The Texas Education Agency (TEA) has released the following update regarding the SHARS cost report informal appeal window:
Settlement Provider Notice & Informal Appeals
School Health and Related Services (SHARS) cost report settlement notices were issued to inform local education agencies (LEA) that all Health and Human Service Commission (HHSC) reviews have been completed and are available for viewing. The settlement amounts have been calculated and are being proposed to the district. These were sent to LEAs through the State of Texas Automated Information Reporting System (STAIRS) on December 15, 2023.
LEAs have 30 days from the notification date to “Agree” or “Disagree” with their proposed settlement. An informal review request can be made in accordance with Tex. Admin. Code § 355.8443. HHSC Provider Finance must receive a written request for an informal review by hand delivery, United States (U.S.) mail, or special mail delivery no later than 30 calendar days from the date on the written notification of the adjustments, December 15, 2023. An LEA must, with its request for an informal review, submit a concise statement of the specific actions or determinations it disputes, its recommended resolution, and any supporting documentation the LEA deems relevant to the dispute. It is the responsibility of the LEA to render all pertinent information at the time of its request for an informal review. Disputed actions or determinations that are not explicitly stated in the request will not be considered by HHSC, and failure of HHSC to act on implied items of dispute will not be considered grounds for a formal appeal. A request for an informal review that does not meet the requirements of this paragraph will not be accepted.
Random Moment Time Study (RMTS) Recalculations
In 2013, the United States Department of Health and Human Services Office of Inspector General (DHHS OIG) began an audit of the federal fiscal year 2011 SHARS program, The report, TEXAS IMPROPERLY RECEIVED MEDICAID REIMBURSEMENT FOR SCHOOL-BASED HEALTH SERVICES, was issued to the Texas Health and Human Services Commission (HHSC) in October 2017. The result of the compliance review requires HHSC to recode certain RMTS moments for personal care services. The moments of an educational nature vs. medical services must be clearly identified. Then, HHSC is required to recalculate the statewide RMTS percentage to determine the fiscal impact for the FFY 2022 SHARS cost reports. To ensure HHSC PFD could complete the analysis related to the total fiscal impact of the audit findings, the FFY 2022 cost report settlements were delayed. LEAs were notified of the delay through STAIRS on November 30, 2023. For some districts, this recalculation will result in a reduction of the anticipated FFY 2022 SHARS cost report reimbursement scheduled to be delivered early in 2024. LEAs may see reductions on future cost reports depending on the adherence to the RMTS training requirements for FFY 2023 and beyond.
Background – How We Got Here
The report, TEXAS IMPROPERLY RECEIVED MEDICAID REIMBURSEMENT FOR SCHOOL-BASED HEALTH SERVICES, was issued to the HHSC in October 2017. The findings made a recommendation to disallow certain random moments in the time studies. HHSC staff began working with the Centers for Medicare & Medicaid Services (CMS) to request reconsideration of the disallowed moments. In October 2023, the Departmental Appeals Board (DAB) handed down a final decision on HHSC’s request for reconsideration. The DAB ultimately denied HHSC’s appeal request. HHSC has now exhausted all administrative appeal opportunities. Some findings and next steps are summarized below.
Interim Claim Issues Identified at 2 Chosen Districts
The report reviewed sample documents from 2 Texas LEAs. Examples of unsupported claims included:
- ineligible specialized transportation
- service on holidays or weekends
- overbilling
- inaccurate billing
- billing for unallowable services
This audit was conducted as a part of a nationwide policy review of the RMTS. Specifically, the overall objective was to determine the effectiveness of the use of random moment sampling as a basis to allocate school-based administrative and health services program expenditures. The above issues show that if the allocation methodology for determining school-based health services program costs changes, there are still significant deficiencies at the LEA claim level that should be considered.
Random Moment Time Study (RMTS)
Next, the report addresses RMTS directly. DHHS OIG found that not all of the direct medical service costs that the HHSC claimed for Medicaid SHARS were reasonable, adequately supported, and otherwise allowable in accordance with applicable Federal and State requirements. Specifically, the Contractor coded random moments incorrectly.
The State agency conducts an RMTS for three of the four Federal fiscal year quarters. However, at the time the audit was conducted, the State agency does not conduct a time study for the fourth quarter (July 1 through September 30). As a result, the RMTS was not representative of the cost period (the entire school year).
RMTS Training
Required RMTS training outlines time study activities and the training required to participate. Through this training, as well as compliance reviews, districts are reminded of the importance of appropriately limiting the Participant List (PL) to support the district and state compliance. As with other aspects of Medicaid, districts are expected to have evidence to support the activities performed and the accuracy of the PL. Finally, the fourth quarter will be added to the moment collection schedule.
Contact Information
For questions, please call the SHARS helpline at (512) 730-7400 or send an email to
providerfinanceshars@hhs.texas.gov
