SHARS Documentation: What School OTs Need to Know

SHARS — the School Health and Related Services program — is Texas’s Medicaid reimbursement mechanism for school-based therapy services. For school-based occupational therapists, getting reimbursed depends almost entirely on documentation quality. A single missing field can trigger a recoupment notice months after services are delivered.

This guide covers exactly what your SHARS documentation needs to include, the most common audit triggers, and how to build a session note workflow that holds up under review.

What Is SHARS?

SHARS stands for School Health and Related Services. It allows Texas school districts to bill Medicaid for certain health-related services — including occupational therapy — that are written into a student’s IEP and delivered by qualified providers. Reimbursement goes to the district, not the individual therapist, but the documentation burden falls squarely on the OT delivering the service.

To qualify for SHARS reimbursement, OT services must be:

• Written into the student’s IEP as a related service
• Medically necessary to enable the student to benefit from special education
• Delivered by a qualified occupational therapist or COTA under OTR supervision
• Documented in a compliant session note for every billable session

What Must Be in Every SHARS Session Note

Texas Medicaid auditors look for specific elements in every OT session note submitted for SHARS reimbursement. Missing even one of these is grounds for recoupment:

• Date of service — the actual session date, not the documentation date
• Start and end time — exact times, not just duration
• Student identifier — initials or local ID, never full name in an AI-generated draft
• Session type — pull-out, push-in, consultation, or evaluation
• IEP goal addressed — cite the specific goal, not just a general area
• Skilled service justification — why a licensed OT is required; not a task an aide could perform
• Objective data — measurable observations (trials, percentages, assist levels)
• Student response — how the student engaged with the intervention
• Plan — what happens next session
• OT signature and credentials

The “Skilled Service” Problem

The single most common SHARS audit failure is a note that describes activities without establishing why a licensed OT was necessary to deliver them. “Student completed bead stringing activity” is not a skilled service. “OT graded bead diameter and string tension to systematically challenge tripod grasp development toward IEP fine-motor goal while providing tactile cueing to inhibit hypersensitive grip response” is a skilled service.

Every SHARS note needs a sentence that explicitly justifies skilled OT involvement. This is what PraxisOT’s AI generation focuses on — the skilled-service language that turns a session recap into a billable note.

SHARS vs. LEA-BOP: What’s the Difference?

SHARS is Texas-specific. Other states use different Medicaid school program frameworks — most commonly LEA-BOP (Local Education Agency Billing Option Program). The documentation requirements are similar but not identical. If you work outside Texas, see our LEA-BOP documentation guide.

Common Audit Triggers to Avoid

• Notes that are copy-pasted between sessions with no session-specific data
• Missing start/end times or times that don’t match billing units
• Goal language that doesn’t match the student’s current IEP
• No objective data — narratives without numbers
• Signing notes more than 7 days after service delivery
• COTA notes without documented OTR supervision

Building a SHARS-Compliant Workflow

The most sustainable SHARS documentation workflow is one you complete before you leave the school — not at home that evening. A 60-second voice recap immediately after the session, while the details are fresh, captures more accurate data than a reconstruction hours later.

PraxisOT is built around this workflow: speak your post-session recap using initials and objective data, and the AI generates a SHARS-compliant note with skilled-service language, goal references, and a service log pre-filled with the fields Texas Medicaid auditors look for. Copy and paste into your district’s system before you move to your next student.

Quick SHARS Documentation Checklist

• ☐ Date, start time, end time
• ☐ Student identifier (initials or local ID)
• ☐ Session type (pull-out / push-in / consult)
• ☐ Specific IEP goal addressed
• ☐ Skilled service justification sentence
• ☐ Objective data (trials, percentages, assist level)
• ☐ Student response / engagement
• ☐ Plan for next session
• ☐ OT/COTA signature + credentials
• ☐ OTR co-signature if COTA-delivered