Has your district started obtaining this information to be compliant by November 1, 2022?

Released on November 1, 2021, changes to the Medicaid program have made it a requirement that a referral is required for Speech Therapy 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 (i.e. Licensed SLP). A referral for Speech Therapy services must be signed and dated within three calendar years before the initiation of services.

In order for Speech Therapy services to be reimbursed through SHARS, the name and national provider identifier (NPI) of the referring licensed physician, or other eligible referring provider, must be listed on the claim and kept in the medical record.

Speech therapists whose evaluations serve as the referral (which TEA has referred to as “self-referring providers”) must be enrolled in Medicaid as individual practitioners and must use their individual NPI for claim submission.  IDEA requires that a student receiving SHARS services must have a re-evaluation every three years, which requires current information; unless the parent and the LEA agree that a re-evaluation is unnecessary (IDEA §1414 (a)(2)(B)).

A physician’s referral is not required for a re-evaluation. The need for a re-evaluation should be determined by the student’s ARD committee. The school district must maintain the referral in the client’s record.

As of November 1, 2022 students who qualify for Speech services and the district intends to submit for SHARS Medicaid reimbursement, must have a referral in place in order to meet HHSC compliance regulations.

For more information on applying for an NPI number, enrolling your NPI number with TMHP Medicaid and completing referral documentation on eligible students, contact your ONWARD Account Manager.