing adverse behaviors of the student and communicating with students who have communication or sensory impairments

The LEA may use the following methods to determine whether an individual is qualified to provide PCS in the two competence areas:

A review of the individual’s education, related certification, or related training
An evaluation from one or more licensed health care practitioners who have verified the individual’s competence
- For the purposes of SHARS reimbursement, a licensed health care practitioner is an individual who is eligible to provide reimbursable services under a SHARS benefit other than PCS.
- The licensed health care practitioner may additionally consider work experience, evaluations from other licensed health care practitioners, and on-site demonstration.

The LEA may provide training to develop understanding and competence if the individual lacks understanding and competence in an area of PCS.

Training and evaluation on appropriate techniques for assisting with ADLs and IADLs must be provided by a licensed health care practitioner within their scope of practice. Training and evaluation related to the needs of students with disabilities must be provided by an individual with appropriate credentials as determined by the LEA.

Beginning October 1, 2025, documentation of competence for a qualified PCS provider must include a signed and dated statement in the student’s record from a licensed health care practitioner verifying that the individual is qualified to perform PCS tasks in accordance with the required PCS areas of understanding and competence. Supporting documents or information must also be included as applicable.

Activities Eligible for PCS

ADLs are activities that are essential to daily self-care, and IADLs are activities related to living independently in the community. PCS facilitate the completion of ADLs and IADLs through direct or indirect intervention, which includes but is not limited to the following:

Hands-on assistance
Performing tasks for the student
Cueing or redirecting the student to perform a task

PCS are not intended to teach the student how to independently perform the task.

For the purposes of reimbursement, the activities that are eligible for PCS are limited to the following ADLs and IADLs:

ADLs	Description
Bathing	Assisting the student with any or all parts of bathing, including selecting appropriate water temperature and flow speed; turning water on and off; laying out and putting away supplies; transferring in and out of the bathtub or shower; washing and drying hair and body; and clean-up after task is completed
Dressing	Assisting the student with any or all parts of getting dressed, including putting on, fastening, and taking off all items of clothing; donning and removing shoes or prostheses; and choosing and laying out weather-appropriate clothing
Eating	Assisting the student with some or all parts of eating and drinking, including feeding the student; assistance with utensils or special or adaptive eating devices; and clean-up after task is completed.
Locomotion or mobility	Assisting the student with moving between locations, including assisting the student with walking or using a wheelchair, walker, or other mobility equipment
Personal hygiene	Assisting the student with some or all parts of personal hygiene, including routine hair care; oral care; ear care; shaving; applying makeup; managing feminine hygiene; washing and drying face, hands, and perineum; basic nail care; applying deodorant; routine skin care; and clean-up after task is completed
Positioning	Assisting the student with positioning their body while in a chair, bed, or other piece of furniture or equipment, including changing and adjusting positions; moving to or from a sitting position; turning side-to-side; and assisting the student to sit upright
Toileting	Assisting the student with some or all parts of toileting, including using a commode, bedpan, urinal, or toilet chair; transferring on and off; cleansing; changing diapers, pads, and incontinence supplies; adjusting clothing; and clean-up after task is completed
Transferring	Assisting the student with moving from one surface to another with or without a sliding board, including moving from a bed, chair, wheelchair, or vehicle to a new surface; moving to or from a standing or sitting position; and moving the student with lift devices

IADLs	Description
Escort	Assisting the student in making transportation arrangements for medical and other appointments; accompanying the student to a SHARS-eligible service or health care appointment on or off campus to assist with needed ADLs or with carrying equipment (feeding pump, oxygen tank, etc.) or other necessary supplies; accompanying the student between locations to facilitate assistance with needed ADLs or assistance with carrying equipment or other necessary supplies. Escort includes monitoring a student’s behaviors that create an unsafe situation for the student, such as removing a seatbelt, attempting to open the vehicle door while the vehicle is in motion, or elopement. Escort duration includes the entire time that the PCS provider accompanies the student during a SHARS-eligible service or health care service on or off campus.
Meal preparation	Assisting the student in preparing meals and snacks, including cooking; assembling ingredients; cutting, chopping, grinding, or pureeing food; setting out food and utensils; serving food; preparing and pouring a predetermined amount of liquid nutrition; cleaning the feeding tube; cleaning the area after a meal; and washing dishes
Medication assistance	Assisting the student with oral medications that are normally self-administered
Money management	Assisting the student with managing their day-to-day finances, including paying bills and adhering to a budget
Telephone use or other communication	Assisting the student in making or receiving telephone calls, managing and setting up communication devices, and sending and receiving communication for the student

For students who are receiving services in a school-based residential program managed by the LEA, the LEA may be reimbursed for the additional ADLs and IADLs listed in the current Texas Medicaid Provider Procedures Manual (TMPPM), Children’s Services Handbook, subsection 2.12.2, “Services, Benefits, and Limitations,” as appropriate.

If personal care services are provided on the bus, documentation of the type of personal care service that was performed must be included on service logs.

PCS will not include the following additional activities:

Teaching a vocational curriculum
Orientation and mobility services or sign language interpretive services
Any form of assistance that does not facilitate the above-listed ADLs and IADLs. Supervision, monitoring, cueing, and redirection are not independently considered ADLs or IADLs but may be used to facilitate the completion of ADLs and IADLs

Reimbursement

LEAs must submit the following:

At least one interim claim for each direct medical service that an eligible student receives within the cost reporting period
Interim claims for all personal care services that an eligible student receives within the cost reporting period
Interim claims for all eligible specialized transportation trips provided within the cost reporting period

For timed procedure codes, providers must only report billable time when the midpoint of the total duration for the procedure code has passed. All claims for reimbursement of timed procedure codes are based on the actual amount of billable time associated with the SHARS service.

For untimed procedure codes, claims that are submitted for reimbursement must reflect one unit of service for each unit billed. Untimed procedure codes are reimbursed on a per-unit basis and are subject to frequency limitations for each SHARS service category.

Random Moment Time Study

The Centers for Medicare and Medicaid Services (CMS) requires SHARS providers to participate in the random moment time study (RMTS) to be eligible to submit claims and receive reimbursement for SHARS services. There will be four annual RMTS quarters: October through December, January through March, April through June, and July through September.

For more information, call the TMHP Contact Center at 800-925-9126.