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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354MEDICAID HEALTH SERVICES
SUBCHAPTER APURCHASED HEALTH SERVICES
DIVISION 25SCHOOL HEALTH AND RELATED SERVICES
RULE §354.1342Conditions for Participation

To claim for school health and related services (SHARS) provided to Medicaid-enrolled students eligible for services provided under the Individuals with Disabilities Education Act (IDEA), school districts must:

  (1) ensure that services are provided in a manner and environment consistent with:

    (A) the student's physical and mental condition;

    (B) the overall goals and objectives of the student's individual education program (IEP); and

    (C) other services and schedules prescribed in the student's IEP;

  (2) ensure that services are provided by persons licensed, accredited, or certified by the appropriate federal or state agency or recognized professional organization to deliver the specific service(s);

  (3) meet Texas Education Agency (TEA) standards for the delivery of SHARS;

  (4) abide by the rules and regulations of TEA related to service delivery, record-keeping, documentation, client confidentiality, and access to client records by other professionals involved in the implementation of the student's IEP;

  (5) comply with all applicable federal, state, and local laws and regulations regarding the services provided;

  (6) be enrolled and approved for participation in the Texas Medical Assistance Program (Medicaid);

  (7) sign a written provider agreement with the Texas Health and Human Services Commission (the Commission) or its designee agreeing to comply with the terms of the agreement and all requirements of Medicaid, including regulations, rules, handbooks, standards, and guidelines published by the Commission or its designee;

  (8) bill for services reimbursable by Medicaid in the manner and format prescribed by the Commission or its designee, at the time services are delivered, including billing for each cost category for which the district will seek reimbursement through the annual cost report required by paragraph (11) of this section;

  (9) participate in the Commission-administered time study;

  (10) certify each quarter the Total Computable Expenditure (Total Computable Expenditure = amount paid (Federal share) + calculated State/Local share); and

  (11) submit an annual cost report, as described in §355.8443 of this title (relating to Reimbursement Methodology for School Health and Related Services (SHARS)).


Source Note: The provisions of this §354.1342 adopted to be effective April 30, 1991, 16 TexReg 2227; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective October 1, 2011, 36 TexReg 4651; amended to be effective July 14, 2016, 41 TexReg 5038

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