Your informed consent is required for the district to seek Medicaid reimbursement for services provided to your child. You may withdraw you consent at any time, for any reason. There is never a cost to you or your family, and the services your child receives at school will never affect the type or amount of Medicaid services your child may receive outside of school. Also, as a program under EPSDT (Early and Periodic Screening, Diagnosis and Treatment), SHARS is not subject to any type of lifetime limit or “cap” on services.

Billing Medicaid is not a new process. The first SHARS claim was filed by a Texas school district in 1993. Reimbursement money from SHARS provides much needed funding for schools to continue to provide programs and services for students and salaries for staff.

Student Eligibility

SHARS reimbursement is provided to school districts for children who meet all of the following requirements:

· Are 20 years of age and younger;

· Have a disability or chronic medical condition;

· Are eligible for Medicaid;

· Are enrolled in a public school's special education program;

· Meet eligibility requirements for special education described in the Individuals with Disabilities Education Act (IDEA);

· Have Individualized Education Plans (IEPs) that prescribe the needed services.

Determination and Covered Services

The Admission, Review, and Dismissal (ARD) committee determines which SHARS services a student qualifies for. SHARS services are:

· Provided by a public school district

· Free to all qualifying students

· Provided within the school setting

· Must be medically necessary and reasonable to ensure that children with disabilities are able to participate in the educational program.

Services that are covered include:

· Audiology services

· Counseling

· Nursing services

· Occupational therapy

· Personal care services

· Physical therapy

· Physician services

· Psychological services, including assessments

· Speech therapy

· Transportation in a school setting

About Third Party Liability (TPL)

Medicaid is a last resort provider. On October 1, 2017, Medicaid enacted a third-party liability (TPL) policy, using a pay and recover process for SHARS. This means that Medicaid pays the school district for services, then seeks reimbursement from any third party (private) insurance. The state is permitted a three year look back period to seek recovery claims after the effective date of this policy. If the third-party insurance denies a claim for an acceptable reason, no further action is taken. Parents or guardians will not incur out-of-pocket costs as a result of this notice, because Texas Medicaid pays copayments and deductibles associated with private insurance. Lifetime benefits of private insurance could be affected depending on the policy or agreement with the insurance company. Because the Individuals with Disabilities Education Act (IDEA) entitles children to a free and appropriate public education, parents or guardians should consult with the school district if they anticipate a financial impact due to this policy.

Parent Q & A

Is there a cost to me?

NO- There is NEVER a cost to you or your family. IEP/SHARS services are provided to students while they are at school. These are educational services which are provided free to all qualifying students. Your consent for the district to bill Medicaid on behalf of the services provided to your child is all that is needed.

Will School Health and Related Service claims for Medicaid reimbursement impact my family’s Medicaid benefits?

NO- the Medicaid reimbursement to the school district does not affect or interfere with your family’s Medicaid benefits in any way. It does not interfere with any “cap” established by the Medicaid department for your family. All Medicaid services, funds or limits designated for you and/or your family remains the same.

What type of information about my child will be shared?

In order to submit claims for School Health and Related Services (SHARS) reimbursement, the following information may be needed regarding your child:

· first name, last name, middle name

· address

· date of birth

· student ID, Medicaid ID

· disability

· service dates and the type of special education services delivered

Who will see my child's information?

Information about your child’s SHARS Services may be shared with the district’s billing agent, Texas Association of School Business (TASB), Texas Health and Human Services Commission (HHSC) and other Medicaid agency and its affiliates for the purpose of verifying Medicaid eligibility and submitting claims. The SHARS department within the school district is held to the same privacy standards as your doctor's office, insurance company, or any other health provider, as determined by the Health Insurance Portability and Accountability Act (HIPAA) requirements.

What are the reimbursement funds used for?

SHARS reimbursements subsidize the general district fund and support the school district budget. Examples of possible expenditures from this fund include, but are not limited to: academic programs, resources and materials for students, as well as staff salaries.

What if I change my mind?

You have the right to withdraw consent to disclose your child’s personally identifiable information to the Texas Medicaid agency and its affiliates at any time.

Will my consent or refusal affect my child's services?

NO. Regardless of whether you have Medicaid coverage or not (and whether you provide consent for the district to bill Medicaid or not) Victoria ISD will always provide the services established in your child’s IEP.

Victoria Independent School District

Special Programs

Adapted P.E.

Homebound

SHARS Medicaid Program

Regional Program for the Deaf

RISE Academy

Transition