SPEECH-LANGUAGE PATHOLOGY EVALUATION DESCRIPTION Evaluation services include the identification of children with speech or language disorders and the diagnosis and appraisal of specific speech and language disorders. Evaluation of speech, language, voice, communication, auditory processing, etc. BILLABLE TIME - Maximum 3 Hours Over Multiple Days, Over a 30-day Time Period Providers must submit documentation of the reasons for the additional time, if more than the recommended maximum time is billed. Document this additional time under the Session Notes section of the eSHARS screen. Individual or Group Setting: Billable as Individual Only Direct SLP evaluation time with student present; must identify the type of activity performed from the following: No. 21 Evaluation of speech fluency (e.g., stuttering, cluttering) No. 22 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) No. 23 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) No. 24 Behavioral and qualitative analysis of voice and resonance Note: Activities No. 22 and 23 will be denied if billed for the same date of service. Indirect time for interpretation and report writing, and time spent in ARD is not a billable SHARS service. Observation time is only billable if it is conjunction with direct testing. Important: Please ensure the Speech evaluation has been signed by the SLP. APPROVED PROVIDER(S) CRITERIA Supervisor Signature Required Approved for SHARS Billing No Please see · ASHA Equivalent (SLP w/TX License & Master’s in Speech) Supervisor · Grandfathered SLP (w/TX License & Master’s in Speech) No · Grandfathered SLP (w/TX License only) · TEA-Certified Speech Therapist Yes Responsibilities on page 48 Yes ARE SESSION NOTES REQUIRED? No. However, the following documentation is required: billable start time, billable stop time, and total billable minutes, with notation as to activity performed (i.e., Speech Evaluation). Note: A referral is required for ST services. The referral must be updated a minimum of one time every three calendar years. Speech and language services must be referred by a physician or other eligible referring provider. A referral for speech therapy services must be signed and dated within three calendar years before the initiation of services. Speech therapists whose evaluations serve as the referral must be enrolled in Medicaid as individual practitioners and must use their individual NPI for claim submission. © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 44
Sample ScrSeaenms pfolreSpSecerceheSnersvifcoesr Speech Therapy Evaluations Speech Therapy Evaluation 1. Select the Visit date 1 2. Indicate if Before the Evaluation the student will be SpEd or not SpEd 2 3. Indicate if After the Evaluation the 3 student will be SpEd or not SpEd 45 67 4. Select the Evaluation Type 5. Select the Visit Start Time 6. Select the Visit End Time 7. Select the Add Visit Icon Continue to add evaluation types if needed 8. Once complete click Save and then Close PLEASE NOTE * For the Documentation Do Not Bill - Only use if directed by administrator * If see IEP is checked; targeted IEP objective must be notated in notes section of the visit screen 45 MEDICAID FINANCE AND CONSULTING SERVICES © 2022-23 Houston Independent School District
SPEECH-LANGUAGE PATHOLOGY THERAPY DESCRIPTION Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); with services delivered under an outpatient speech-language pathology plan of care. BILLABLE TIME - Maximum 1 hour per day Providers must submit documentation of the reasons for the additional time, if more than the recommended maximum time is billed. Document this additional time under the Session Notes section of the eSHARS screen. Individual or Group Setting: Billable as both Individual and Group Setting Direct SLP Therapy time with student present, including assisting the student with learning to use adaptive equipment and assistive technology. Speech therapy services include the provision of speech and language services for the habilitation or prevention of communicative disorders. APPROVED PROVIDER(S) CRITERIA Approved for SHARS Billing Supervisor Signature Required · ASHA Equivalent (SLP w/TX License & Master’s in Speech) · Grandfathered SLP (w/TX License & Master’s in Speech) No · Grandfathered SLP (w/TX License only) · Licensed SLP Intern No · Licensed SLP Assistant · TEA-Certified Speech Therapist Yes Please see Supervisor Responsibilities Yes on page 48 Yes Yes Note: ARD/IEP meeting time is NOT a billable SHARS service. Consultation time spent training teachers/aides to work with a student is billable ONLY if therapist works directly with student during the consultation time. ARE SESSION NOTES REQUIRED? Yes. Session notes should include the following minimum documentation: billable start time, billable stop time, billable total minutes, activity performed during session, student observation, and related IEP objective. © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 46
Sample Screens for Speech Therapy Services Speech Therapy Services 1. Select the Visit date 2. Select the Visit Start Time 3. Select the Visit End Time 12 3 Enter notes if applicable 4 4. Select the Primary Activity 5. Select the Student Observation 6. Select the Target IEP Objective 5 7. Once complete click Save and then Close 6 7 PLEAPSLEENAOSTEEN: OTE * Fo*r tFhoer DthoecuDmoecunmtaetinotnatDioonNDoot BNilol t- BOinllly- Ousnelyifudsireeicfteddirebcytaeddmbinyisatdramtoinristrator * If see IEP is checked; targeted IEP objective must be notated in notes section of the visit screen * If see IEP is checked; targeted IEP objective must be notated in notes section of the visit screen 47 MEDICAID FINANCE AND CONSULTING SERVICES © 2022-23 Houston Independent School District
SUPERVISOR RESPONSIBILITIES: The only positions who can supervise other providers of speech language services are: · ASHA Equivalent (SLP w/TX License & Master’s in · Grandfathered SLP (w/TX License & Master’s in Speech) Speech) The supervision must meet the following provisions: · Supervising Speech-language pathologist provides · The speech pathologist providing the direction must sufficient supervision to ensure appropriate ensure that the personnel carrying out the directives completion of the responsibilities assigned. meet minimum qualifications set forth in the rules of the State Board of Examiners for Speech-Language · The direct involvement of the supervising SLP in Pathology and Audiology relating to Licensed Interns overseeing the services that were provided must be or Assistants in Speech-Language Pathology. documented. The Center for Medicare & Medicaid Services (CMS) interprets “under the direction of SLP,” as the speech-language pathologist who: · Is directly involved with the individual under his or · Has input about the type of care provided her direction · Reviews the student Speech records after the · Accepts professional responsibility for the actions of therapy begins the personnel he or she agrees to direct · Assumes professional responsibility for the services · Sees each student at least once provided Sample Screens for RX/Referral Sample Screens for RX/Referral 1 1. Select Add RX/Referral 2. Fill in NPI #, Doctor Last & First Name 3. Select Service Category 4. Enter Start Date 5. Once complete click Update 5 2 34 Sample Screens for Speech Services Speech Therapy Evaluation © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 48
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SPECIAL TRANSPORTATION SERVICES DESCRIPTION Transportation services are provided on a specially adapted school bus to or from the location where the school-based service is provided. A specially adapted vehicle is one that has been physically modified (e.g., addition of a wheelchair lift, addition of seatbelts or harnesses, addition of child protective seating, or addition of air conditioning). If a school district already provides a modification for all students, then the modification is not considered a special adaptation. For example, if air conditioning is already provided to all students, then air conditioning is not considered a specially adapted modification. Bus monitor or other personnel accompanying children on the bus is not considered an allowable special adaptive enhancement for Medicaid reimbursement under SHARS specialized transportation. The student’s IEP must document the need for transportation to be provided on a specially adapted vehicle. Transportation services in a school setting may be reimbursed when they are provided on a specially adapted vehicle and if the following criteria are met: · Provided to or from a Medicaid-covered service on the day for which the claim is made · A child requires transportation in a specially adapted vehicle to serve the needs of the disabled · A child resides in an area that does not have school bus transportation, such as those in close proximity to a school · The Medicaid services covered by SHARS are included in the student’s IEP · The special transportation service is included in the student’s IEP Specialized transportation services reimbursable under SHARS requires the Medicaid-eligible special education student has the following documented in the IEP: · The student requires a specific physical adaptation or adaptations of a vehicle in order to be transported · The reason the student needs the specialized transportation BILLABLE TIME (INDIVIDUAL OR GROUP SETTING: INDIVIDUAL, ONE WAY TRIP) - Maximum 4 trips per day Reimbursement for covered transportation services is on a student one-way trip basis. If the student receives a billable SHARS service (including personal care services on the bus) and is transported on the school’s specially adapted vehicle, the following one-way trips may be billed: · From student’s residence to school; · From school to student’s residence; · From student’s residence to a provider’s office that is contracted with the district; · From a provider’s office that is contracted with the district to the student’s residence; · From school to a provider’s office that is contracted with the district; · From a provider’s office that is contracted with the district to the school; · From school to another campus to receive a billable SHARS service; or · Back to student’s campus from the campus where the student received the SHARS service. Documentation of each one-way trip provided must be maintained by the school district (e.g., trip log). This service must not be billed by default simply because the student is transported on a specially adapted bus. APPROVED PROVIDER(S) CRITERIA Approved for SHARS Billing Supervisor Signature Required School Bus Driver or Designee No Note: The transportation log must include the student’s name and a second identifier such as a student ID# or date of birth. © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 50
ARE SESSION NOTES REQUIRED? No. However, a transportation log is required showing the start and stop time for each trip. At a minimum, trip logs should also include the following: · Name of the school district · Route name or number · Bus driver’s name · Dates of service and day of the week · If a service is not provided on a school day, Monday-Friday, mark the student as absent · Copy of the school district’s calendar (to be submitted once during the annual desk review) · Student’s full name and Medicaid number · Date signature of the bus driver and bus aide, attendant/monitor (if applicable) · If Personal Care Services are provided on the bus, the following documentation is required: o Indication if a bus aide, attendant, or monitor was needed. School districts may only bill for personal care services on the bus if the service is prescribed in the child’s IEP o Documentation of the type of personal care services (e.g., type of activity and group/individual setting) o Bus aide, attendant, or bus monitor name (if applicable) and initials for each one-way trip SSSaaammmpppllleee SSScccrrreeeeeennnsss fffooorrr SSSpppeeeccciiiaaalll TTTrrraaannnssspppooorrrtttaaatttiiiooonnn SSSeeerrrvvviiiccceeesss SSSpppeeeccciiiaaaSlll TTTarrrmaaannnssspppploooerrrtttaaaStttciiiooornnneSSSeeeenrrrvvvsiiiccceeefsssor Special Transportation Services 1 1. If Applicable, select Create Transportation 2 AIDE Visits 3 2. Select AM, PM, or Mid-day option 3. Select the Month of billing 4. Uncheck days students were absent 5. Once complete click Save and then Close 4 5 51 MEDICAID FINANCE AND CONSULTING SERVICES © 2022-23 Houston Independent School District
SPECIAL TRANSPORTATION ATTENDANT - PERSONAL CARE SERVICES ON BUS DESCRIPTION Personal care services provided by a bus aide, attendant/monitor on a specially adapted vehicle may be reimbursed when the service is prescribed in the student’s IEP. Personal care services are provided to help a child with a disability or chronic condition benefit from special education, which includes special transportation services. These services include a range of human assistance provided to persons with disabilities and chronic conditions which enables them to accomplish tasks that they would normally do for themselves if they did not have a disability. Personal care services on the bus may be in the form of direct intervention (assisting with performing a personal care task) or indirect intervention (cueing or redirecting to perform the task). Refer to the Personal Care Services section of this training and resource guide for a detailed explanation of personal care services. BILLABLE TIME (INDIVIDUAL OR GROUP SETTING: INDIVIDUAL, ONE WAY TRIP) Maximum 4 trips per day Personal care services provided by a bus aide, attendant/monitor on a specially adapted vehicle may be delivered in one of the following settings: · Individual (e.g., one-to-one) or · Group (e.g., more than one student) If Personal Care Services are provided on the bus, the following transportation log documentation is required: · Indication of the need for a bus aide, attendant/monitor. School districts may only bill for personal care services on the bus if the service is prescribed in the child’s IEP · Documentation of the type of personal care services (e.g., type of activity and group/individual setting) · Bus aide, attendant/monitor initials for each one-way trip · Date signature of the bus aide, attendant/monitor Please Note: ARD time is NOT a billable SHARS service. APPROVED PROVIDER(S) CRITERIA Supervisor Signature Required No Approved for SHARS Billing No School Bus Driver or Designee Designated Personal Care Attendant ARE SESSION NOTES REQUIRED? No. However, a transportation log is required for each trip and must have the Transportation Attendant’s signature. © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 52
Sample Screens for Special Transportation – PC on the Bus SSpaemciapl TlreanSspcorretaetinons Afioder SSeprveiccesial Transportation – PC on the Bus 1 1. Select AM, PM, or Mid-day option 2. Select the Month of billing 2 3. Uncheck days students were absent 4. Once complete click Save and then Close 3 4 53 MEDICAID FINANCE AND CONSULTING SERVICES © 2022-23 Houston Independent School District
IMPORTANT REMINDERS and INFORMATION ADDITIONAL SHARS INFORMATION If you would like additional information regarding the SHARS program please refer to the Texas Medicaid Provider Procedures Manual. RANDOM MOMENT TIME STUDY (RMTS) All Providers and Clinicians must receive training and be part of the Random Moment Time Study (RMTS) as required when participating in the SHARS program. BEFORE YOU ENTER SHARS VISITS MAKE SURE THE FOLLOWING CRITERIA ARE MET: · The SHARS service must be stated in the student’s ARD/IEP (such as a Personal Care Supplement form). · The student is under 21 years of age with a disability and is Medicaid eligible. · Parental Consent · Assure the student whom you are billing for was in attendance on the days you are billing for, if student is tardy and will be counted absent, please add this to the Visit Notes section. PARTICIPATION IN THE SHARS PROGRAM does not preclude a child from receiving similar or additional services by parent choice under another Medicaid program or provider in the private sector. DSAFS LICENSURE/CERTIFICATION As a requirement for Medicaid compliance, Providers and/or Clinicians must keep their appropriate licensure and/or certification current to provide direct SHARS services. DO NOT submit visits for any time that your licensure and/or credentials have lapsed or are in a “grace period” status. DSAFS PHYSICIAN’S REFERRAL/PRESCRIPTION Before SHARS billing may occur for Occupational Therapy (OT), Physical Therapy (PT), and Speech Therapy (SP), a Physician’s Referral/Prescription must first be obtained for students who have been identified as Medicaid eligible. However, for Speech Therapy, a Speech-Language Pathology Evaluation may take the place of a physician’s referral if performed or approved by a fully licensed SLP. IMPORTANT: The Speech Evaluation MUST be signed by a licensed SLP. TEXAS MEDICAID CLIENT HOTLINE and WEBSITE Refer Students, Parents, or Guardians to the Medicaid Hotline (800-252-8263), CHIP Call Center (877-543-7669) or website at https://yourtexasbenefits.hhsc.texas.gov for the following: · Medicaid Enrollment and Eligibility Requirements · Texas Health Steps Program: (EPSDT) Early and · Medicaid Application Information and Assistance Periodic Screening, Diagnosis and Treatment · Medicaid Benefits and Services Information · Medicaid Transportation Assistance · Medicaid Client Assistance: Case Information, Change of Address, or other Client Services © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 54
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© 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES BD
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TELECOMUNICATION SERVICES What is the difference between Telemedicine and Telehealth? Telemedicine - refers to “Health care service[s] delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state. If you would like more information regarding telemedicine, please contact TMHP or your MFCS representative. Telehealth - Health service[s], other than physicians services, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state. TELEHEALTH SERVICES Telehealth services delivered to children in school-based settings are a benefit of Texas Medicaid. Schools that participate in the SHARS program may be reimbursed for telehealth OT, ST, and Counseling services delivered to children in school-based settings. A school-based setting is defined in Texas Government Code §531.02171(b) as a school district or an open enrollment charter school. OT, ST, and Counseling services provided by school districts through SHARS can be delivered during school hours. Providers may be reimbursed for telehealth services delivered to children in school-based settings with the following criteria: • Reimbursement for providers is only available when the patient site is a school-based setting. • All medical necessity criteria and prior authorization requirements for in-person services apply when services are delivered to children in school-based settings. All other reimbursement and billing guidelines that are applicable to in-person services will also apply when OT, ST, and Counseling services are delivered as telehealth services. © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 56
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Logging into eSHARS Description Logging into eSHARS is fast and easy. The Login screen provides general information about the eSHARS application on three tabs that covers general information about eSHARS, product features, and contact support information. Action 1. Access eSHARS using your browser. (www.myeshars.com) 2. Review the information on each tab. (if logging in for the first time) 3. Enter your Username. 4. Enter your Password. 5. Click the Log In button. © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 58
Two-Step Authentication As a second layer of security, an email is sent to the user’s email on file (username) once the correct credentials have been entered. The email contains the temporary verification code that expires after 6 minutes. Action 6. Check inbox (Junk and SPAM folders) for email from [email protected] and copy the code. 7. Enter the verification code. 8. Click the Submit button. 9. Once these steps are completed, access to myeSHARS is granted. Please note, the Two-Step Authentication process is required each day to access eSHARS. ! 59 MEDICAID FINANCE AND CONSULTING SERVICES © 2022-23 Houston Independent School District
When You Forget Your Password When you forget your password and cannot log in, you will need to create a new password. You start the process from the Login screen. Action 1. Click the “Forgot Your Password?” link below the Login fields. The “Forgot your password?” screen will prompt you to enter your email address. 2. Enter your email address. 3. Click the Email me button. © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 60
A confirmation message displays, and the system sends you an email. 4. Go to your email inbox and check your Inbox for an email from eSHARS support. 5. Check Juna and SPAM folder. When you open the email, you will see a link for resetting your password. 6. Click the “click here to reset your password.” hyperlink in the email. 61 MEDICAID FINANCE AND CONSULTING SERVICES © 2022-23 Houston Independent School District
The link opens a form in eSHARS where you can create a new password. 7. Enter your email address. 8. Enter the new password. 9. Re-enter the new password to confirm it is correct. 10. Click the dropdowns and complete the 2 security questions. 11. Click the Save button. Note: Passwords must have a minimum length of 7 characters and must contain at least 1 upper case letter, 1 lower case letter, 1 number and 1 non-alphanumeric character. The “Reset password confirmation” message displays. You can back to the eSHARS Login screen by clicking the link in the message. 12. Click the hyperlink in the email or by clicking the “click here to log in” hyperlink. 13. Follow the steps at the beginning of this guide to log in. If you unsuccessful in changing or re-setting your password, contact your eSHARS Administrator or customer support for assistance. Phone: 800-381-6334 © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 62
Completing Signature Authorization Description The Signature Authorization Form (SAF) must be completed before the administrator approves access to myeSHARS. The SAF is required for every eSHARS user, and it is required to be completed every school year. It is also required each time user information changes. 1. Access myeSHARS in your browser. (www.myeshars.com) The Login screen provide general information about the eSHARS application on three tabs. 2. Review the information on each tab. 3. Enter your Username. 4. Enter your Password. 5. Click the Log In button. 63 MEDICAID FINANCE AND CONSULTING SERVICES © 2022-23 Houston Independent School District
The signature authorization screen displays with information about your account. At the bottom of the screen is where you agree that the information on this form is correct. If you disagree you will not have access to the eSHARS system. However, you can still login, reset your password, and access the SAF section of eSHARS. 6. Review your information for accuracy. 7. If you Don’t Agree with the displayed information, select ‘I DON’T Agree’. (See note below graphics at the left.) 8. If you agree with the displayed information, select ‘Agree’ 9. Click the View SA Form button. Note: If you select ‘I DON’T Agree’, a text box displays where you can explain why you do not agree. It could be as simple as a misspelling of the name, but it needs to be corrected. Your response shows up in SA Submittals to be addressed by MFCS staff, and a new SA form is available when the user logs in again. © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 64
A screen displays showing the SAF. Clicking in the Signature field will start the document signing process. 10. Click the Signature field and a pop-up window will provide a field for your electronic signature. 11. Enter your full name in the top field and it will be reproduced in the field below. 12. When you have finished entering your name, click the Apply button. Your signature can be seen in the signature field of the document, and a button displays to sign the document. 13. Click the Click to Sign button. 65 MEDICAID FINANCE AND CONSULTING SERVICES © 2022-23 Houston Independent School District
Use the “download a copy” link to store a copy on your computer. eSHARS stores the PDF in your user profile. (These steps are Optional) 14. Click the “download a copy” link. 15. Navigate to where you want to save the PDF file on your computer. 16. Click Save. The eSHARS Dashboard displays. The next step is to check your email (Junk and SPAM folders). You will receive a email from MFCS: 17. (Optional) Save the document to your computer if you have not already saved it. ! © 2022-23 Houston Independent School District MEDICAID FINANCE AND CONSULTING SERVICES 66
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© 2022-23 Houston Independent School District HOUSTON ISD HOUSTON ISD Certificate of Attendance This certificate verifies that MEDICAID FINANCE AND CONSULTING SERVICES Participated in an SHARS training session for the 20__- 20__ school year. This training session covered SHARS policy and audit criteria as well H OasUaSn TinOdeNpthI SreDview of the eHSOHAURSSTwOebN-baI sSeDd system. Trainer Date 68
COPYRIGHT © 1998 BY THE HOUSTON INDEPENDENT SCHOOL DISTRICT (HISD) ALL RIGHTS RESERVED IT IS AGAINST THE LAW TO COPY THIS MATERIAL © ALL RIGHTS RESERVED. This is unpublished material and contains trade secrets and other confidential information and is subject to a confidentiality and/or license agreement. The unauthorized possession, use, reproduction, distribution, display or disclosure of this material or the information contained herein is prohibited. This material, and the information contained herein, is the property of the Houston Independent School District (HISD). The ideas, procedures, processes, systems, methods of operation, concepts, principles, or discoveries, regardless of form, which are described, explained, illustrated or embodied in the material are trade secrets of the HISD, and are protected from unauthorized possession, use, reproduction or disclosure by means of a confidentiality and/or license agreement and the confidential relationship between HISD and the person(s) or entity to whom lawful possession of this material has been given. Possession of this material constitutes an agreement to be bound by the provisions of this confidentiality notice. This material, as a tangible medium of expression, is also protected from unauthorized use, reproduction, distribution and/ or display by the Copyright Laws of the United States. The unauthorized possession, use, reproduction, distribution, display or disclosure of this material, or the information contained herein is prohibited, and any violation could result in severe legal consequences. This material is copyright protected and no part of this manual and its contents may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and recording, for any purpose without the written permission of the Houston Independent School District (HISD). This document is furnished under a license agreement and may be used or copied in accordance with the terms and conditions of the executed agreement. HOUSTON INDEPENDENT SCHOOL DISTRICT 4400 West 18th Street| Houston, Texas 77092 PHONE: 1-800-381-6334 FAX: 1-866-579-4837 © 2022-23 Houston Independent School District
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