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Time Study Independent School Districts (ISD)

General Information

The United States Congress recognizes the vital role of public schools in providing health services for our nation’s children. For that reason, schools are reimbursed with federal Medicaid funds for the provision of covered medical services, including mental health services, and for the costs of administrative activities, such as outreach, which support the Medicaid program. These services are funded through the School Health and Related Services (SHARS) program and the School-Based Medicaid Administrative Claiming (MAC) program.

Medicaid is a joint state-federal program authorized under Title XIX of the Social Security Act that provides federal financial participation for a state’s expenditures for providing health care to needy individuals.  Texas Health and Human Services Commission (HHSC) is the single state agency that administers Medicaid in Texas.  The Centers for Medicare and Medicaid Services (CMS) is the federal agency that administers Medicaid.  HHSC contracts with providers to obtain reimbursement for certain health-related activities that support the Medicaid program.

There is a mandatory requirement that all participating providers must participate in a time study which is used to determine the amount of time spent in providing services.  The time study methodology approved by CMS for use in Texas is a Random Moment Time Study (RMTS).

The time study covers the entire federal fiscal year of Oct to Sep.  There are four separate quarterly time studies, Oct-Dec, Jan-Mar, Apr-Jun, and Jul-Sep.

Prior to each federal fiscal quarter, the RMTS contact for each participating provider will identify personnel who are eligible to participate in the RMTS.  This information is entered into the State of Texas Automated Information Reporting System (STAIRS) and reviewed each quarter by the provider to create the participant list (PL).  The PL must be entered and certified by the provider by a date specified by HHSC, so that the provider personnel may be included in the pool from which the sampled moments are randomly selected.

An RMTS moment represents one minute at a particular time and moments are sampled throughout each quarter.  If sampled, the sampled participant must document what they were doing at that precise moment by answering a series of questions via the online STAIRS system; who was with you, what were you doing and why were you performing this activity.

The RMTS method polls participants on an individual basis at random time intervals over a given time period and totals the results to determine work effort for the entire statewide population of participating staff over that same period.  RMTS participants are not required to understand complicated Medicaid regulations or codes and the entire online response takes no more than a few minutes to complete. 

The RMTS results allow HHSC and the providers to determine the percent of total time the sampled group is spending on each activity so as to document activities relating to reimbursable federal programs.  Applying these percentages to costs incurred for delivering services determines the portion of those costs that may be claimed for federal reimbursement.

DHHS Appeal Information

This document is in response and specific to the SHARS provider community specific to the Department of Health and Human Services Office of the Inspector General 2011 audit of the SHARS program Random Moment Time Study (RMTS) and subsequent results which decreased the statewide RMTS calculation percentage. For more information, please visit the SHARS website

PFD DAB RMTS Activity Codes

Related Information

School Health and Related Services (SHARS)

MAC Independent School Districts

Guides / Manuals

Time Study and MAC Guide (.pdf)

ISD Implementation Guide (.pdf)

Methodology / Rules:

The Random Moment Time Study program rules  is located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 23, Rules 8443. 


View a list of important notices regarding Time Study for Independent School Districts.


The link below contains information regarding the ISD training information. It is IMPORTANT to carefully read all the information provided so as to fully understand who must attend "initial" training and who is eligible to take "refresher" training.

Learn more about training opportunities