Independent Living Services Standards for Providers
Chapter 1, Overview
Revision 19-1, Effective March 1, 2019
The program provides independent living services that promote to the fullest extent the integration and inclusion of individuals with significant disabilities into society.
The Texas Health and Human Services Commission (HHSC) awards contracts, whether by grant or other form of agreement, to service providers under the Independent Living Services Program pursuant to Texas Human Resources Code, §117.079. These service providers include centers for independent living and other organizations or persons skilled in the delivery of independent living services.
Service providers must comply with:
- the requirements under 1 Texas Administrative Code (TAC), Part 15, Chapter 392, Purchase of Goods and Services for Specific Health and Human Services Commission Programs, Subchapter J, Independent Living Services Program Contracts;
- the Independent Living Services rules; and
- the Independent Living Services Standards.
Chapter 2, Definitions
Revision 19-1, Effective March 1, 2019
The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.
Ability to pay – The determination that the consumer is able to contribute financially toward the cost of independent living services.
Accessible format – An alternative way of providing to people with disabilities the same information, functionality, and services provided to people without disabilities. Examples of accessible formats include braille, ASCII text, large print, American Sign Language, and recorded audio.
Act – The Rehabilitation Act of 1973, as amended.
Adjusted income – The dollar amount that is equal to a household’s annual gross income, minus allowable deductions.
Allotment – Funds distributed to a service provider by HHSC to provide services under the Independent Living Services Standards.
Allowable deductions – Certain unreimbursed household expenses that are subtracted from a household’s annual gross income to calculate the adjusted income.
Attendant care – A personal assistance service provided to help an individual with significant disabilities perform essential personal tasks, such as bathing, communicating, cooking, dressing, eating, homemaking, toileting, and transportation.
Blind – A condition of having no more than 20/200 visual acuity in the better eye with correcting lenses or having visual acuity greater than 20/200 but with a field of vision in which the widest diameter subtends an angle no greater than 20 degrees.
Center for Independent Living (CIL) – A private nonprofit agency for individuals with significant disabilities (regardless of age or income) that is not residential; is consumer-controlled; is community-based; takes a cross-disability approach; is designed and operated within a local community by individuals with disabilities; and provides an array of independent living services, including, at a minimum, independent living core services as they are defined in 29 United States Code (U.S.C.) §705(17).
Comparable services or benefits – Services and benefits that are provided or paid for, in whole or part, by other federal, state, or local public programs; by health insurance, third-party payers, or other private sources; or by the employee benefits that are available to the consumer and are commensurate in quality and nature to the services that the consumer would otherwise receive from service providers.
Complaint - An allegation of a violation of these standards or a service provider’s policies and procedures related to these standards.
Confidential information – Any communication or record (whether oral, written, or electronically stored or transmitted, or any other form of communication or record) provided to or made available to the service provider or that the service provider may create, receive, maintain, use, disclose, or have access to on behalf of HHSC that consists of or includes any or all of the following:
- Consumer Information
- Protected Health Information in any form, including without limitation, electronic protected health information or unsecured protected health information
- Sensitive personal information defined by Texas Business and Commerce Code Chapter 521
- Federal tax information
- Personally identifiable information
- Social Security Administration data, including, without limitation, Medicaid information
- All privileged work products
- All information designated as confidential under the constitution and laws of the State of Texas and of the United States, including the Texas Health and Safety Code and the Texas Public Information Act, Texas Government Code, Chapter 552
Consumer – An individual who has applied for or is receiving the independent living services that are referred to under the Independent Living Services Standards – Part A.
Consumer participation – The financial contribution that a consumer may be required to pay for receiving independent living services.
Consumer participation system – The system for determining and collecting the financial contribution that a consumer may be required to pay for receiving independent living services.
Consumer representative – Any person chosen by a consumer, including the consumer’s parent, guardian, other family member, or advocate. If a court has appointed a guardian or representative, that person is the consumer’s representative. Unless documentation is provided showing otherwise, a parent or court-appointed guardian is presumed to be the consumer representative for a minor who is:
- younger than 18 years old; and
- not emancipated; or
Federal poverty level guidelines – The poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under the authority of 42 U.S.C. §9902(2).
Fee – A percentage of the full cost for a purchased service that a consumer pays. The percentage is based on the HHSC fee schedule and the fee does not exceed the maximum amount prescribed.
HHSC – The Texas Health and Human Services Commission
Independent living plan – A written plan in which the consumer and service provider have collaboratively identified the services that are needed to achieve the consumer’s goal of living independently.
Nonprofit – An agency, organization, or institution that is owned and operated by one or more corporations or associations whose net earnings do not and cannot lawfully benefit a private shareholder or entity.
NVRA – The National Voter Registration Act of 1993 is a federal law that requires states to offer voter registration services to a consumer who applies for services.
Private – An agency, organization, or institution that is not under federal or public supervision or control.
Service provider – A center for independent living, nonprofit organization, organization, or other person contracted or subcontracted to provide independent living services.
Severe visual impairment – A condition of having a visual acuity with best correction of 20/70 or less in the better eye, a visual field of 30 degrees or less in the better eye, or having a combination of both.
Significant disability – A severe physical, mental, cognitive, or sensory impairment that substantially limits an individual's ability to function independently in the family or community and for which the delivery of IL services would improve the ability to function, continue functioning, or move toward functioning independently in the family, community or in an employment setting.
Sliding fee scale – The fee scale HHSC uses to determine the maximum financial contribution that a consumer may be required to pay for receiving independent living services. The scale is based on the federal poverty level guidelines.
Transition services – Services that:
- facilitate the transition of individuals with significant disabilities from nursing homes and other institutions to home and community-based residences, with the requisite supports and services;
- provide assistance to individuals with significant disabilities who are at risk of entering institutions so that the individuals may remain in the community; and
- facilitate the transition of youth who are individuals with significant disabilities, who were eligible for individualized education programs under section 614(d) of the Individuals with Disabilities Education Act (20 U.S.C. 1414(d)), and who have completed their secondary education or otherwise left school, to postsecondary life.
Vendor – A person or organization that a service provider contracts with to deliver services or provide goods to consumers.
Waived independent living plan – A written plan in which the service provider identifies on the behalf of the consumer the services that are needed to achieve the consumer’s goal of living independently. The service provider writes the plan because the consumer has signed a waiver giving up the consumer’s right to participate in the development of such a written plan.
Chapter 3, Scope of Independent Living Services
Revision 19-1, Effective March 1, 2019
3.1 Scope of Services
All services are available in an accessible format for individuals, applicants and consumers who rely on alternative modes of communication.
The service provider provides each independent living service in accordance with the independent living plan or waived independent living plan. Ancillary services such as eyeglasses, bus passes, dental intervention, training registration fee or other supports may be provided to the extent necessary to participate in a planned service or to achieve an appropriate independent living goal. For questions regarding whether a service is allowable, consult with the HHSC staff member assigned to the contract.
The service provider may provide the following independent living services under the Independent Living Services Standards:
- Independent living core services, which include:
- information and referral services;
- independent living skills training;
- peer counseling (including cross-disability peer counseling);
- individual and systems advocacy; and
- transition services.
It shall be noted that core services will not be the sole services provided under the ILS Contract Services; rather, at least one service must be included from the following list:
- Independent living services, which include:
- counseling services, including psychological and psychotherapeutic services;
- services for securing housing or shelter (including community living) that support the purposes and titles of the Act, and services related to securing adaptive housing (including making appropriate modifications to spaces that serve or are occupied by individuals with disabilities);
- rehabilitation technology;
- mobility training;
- services and training for individuals with cognitive and sensory disabilities, including life skills training and interpreter and reader services;
- personal assistance services, including attendant care and the training of personnel providing such services;
- surveys, directories, and other materials that identify appropriate housing, recreation opportunities, accessible transportation, and other support services;
- consumer information programs on the rehabilitation and independent living services that are available under the Act, especially services that are available for minorities and other individuals with disabilities who have traditionally been unserved or underserved by programs under the Act;
- education and training necessary for living in a community and participating in community activities;
- supported living;
- transportation, including referral services, personal assistance, and training on the use of public transportation vehicles and systems;
- physical rehabilitation;
- therapeutic treatment;
- the provision of needed prostheses and other appliances and devices;
- social and recreational services (individual and group);
- training for youth with disabilities that is designed to develop self-awareness, self-esteem and the ability to self-advocate, self-empower, and explore career options;
- services for children;
- federal, state, or local training, counseling, or other assistance designed to help individuals with disabilities become independent and productive and live a good life;
- preventive services that encourage independence and reduce the need for the services that are provided under the Act;
- awareness programs that encourage an understanding of individuals with disabilities and help individuals integrate into the community; and
- other services, as needed, which are consistent with the provisions of the Act.
Chapter 4, Consumer Rights
Revision 19-1, Effective March 1, 2019
4.1 Complaint Process
4.1.1 Filing a Complaint with the Texas Health and Human Services Commission
An individual, consumer or consumer’s representative, subcontractor or organization may file a complaint with HHSC alleging that a requirement of independent living services was violated. A complaint may be filed directly with the HHSC Independent Living Program manager or HHSC Office of the Ombudsman without having been filed with the service provider.
A complaint may be filed by contacting the HHSC Office of the Ombudsman by:
- mail: Texas Health and Human Services Commission, Office of the Ombudsman, MC H-700; P.O. Box 13247, Austin, TX 78711-3247;
- phone: 877-787-8999 or Relay Texas for people with a hearing or speech disability: 7-1-1 or 800-735-2989;
- fax: 888-780-8099; or
- online: HHSC’s Ombudsman page.
A complaint may also be filed by contacting the Independent Living Program manager’s office by:
- email: email@example.com; or
- phone: 817-588-2413.
More information regarding the complaint process may be obtained by calling the Office of the Ombudsman at 877-787-8999 or Relay Texas for people with a hearing or speech disability: 7-1-1 or 800-735-2989.
4.1.2 Filing a Complaint with the Client Assistance Program (CAP)
The Client Assistance Program (CAP) is federally funded and mandated under the Act to provide information, assistance, and advocacy for people with disabilities who are seeking or receiving services from programs, including the Independent Living Services Program. CAP services can include:
- informing the consumer of his or her rights;
- providing information about services and benefits of the program;
- advocating for consumers in his or her relationship with the program;
- assisting the consumer in understanding and using the appeals process;
- assisting the consumer and systemic advocacy in relation to the program that may include policy issues and changes; and
- resolving issues at the lowest level possible.
The CAP is implemented by Disability Rights Texas (DRTx), a legal services organization whose mission is to protect the human, service, and legal rights of persons with disabilities in Texas.
DRTx advocates are not employees of any state agency. There are no fees for CAP services, which are provided by advocates and attorneys when necessary. Services are confidential.
Service providers must use accessible formats to notify individuals with disabilities who are prospective or current consumers about
- the availability of the CAP;
- the purposes of the services provided under the CAP; and
- how to contact the CAP.
Service providers should notify consumers of the CAP at application, the development of the independent living plan, and anytime services are reduced, suspended or terminated.
A consumer or the consumer’s representative may file a complaint with DRTx alleging that a requirement of independent living services was violated. The complaint need not be filed with the service provider.
A complaint may be filed by:
- phone: 800-252-9108; or
- videophone: 866-362-2851.
More information about the complaint process is available by calling DRTx at 800-252-9108 or videophone at 866-362-2851.
4.1.3 Complaint Investigation
Service providers are required to participate in the complaint investigation process initiated with the HHSC Independent Living Program manager, HHSC Office of the Ombudsman or Client Assistance Program. This includes responding to all requests for information necessary to investigate allegations that a requirement of independent living services was violated. The service provider must ensure that attempts are being made to resolve the complaint. Service provider responses to complaints must be received, in their entirety, within deadlines provided by the complaint investigator.
Chapter 5, Service Delivery Process
Revision 19-1, Effective March 1, 2019
5.1 Initial Contact
An individual's or referral organization's first contact with a service provider is a critical point in the independent living services (ILS) process. It is a time for an information exchange that will provide the individual or referral organization with information regarding the individual's independence needs and form impressions related to whether the ILS Program may meet those needs. The service provider must gather the referred individual's demographics required to be entered into the Independent Living Services Data Reporting System. If the referral organization is unable to provide all demographic information, the service provider will contact the individual to obtain necessary data to complete the initial contact.
The initial contact date is the first request for assistance that requires an application, eligibility determination, and funding under this ILS Program contract. The initial contact is date sensitive and is entered into the Independent Living Services Data Reporting System.
(Note: A consumer may have previously contacted the service provider and received any or all of the independent living core services funded, as addressed in 40 TAC. Part 2, §§104.201 and 106.1001 Allocation of Funds.)
5.2 Application for Services
When an individual has made a request for services included in the program scope of services covered by the contract, an application should be processed within 30 days of initial contact. Any circumstances delaying the completion of an application should be noted in the case file.
Applications may not be completed by telephone or other remote methods, such as, Skype, FaceTime, GoToMeeting, and so on. The meeting should be in an accessible location of the individual's choosing that may include the individual's home, confidential space in a community setting, or the service provider's facility. If an individual is unable to apply in person at an office location, a home visit to complete the application must be conducted.
The service provider must develop and maintain an application process to provide, in accessible format, information related to:
- consumer rights;
- rights to complain or appeal a process decision (see 4.1.1 and 4.1.2);
- disposition of confidential information;
- permission to collect and/or release information;
- assignment of a representative for minors or when the consumer chooses to be represented;
- the consumer participation system and need for financial records, if determined eligible to receive services;
- voter registration information (see 8.5); and
- additional services for veterans (see 8.9).
The service provider must develop a process for gathering information from the consumer related to:
- the consumer's perspective, abilities, resources, limitations, and other issues that impact his or her ability to function in the home, family, and/or community;
- goals for independence;
- services considered to address independence goals;
- existing service provider relationships; and
- other considerations that will support the eligibility decision.
Information gathered will be documented in the consumer case file for use in eligibility determination.
To be eligible for independent living services, an individual must:
- have a significant disability as defined in Chapter 2 Definitions; and
- be present in Texas.
Under Texas Government Code §531.02002 and §531.02014 and Texas Labor Code §351.002, consumers who are determined to be eligible for independent living services on or before August 31, 2016, remain eligible on September 1, 2016, and are considered grandfathered under the former Department of Assistive and Rehabilitative Services Independent Living Program and do not need to reapply for independent living services to the respective receiving agency on September 1, 2016.
Eligibility requirements are applied without regard to a person's age, color, creed, gender, national origin, race, religion, income or length of time present in Texas.
Eligibility is determined by the service provider, based on the documented diagnosis of a licensed practitioner, such as an MD, DO, Nurse Practitioner or Advanced Practice Nurse, and information gathered from the consumer, to define his or her ability to benefit from services and reach independent living goals. All source records gathered to document eligibility should be maintained as part of the consumer case file. Applicants and consumers are not required to participate in the cost of diagnostic assessments and evaluations.
The service provider must document the eligibility decision, including the records of diagnosis from a licensed practitioner, in the consumer case file. Once a consumer is determined to be eligible for services, the service provider:
- notifies the consumer of the eligibility decision and the need to gather financial information from the consumer to include the most recent federal tax return or documents to assess and confirm household size, gross income and allowable expenses;
- verifies the benefits of all consumers who may be covered for independent living services by comparable services or benefits, as provided under the Independent Living Services Standards, and maintains all related documentation;
- assesses the consumer's ability to pay according to the federal poverty limit guidelines; and
- notifies the consumer, or the consumer's representative, in writing for planning purposes about the assessment of ability to pay and the anticipated percentage to be applied as fee for service.
(Note: Refer to 5.6.3 Consumer Participation in Cost of Purchased Services)
If a service provider determines that an individual is not eligible based on the eligibility criteria in 5.3 Eligibility, the service provider documents the determination of ineligibility and provides HHSC with a copy that is signed and dated by the service provider's executive director or designee. This ineligibility determination should be filed in the consumer case file along with any supporting documentation.
The service provider may determine an individual to be ineligible for independent living services only after consultation with the individual or after providing a clear opportunity for consultation. See 5.7: Termination of Services.
5.4 Pre-Planning Assessment
Assessments and related evaluations required for planning services and IL plan completion may be purchased after eligibility is determined and before the independent living plan's signed date or waiver date. Consumers are not required to participate in the cost of diagnostic assessments and evaluations.
5.5 Assessments for Individuals Who Are Blind
The needs assessment will be conducted in the home (assessments may not be conducted by phone).
The assessment must address the following areas:
- Daily living skills, such as a consumer's ability to prepare meals, work safely in the kitchen, measure, pour, eat, perform household chores, sew, do craft work, and provide dependent care (such as helping a spouse or other family member dress or groom).
- Communication skills, such as a consumer's ability to read printed material, write, use a calendar, tell time, identify money, manage finances, organize, label, use braille, use a computer, understand technology, and use low vision aids.
- Ability to manage secondary disabilities, such as hearing loss, diabetes, or other health conditions (for example, whether the consumer needs a deafblind or hearing evaluation, diabetes education, or help managing medication).
- Ability to travel and transport, such as a consumer's ability to be mobile in and around the home, detect home deliveries, maintain balance while walking, use public transportation, and travel outside the home (for example, whether the consumer wants to attend orientation and mobility training and, if so, what the consumer's goals are for travel and mobility).
- Support systems, such as the consumer's natural support system, community resources, and needed referrals.
- Quality of life, such as the consumer's leisure, volunteer, or recreational activities (for example, whether the consumer wants to be more active and what training would improve the consumer's quality of life).
- Adjustment to blindness, such as the consumer's ability to cope with vision loss, the consumer's readiness to participate in services, and whether the consumer self-advocates and uses adaptive techniques.
- Future independence, such as whether the consumer is at risk of going to a more dependent living environment if the consumer does not receive services.
5.6 Development of the Independent Living Plan or Waived Independent Living Plan
After determining eligibility, the next step in the independent living services process is to develop the independent living plan (ILP) or waived ILP.
The service provider uses all available information to counsel the consumer about the service options available to help the consumer:
- identify independent living goals;
- complete the consumer cost participation requirements; and
- develop the ILP or waived ILP.
The service provider must fully disclose information available to explore options for services that may meet the consumer's need in the most cost effective way, minimizing expenditures for the consumer and the program.
The service provider must ensure that the consumer uses comparable services or benefits when developing the independent living plan. Comparable services or benefits include the services and benefits that are provided or paid for, in whole or part, by other federal, state, or local public programs; by health insurance, third-party payers, or other private sources; or by the employee benefits that are available to the consumer and are commensurate in quality and nature to the services that the consumer would otherwise receive from the service provider.
5.6.1 Identifying the Independent Living Goals
Suitable independent living goals relate directly to addressing the consumer's functional needs and what the consumer wants to achieve in order to access his or her home, family, and/or community.
Independent living goals are significant life achievements that:
- enable the consumer to become more, or to remain, independent in the home, family, or community; and
- are made possible through independent living services.
A consumer may have more than one goal listed on the independent living plan.
Independent living goals may be related to:
- community-based living;
- community and social participation;
- education needed for independent living;
- information access and technology;
- mobility and transportation;
- personal resource management;
- relocation from a nursing home or other institution;
- self-advocacy and self-empowerment;
- self-care; and
- other areas leading to independent living.
5.6.2 Initiating an Independent Living Plan or Waived Independent Living Plan
A consumer's independent living plan or waived independent living plan is initiated after the consumer's eligibility is documented, according to 5.3 Eligibility. The plan explains the goals or objectives established and the services necessary to meet those goals. These services may include a comparable service that is being arranged for the consumer or a service being provided by staff or purchased for the consumer. It indicates the anticipated duration of the service plan and the duration of each component service.
An IL Plan amendment is required when any changes to the original Independent Living Plan or Waived Independent Living Plan are completed with the consumer. The service provider develops written policies to address IL Plan amendments.
The independent living plan and any amendment are developed by the service provider and the consumer or the consumer's representative. If the consumer signs a waiver, a waived independent living plan is developed by the service provider.
A copy of the independent living plan and any amendment is provided in an accessible format to the consumer or the consumer's representative and documented in the consumer's case file. The waived independent living plan is also documented in the consumer's case file.
5.6.3 Consumer Participation in the Cost of Purchased Services
The service provider administers the consumer participation system in accordance with the independent living services rules, the Independent Living Services Standards, and the contract requirements. The service provider gathers financial information about the consumer to determine the consumer's participation.
In summary, the service provider determines the consumer's requirement and ability to participate by:
- collecting financial information;
- calculating the consumer's household size and adjusted gross income;
- assessing the consumer participation fee according to the published scale;
- processing the consumer participation agreement with the consumer; and
- documenting the agreement in the consumer case file.
The service provider provides independent living core services, and any necessary assessments for the purpose of determining eligibility, and evaluations for determination of appropriate independent living service provision as defined in Chapter 3: Scope of Independent Living Services, 3.1 Scope of Services, at no cost to the consumer.
Purchased independent living services defined in Chapter 3: Scope of Independent Living Services, 3.1 Scope of Services are subject to consumer participation and comparable benefits requirements of the Independent Living Services Standards.
220.127.116.11 Collecting Financial Information
When the consumer has been determined eligible for services, the service provider reviews information related to the consumer's ability to pay.
The service provider gathers financial information about the consumer to determine the consumer's adjusted gross income and the percentage of the federal poverty level for that income. For planning purposes, the consumer is notified of his or her expected percentage fee for services after the eligibility notification. This allows the consumer to consider his or her fee before agreeing to a plan of services and the opportunity to request a re-review and provide information regarding any exceptional circumstances or further documentation to assess the consumer's ability to pay.
The request for documented proof of income includes:
- a federal tax return, including the addition of the parent's federal tax return for an eligible minor; or
- benefits award letters, receipts, bank statements, retirement account and any other available financial record to demonstrate income, allowable expenses, and household size.
18.104.22.168 Calculating the Consumer's Household Size and Adjusted Gross Income
Based on financial records provided by the consumer, the household size equals:
- any person living inside or outside of the home who is eligible to be claimed as a dependent of the consumer on the consumer's federal income tax return; or
- if the consumer is a minor, any other person living inside or outside of the home who is eligible to be claimed as a dependent of the consumer's parent or guardian on the parent or guardian's federal income tax return.
The consumer's annual gross income:
- equals the total annual gross income received by the household; and
- includes all income classified as taxable income by the Internal Revenue Service before federally allowable deductions are applied.
The consumer's allowable deductions are limited to the consumer's expenses in the following categories:
- Attendant care;
- Rent or home mortgage payments;
- Court-ordered child support payments made by the consumer for financially dependent children who were not included in the calculation of household size;
- Medical or dental expenses for treatment primarily intended to alleviate or prevent a physical or mental illness or manage a disability, with the expenses limited to the cost of:
- diagnosis, cure, alleviation, treatment, or prevention of disease;
- treatment of any affected body part or function;
- medical services legally delivered by physicians, surgeons, dentists, and other medical practitioners;
- medications, medical supplies, and diagnostic devices;
- medical and dental health care insurance premiums;
- transportation to receive medical or dental care; and
- medical or dental debt that the family is paying on an established payment plan.
The service provider calculates the allowable deductions using the actual amounts the consumer paid during the previous 12-month period, according to financial records provided by the consumer.
The consumer provides the most recent tax return available as proof of annual gross income and allowable deductions. If the consumer has no tax return, the consumer provides bank statements, medical records, receipts, proof of benefits awards, and other documentation to demonstrate annual gross income and allowable deductions.
If the consumer does not provide documentation supporting the household's allowable deductions, the service provider determines the consumer's fee for service based on the consumer's documented annual gross income with no allowable deductions.
22.214.171.124 Assessing the Consumer Participation Fee According to the Published Scale
Once the service provider calculates household size and adjusted gross income, the consumer's financial situation is assessed to determine the percentage of federal poverty guidelines. The consumer's fee, listed on the HHSC fee schedule is then based on the corresponding percent of cost to be paid.
Factors that affect the consumer's fee for service, as described above, are:
- household size;
- annual gross income; and
- allowable deductions.
The consumer's fee for service is equal to the amount on the HHSC sliding fee scale according to the household's annual adjusted income (that is, the annual gross income minus the allowable deductions).
The service provider uses the most current sliding fee scale and instructions published by HHSC to determine the consumer's fee for service.
As the independent living plan or waived independent living plan is developed, the service provider and consumer discuss cost of services so that the consumer is aware of the fee that will be due for agreed upon services and, if necessary, request a re-review and provide information regarding any exceptional circumstances.
The service provider charges the consumer a fee for each purchased service provided, according to the consumer's percentage of the federal poverty level.
126.96.36.199.1 Fee Schedule Amount
The service provider is required to use the HHSC fee schedule and instructions to calculate the consumer's fee for service.
After the independent living plan or the waiver is signed and completed and the service provider is proceeding with the purchase of the good or service, the service provider charges and collects the consumer's fee for each purchased service provided, according to the consumer participation agreement.
The procedures, fee schedule, and instructions that HHSC uses to calculate a consumer's fee for service is available from HHSC, between 8:00 a.m. and 5:00 p.m. on business days. The fee schedule is also available on the HHSC Independent Living Services Program website and provided to the consumer.
188.8.131.52.2 Insurance Payments
If the consumer has medical and dental insurance that covers an independent living service received by the consumer and the agreement for in-network services made between the insurance company and the service provider or service provider's subcontractor requires that the service provider or subcontractor accept as payment in full the deductible, copayment, or coinsurance and insurance reimbursement, then the consumer's fee for service is either the deductible, copayment, or coinsurance, or the amount calculated by the HHSC fee schedule, whichever is less.
The consumer pays the premiums for medical and dental insurance. Neither HHSC nor the service provider pays the premiums.
The premiums for medical and dental insurance do not count toward meeting the consumer's fee for service.
The service provider may not need to spend independent living service funds to help the consumer achieve his or her independent living goals. Before providing independent living services to a consumer, the service provider explores any possible comparable services or benefits and whether those services and benefits are available to the consumer. The service provider records these services on the independent living plan or waived independent living plan as coordinated services.
All comparable benefits must be exhausted before funds are used for services covered under this contract.
184.108.40.206 Processing the Consumer Participation Agreement with the Consumer
The consumer or consumer's representative signs a consumer participation agreement that indicates the household adjusted gross income level and corresponding percentage fee for services. Signing the agreement acknowledges the amount of the consumer's fee for services and provides written agreement that:
- the information provided by the consumer or the consumer's representative about the consumer's household size, annual gross income, allowable deductions, and comparable services or benefits is true and accurate; or
- the consumer or the consumer's representative chooses not to provide information about the consumer's household size, annual gross income, allowable deductions, and comparable services or benefits.
The service provider does not initiate or authorize independent living services subject to Chapter 3: Scope of Independent Living Services until the consumer or the consumer's representative signs the consumer's participation agreement.
If the consumer chooses not to provide information on the consumer's household size, annual gross income, allowable deductions, and comparable services or benefits, the consumer agrees to pay the entire cost of services.
As soon as possible the consumer reports to the service provider all changes to household size, annual gross income, allowable deductions, and comparable services or benefits and signs a new consumer's participation agreement.
When the consumer signs a new participation agreement, the new amount of the consumer's fee for service takes effect the beginning of the following month. The new amount is not retroactive.
The service provider must develop a process to reconsider and adjust the consumer's fee for service based circumstances that are both extraordinary and documented. This may include assessing the consumer's ability to pay the consumer's fee for service.
Only the service provider's executive director or designee has authority to reconsider and adjust a consumer's fee for service.
Extraordinary circumstances include:
- an increase or decrease in income;
- unexpected medical expenses;
- unanticipated disability related expenses;
- a change in family size;
- catastrophic loss, such as a fire, flood, or tornado;
- short-term financial hardship, such as a major repair to the consumer's home or personally owned vehicle; or
- other extenuating circumstances for which the consumer makes a request and provides supporting documentation.
The consumer's calculated fee for service remains in effect during the reconsideration and adjustment process.
The service provider:
- uses program income that is received from the consumer participation system only to provide the independent living services that are outlined in Chapter 3: Scope of Independent Living Services, 3.1 Scope of Services; and
- reports fees collected to HHSC as program income for services provided under this contract.
The service provider does not use program income received from the consumer participation system to supplant any other fund sources.
HHSC does not pay any portion of the consumer's fee for service.
The consumer's participation agreement and all financial information collected by the service provider are subject to any data use agreement between HHSC and the service provider, a subpoena, and monitoring.
This documentation must be provided to HHSC in manner requested (hard copy, scanned copied transmitted by mail or electronically or during on-site visits).
220.127.116.11 Documenting the Agreement in the Consumer Service Record
A consumer case file is maintained for all applicants and eligible consumers receiving independent living services. All entries to the Independent Living Services Data Reporting System made by the service provider will be considered a part of the consumer case file.
Each consumer case file must minimally meet the requirements of 34 Code of Federal Regulations (CFR), Subtitle B, Chapter III, Part 364, §364.53, and provide documentation concerning:
- intake information, including prescribed consumer demographics and contact information;
- application processing to include any and all forms indicating consumer rights notices, permission to collect and release personal information, representative signatures, legal status verification documents, and so on;
- eligibility or ineligibility determination, including a record provided by a licensed practitioner of diagnosis of a significant disability;
- services requested;
- an independent living plan or a signed waiver declining participation in plan development;
- the consumer's goals for independence and anticipated methods and services to achieve the goals;
- services coordinated, arranged, and provided;
- independent living goals or objectives established with the consumer and achieved by the consumer; and
- summary case management log notes.
The consumer case file may be in written or electronic form; however, the independent living plan or waiver must have an original signature.
All paper documents received, such as medical records, assessment, quotes or legacy agency files, must be kept in their original format in a paper case file.
The service provider must meet in person with the consumer to process an application for services. The meeting should be in an accessible location of the consumer's choosing that may include the consumer's home, confidential space in a community setting, or the service provider's facility, if the consumer agrees.
5.6.4 Completing the Independent Living Plan or Waived Independent Living Plan
Unless the consumer who will receive independent living services under the Independent Living Services Standards signs a waiver in accordance with the requirements of this section, the service provider works with the consumer to develop and periodically review an independent living plan in accordance with this section.
If the consumer knowingly and voluntarily signs a waiver stating that the consumer's participation in developing an independent living plan is unnecessary, the service provider develops a waived independent living plan.
The service provider provides each independent living service in accordance with the independent living plan or waived independent living plan.
5.6.5 Reviewing Annually the Independent Living Plan or Waived Independent Living Plan
At least annually, the service provider must review and update accordingly the consumers plan for services, including:
- the consumer's goals;
- the services delivered and still needed;
- opportunities for referral or coordination with other programs or resources;
- the consumer's income, allowable expenses, and any other factors impacting the consumer's participation agreement; and
- the review results documented in a summary note in the consumer's service record.
The consumer reviews the independent living plan and, if necessary, revises it and agrees by signature to its terms.
Any time that the consumer's financial situation changes, the consumer must provide documentation and renegotiate the consumer participation agreement accordingly. All changes and agreements will be captured in the consumer case file.
5.6.6 Coordinating With Vocational Rehabilitation, Developmental Disabilities, and Special Education Programs
The review of the independent living plan or waived independent living plan must be coordinated, to the extent possible, with all of the following programs for which the consumer may be eligible and gain benefit:
- A vocational rehabilitation program
- A habilitation program, prepared under the Developmental Disabilities Assistance and Bill of Rights Act
- An education program, prepared under part B of the Individuals With Disabilities Education Act
5.6.7 Coordinating with Independent Living Program for Older Individuals Who are Blind (ILS-OIB)
The ILS-OIB program is administered through the Texas Workforce Commission (TWC). OIB staff are located in Workforce Solutions offices across the state and are assigned coverage areas by county. For a list of offices, visit: http://www.twc.state.tx.us/partners/independent-living-services-older-individuals-who-are-blind#contact.
To be eligible for the ILS-OIB program, the individual must be 55 years of age or older and have a significant visual impairment that creates barriers for the individual to live independently.
Services that the ILS-OIB program provides to individuals may include:
- Counseling, guidance, and referral services provided by TWC-ILS-OIB staff:
- Orientation and Mobility Training;
- Independent Living Services Training;
- Diabetes Education Training;
- Low-Vision evaluations; and
- Adaptive aids, Low-Vision devices.
Individuals may receive goods and services from both programs. To provide coordinated services for mutual consumers, the following activities are expected from both the service provider's IL staff person and the TWC OIB worker:
- Monthly or quarterly meetings, as agreed upon, with the OIB worker to discuss mutual referrals.
- ILS service provider acceptance of referrals for services that are related to non-visual disabilities (e.g., hearing aids, medical equipment).
- Discussion of ongoing progress with the mutual customer.
Individuals may benefit from one or both programs; therefore, OIB staff and the service provider's IL staff are required to refer individuals to each respective program and ensure that this referral is correctly captured in the case management system.
5.7 Termination of Services
When the goals of an independent living plan are achieved, the service provider stops providing services and closes the case as successful. The service provider reports successful case closures to HHSC.
If a consumer does not meet the goals of the independent living plan and the service provider determines a need to stop providing services, the service provider must close the case as unsuccessful. The service provider reports unsuccessful case closures to HHSC.
For both successful and unsuccessful case closures:
- the service provider notifies the consumer in writing of the action taken and informs the consumer about the consumer's rights and the means by which the consumer may appeal the action taken or file a complaint;
- the service provider refers the consumer to other agencies and facilities, if appropriate, including referring the consumer to the state's vocational rehabilitation program, and documents this referral in the consumer case file;
- if a service provider determines that a consumer is ineligible for independent living services, the service provider reviews the consumer's status again within 12 months of the determination and whenever the service provider determines that the consumer's status has materially changed; and
- a review of an ineligibility determination need not be conducted if the consumer has refused one, the consumer is no longer present in Texas, or the consumer's whereabouts are unknown.
5.8 Waiting List
Independent living services are provided when funding is available. When funding is not available, the consumer is considered waiting for purchased services.
A consumer is placed on a waiting list by the service provider when the consumer:
- meets the eligibility requirements explained in 5.3 Eligibility; and
- has a signed independent living plan or a signed waiver; and
- is ready for services and there is no funding for the purchased service; therefore, the consumer is considered to be waiting for purchased services until funds are available.
The date the Independent Living Plan is completed with the consumer is used as the date the consumer began waiting for services, if applicable.
Plans for consumers who are waiting for purchased services are reviewed every six months by the service provider to determine whether consumers are still eligible for or interested in services.
Consumers are no longer considered waiting when funding becomes available for the purchased service, the consumer is no longer eligible, or the consumer is no longer interested in the purchased service.
5.8.1 If Funds Are Not Readily Available to Purchase the Service
If funds are not readily available to serve the consumer immediately after eligibility determination, do not purchase evaluations such as:
- therapy evaluations;
- seating evaluations;
- residential modification evaluations; or
- evaluations for other equipment.
Instead, develop the independent living plan using projected costs and estimated service needs.
To estimate the projected needs and costs, use:
- available medical records;
- medical evaluations;
- consumer input; and
- staff observation.
Within 60 to 90 days before the service provider anticipates having funds available to serve the consumer, purchase or obtain needed evaluations to determine actual costs and specifications.
5.9 If a Consumer Is Not Ready to Participate in Services
Sometimes consumers may experience personal circumstances rendering them unable to participate in services. If services are to be delayed for a period of greater than 90 days due to the consumers' circumstances, the date on which the consumer becomes "not ready" is recorded in the Independent Living Services Data Reporting System with a summary note of circumstances.
Examples of "not ready" may include:
- an illness or hospitalization;
- a death in the family requiring an extended pause in services or time out of town; or
- working through the process of purchasing a vehicle that will not be available for greater than 90 days.
The service provider reviews the "not ready" status with consumers every 60 days to determine whether the consumer is ready to engage in services, should remain inactive temporarily, or needs to terminate services if the consumer is not likely to engage in services.
Chapter 6, Purchased Goods and Services for Consumers
Revision 19-1, Effective March 1, 2019
The Independent Living Services (ILS) Program funds a continuum of goods and services designed to support consumers in meeting established independence goals in accordance with their independent living plan. A service provider may choose to provide a service with existing staff members or to contract for a service. When contracting for a good or service, the service provider must follow standards related to these purchases.
The contract budget percentages of the total spent in each category for complex rehabilitation technology are allocated as follows:
- Hearing Aids – 25 percent
- Home Modifications – 10 percent
- Power Wheelchairs and Scooters – 18 percent
- Prosthetics – 15 percent
- Vehicle Modifications – 32 percent
The work plan includes corresponding targets for funds budgeted and expended for consumer goods and services. These parameters are set to ensure that sufficient funds are available and spent for certain goods and services for consumers served by the ILS Program.
The service provider must provide purchased goods and services that are within the scope of the program and that best fit consumer's needs while observing efficient budgeting practices and standards.
The service provider must adopt and implement procurement policies that address:
- conflict of interest situations;
- planning for procurement needs;
- separation of duties;
- criteria and situations for obtaining bids or proposals;
- purchasing of supplies and equipment;
- contracts for goods or services; and
- maintenance of procurement records.
Written procurement policies are required to align with standards and procedures under 2 Code of Federal Regulations (CFR), Subtitle A, Chapter II, Part 200, Subpart D, §200.318 general procurement standards. These procurement policies must be followed in purchasing goods and services for consumers.
All purchases should be coordinated with any comparable benefit, resource, or service available before expending funds from this contract. Consumer participation fees must be collected by the time the service and goods are delivered according to the participation agreement.
6.2 Authorized Services
The service provider should establish a purchase or service order system for authorizing consumer goods and services.
Vendors and subcontractors should not begin some services without proper authorization and HHSC approval for the purchase, which are described below.
The service provider is not authorized to receive payment for some services or conditions that do not have impact or are not relative to the independent living goals agreed to by the consumer or addressed by comparable benefits.
Other services not authorized include:
- gym memberships or home exercise equipment, including home equipment for water therapy or strengthening;
- general medical care (that is, medical or surgical services that are not directly related to the consumer’s independence goals or do not support other independent living services);
- maternity care;
- medical or surgical treatment associated with:
- active tuberculosis;
- sexually transmitted diseases;
- organ transplantation;
- AIDS; or
- end-stage renal disease;
- payment for transportation that is not associated with a necessary evaluation or specific good or service provided for under this contract; and
- payment of consumer’s rent, mortgage, security deposits, homeowner’s or renter’s insurance or property taxes.
Goods and services that are not authorized will be unallowable for reimbursement.
6.3 Description of Purchased Services
The appendices provide a description of purchased services under the Independent Living Services (ILS) Program. The descriptions include vendor qualifications, required procedures, and other requirements applicable to these services.
The services include:
- Appendix A: Assistive Technology
- Appendix B: Counseling
- Appendix C: Complex Rehabilitation Technology
- 1 - Hearing Aids Devices and Services
- 2 - Home Modifications
- 3 - Prosthetics
- 4 - Vehicle Modification Consumer Service
- 5 - Wheelchairs and Scooters
- Appendix D: Diabetes Self-Management Education Services
- Appendix E: Independent Living Skills Training (Individualized Skills Training Only)
- Appendix F: Interpreter, Translator, and Communication Services
- Appendix G: Orientation and Mobility Services
- Appendix H: Physical Rehabilitation and/or Therapeutic Treatment
- Appendix I: Services for Individuals Who Are Deafblind
- Appendix J: Vision Services
6.4 Services Requiring HHSC Program Approval
When the consumer is ready to participate in receiving purchased services on the independent living plan and there is funding for receiving these services, the service provider must obtain prior approval by the HHSC Independent Living Program manager before certain purchased services can be funded and reimbursed under the contract.
The purchased services that require prior approval includes:
- Hearing Aids Devices that cost over $2500 per ear or $5000 bilaterally and Video Magnification Devices that cost $1500 or more;
- Home Modifications that cost $5000 or more;
- Prosthetics that cost $12,500 or more;
- Vehicle Modification that cost $5000 or more;
- Wheelchairs and Scooters that cost $5000 or more; and
- Any single item purchase over $5,000, such as, portable patient lifts, specialty beds or other devices.
To request approval of these services, the service provider will prepare a packet of information, including:
- any and all required evaluations, including diagnosis of the disability;
- related documentation, including the service justification and the relationship to the consumer’s established independent living goals;
- specifications for the recommended service, including any certificate of title, lienholder information, and waivers, if applicable;
- cost estimates or quotes from the proposed service provider;
- any other report or document contributing to the support of the goal; and
- consumer cost participation agreement.
Additionally, the ILS Data Reporting System should contain up to date information including completion of requested services and ILS goals as well as entry of phase dates.
The service provider submits the consumer prior approval packet for independent living services to the assigned HHSC staff member to confirm the soundness and completeness of the packet. The packet will then be forwarded to the HHSC Independent Living Program Manager or their designee for approval.
Within four business days of receipt, HHSC will coordinate information and notify the service provider about:
- the need for additional information;
- the approval decision; or
- the denial of use of funds.
The HHSC prior approval of services is valid for 60 days, unless additional time has been requested in the prior approval packet submitted for review. If a purchase has not been initiated within 60 days, the prior approval packet must be re-submitted for review. All prior approval purchases must be complete within 90 days.
6.5 Scope of Available Services
The scope of purchased services available under this contract includes federally defined and state implemented services for independent living according to the Rehabilitation Act of 1973, as amended, and the rules for independent living services. Some services require special consideration in decision making, vendor qualifications, documentation, and approval. The categories of services and references for such consideration are listed in 6.5.1 – 6.5.10.
6.5.1 Assistive Technology
Assistive technology evaluations are conducted to determine the most effective assistive technology to meet the consumer's independent living needs. Assistive technology training is provided to prepare a consumer to use assistive technology effectively in the home, community, or other independent living setting. Training may be provided at a facility, on-site at a consumer's home, in a service provider’s office, or in a community resource center. Group training may be provided by facility-based trainers or on-site trainers. See Appendix A: Assistive Technology, for information on the standards related to these services.
6.5.3 Complex Rehabilitation Technology
Home modifications, hearing aids, prosthetics, power wheelchairs and scooters, and vehicle modifications are considered complex rehabilitation technology due to their component or volume expense and/or complexity in coordination and purchasing of items. Complex rehabilitation technology requires certain considerations, up to and including special pre-approval by the HHSC Independent Living Program manager. See Appendix C: Complex Rehabilitation Technology, sections 1 through 5, for information on the standards related to these services.
6.5.4 Diabetes Self-Management Education Services
Consumers may need education about diabetes self-management.
Diabetes self-management education services are used to:
- assess the consumer's ability to independently manage the disease at home, in the community, and in other independent living settings;
- assess the consumer's ability to participate in intensive rehabilitation training for persons who are blind, such as the training sessions and mini-training sessions;
- prepare a consumer to make informed choices about his or her diabetes; and
- help the consumer develop the confidence and skills to implement his or her choices.
See Appendix D: Diabetes Self-Management Education Services, for information on the standards related to these services.
6.5.5 Independent Living Skills Training (Individualized Skills Training Only)
Independent living skills training is designed to accommodate for the consumer's vision loss in daily living activities. See Appendix E: Independent Living Skills Training (Individualized Skills Training Only), for information on the standards related to these services.
6.5.6 Interpreter, Translator, and Communication Services
Interpreter, Translator, and Communication Services are designed to facilitate consumer communication. Interpreter services are provided by qualified personnel and include sign language and oral interpretation for persons who are deaf or hard of hearing and tactile interpretation for persons who are deafblind. See Appendix F: Interpreter, Translator, and Communication Services, for information on the standards related to these services, including qualifications of personnel.
6.5.7 Orientation and Mobility Services
Orientation and Mobility (O&M) vendors offer complex, interrelated services designed to promote independent travel skills for people who are blind or visually impaired.
O&M training prepares consumers to travel independently with competence and confidence. Orientation is the process of using the available senses to establish one's position and relationship within the environment. Mobility is the ability to travel in the environment with the help of an established tool (including white canes, dog guides, and electronic travel aids). See Appendix G: Orientation and Mobility Services, for information on the standards related to these services.
6.5.8 Physical Rehabilitation and/or Therapeutic Treatment
On occasion, consumers need assistance in accessing services to address physical issues. A continuum of services from physical and occupational therapy, medication, outpatient services, and so on, are necessary to assist in the support of the agreed-upon independent living goals. See Appendix H: Physical Rehabilitation and/or Therapeutic Treatment, for information on the standards related to these services.
6.5.9 Services for Individuals Who Are Deafblind
Consumers who are deafblind may need assistance for independent living or communication access to be able to participate in deafblind services training. See Appendix I: Services for Individuals Who Are Deafblind, for information on the standards related to these services.
6.5.10 Vision Services
Vision services are designed to accommodate for the consumer's vision loss when engaged in daily living activities.
Consumers who need assistance with glasses, contact lenses, low vision aids, video magnifiers, or other devices and services to maximize their access to visual input may receive a variety of services to support their independent living needs. Services are designed to assist in mitigating, remedying, or accommodating the impact of vision loss. See Appendix J: Vision Services, for information on the standards related to these services.
Chapter 7, Contract Application and Award
Revision 19-1, Effective March 1, 2019
7.1 Allotment of Funds
HHSC may consider the following when determining the amount allotted to each service provider:
- service area;
- population of the area served; and
- history of service delivery, which is the number of previous consumers served and cost of services provided by county.
The funds are administered by the designated service provider in accordance with the rules in the 40 TAC Chapter 104, Independent Living Services, and in accordance with the Independent Living Services Standards.
When HHSC determines that a service provider will not spend all the funds allotted for a fiscal year to carry out the rules in the independent living services, HHSC may allot the projected unused portion to other service providers to provide the covered services in the chapter and subchapter. The extra allotment is considered an increase in the other service providers’ allotments for that fiscal year.
The service provider ensures other sources of funds, such as other grants and comparable benefits, are expensed before using funds allocated under the Independent Living Services Standards.
7.2 Contract Application
An application process is used for awarding contracts to service providers under the Independent Living Services Program. HHSC shall establish a process for applications to be submitted in accordance with 1 TAC, Part 15, Chapter 392 Subchapter J Independent Living Services Program Contracts.
Service providers seeking financial assistance to provide the services outlined in the Independent Living Services Standards shall submit a contract application packet in accordance with the established process.
The contract application packet will include instructions, required forms, and a deadline for submission. It will also provide information on:
- county service areas;
- the work plan;
- the budget;
- the cost allocation plan, including the indirect cost rate if applicable;
- job descriptions for contract-funded positions; and
- other requirements.
Financial assistance is provided based on a completed and approved contract application submitted by the service provider.
7.3 Contract Work Plan and Budget
The service provider prepares a work plan with activities for carrying out the Independent Living Services (ILS) Program. Work plan activities are required for all service providers according to the requirements in the Independent Living Services Standards and other activities specific to the contract application. The service provider has the responsibility to fulfill the approved work plan and comply with the ILS Program requirements.
The contract budget shall reflect anticipated costs associated with the activities outlined in the work plan.
Costs are to be budgeted under these cost categories:
- Salaries and Wages
- Fringe Benefits
- Equipment (capitalized)
- Supplies and Materials
- Purchased Services
- Other Costs
- Indirect Cost (if applicable)
Funds budgeted by cost category cannot be moved to other cost categories without requesting and receiving approval from HHSC through a formal budget revision. Additionally, funds within Purchased Services cannot be moved between complex rehabilitation or other purchased service categories without requesting and receiving approval from HHSC through a formal budget revision. Funds may be requested to be moved out of an administrative cost category into a purchased service category; however, purchased service funds cannot be moved into an administrative category.
To request a budget revision, the service provider must submit Form 3000, Budget Revision Request, reflecting the revised budget request (with the justification included) for review and approval by the contract manager.
7.4 Contract Award
HHSC develops an agreement with the service provider, upon approval of the contract application. The basis for the agreement is the approved application and contract.
Any commitment or expenditure of contract funds must be based on the approved application and signed contract, including any subsequent, properly approved amendment.
An amendment to the contract is required when:
- a formal budget revision approved by HHSC is required; or
- a substantial change is made to the work plan (whether or not the change is linked to budget changes).
The contracts for independent living services are paid in part with federal grant funds. Because the contract is considered a sub recipient relationship, the service provider is required to follow the federal grant management guidance in 2 Code of Federal Regulations (CFR), Part 200, Uniform Guidance, Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.
7.5 Special Contract Provisions or Restrictions
The contract may include special provisions or restrictions based on an assessment of risk during the contract application process.
Factors considered in determining whether special provisions or restrictions are appropriate include the potential service provider’s:
- breadth of experience with the Independent Living Services Program;
- history of performance with health and human services contract requirements;
- monitoring reviews and audit findings;
- financial stability;
- quality of management systems; and
- ability to effectively implement program requirements.
The contract’s special conditions or restrictions may address such topics as:
- additional approvals needed for contract decisions;
- required training and/or technical assistance;
- more frequent financial and/or program performance reporting; and
- increased contract monitoring.
7.6 Service Provider Responsibilities
- be responsible for providing required information about consumers, services provided, services outcomes, expenditures, and any other related activity deemed necessary to meet federal reporting, state reporting, or monitoring requirements, or to assure the provision of quality services;
- accept full legal responsibility for the program, including fulfilling contract requirements;
- direct all program and administrative aspects through effective and sound management practices and policies;
- provide fiscal and program management of the contract; and
- not assign any portion of the contract in whole or in part without prior approval from HHSC.
Chapter 8, Organization and Administration
Revision 19-1, Effective March 1, 2019
8.1 Internal Controls
The term internal controls refers to a process implemented and designed to provide reasonable assurance that the necessary objectives under the following categories will be achieved:
- Effectiveness and efficiency of operations;
- Reliability of reporting for internal and external use; and
- Compliance with applicable laws and regulations.
The service provider must:
- Establish and maintain effective internal control that provides reasonable assurance that the federal funds awarded under the contract are being managed in compliance with federal statutes, regulations, and the terms and conditions of the award.
- Comply with federal statutes, state laws, ILS Standards, regulations, and the terms and conditions of the awards.
- Evaluate and monitor compliance with statutes, regulations, and the terms and conditions of awards.
- Take prompt action when instances of noncompliance are discovered, including when identified in audit findings.
The service provider must establish internal controls to promote employee awareness of the nature of workplace fraud. The controls may include employee training programs and policies that ensure careful oversight when purchasing goods and services for the Independent Living Services Program.
8.2 Confidentiality of Information
The service provider adopts and implements written policies and procedures to safeguard confidential personal information, including photographs and lists of names.
These policies and procedures comply with 34 Code of Federal Regulations, Subtitle B, Chapter III, Part 364, §364.56, and assure that:
- specific safeguards protect current and stored personal information;
- all consumers of independent living services and, as appropriate, consumers’ representatives, and interested persons are informed and the conditions for gaining access to and releasing this information; and
- all consumers and consumers’ representatives are informed about the service providers need to collect personal information, and the policies governing its use.
8.2.1 Data Encryption
HHSC policy and federal law mandates all emails containing consumer or agency confidential information must be sent under encryption. Contractors must send HHSC consumer confidential information in a secure manner when emailing information to HHSC employees or to any other individual.
HHSC requires FIPS 140-2 level of encryption. If a contractor does not have this level of data encryption, the provider shall ask HHSC staff to send an encrypted email related to the consumer to the contractor's email address and this email can be used to send encrypted information back to HHSC if the directions are followed accurately.
Upon request, the contractor must make available to HHSC any documents, papers, and records that are directly pertinent to the goods or services being provided to HHSC consumers.
Examples include, but are not limited to:
- service authorizations;
- consumer service reports;
- company financials;
- insurance certificates;
- staff information sheets;
- any documentation required under the entity’s contract; and
- the HHSC Standard Procurement Terms and Conditions, and/or Independent Living Services Standards.
8.3.1 Record Storage
When original records are electronic and cannot be altered, there is no need to create and retain paper copies. When original records are paper, electronic versions may be created through the use of duplication or other forms of electronic media, provided that they are subject to periodic quality control reviews, provide reasonable safeguards against alteration, and remain readable. However, the original paper record (e.g., invoices, medical records) must be maintained. If records are maintained on company or personal server(s) or computer(s), these records must be protected in a secure manner.
8.3.2 Record Retention
All records must be maintained in a paper format for seven years from the date of submission of the final bill or until all billing-related questions are resolved, whichever is later. Local servers and personal computers may be used to complete records and to store copies of records. All local servers and/or personal computers are required to maintain a level of security that ensures records are maintained in a safe and confidential manner, as defined in the HHS Information Security and Privacy Initial Inquiry (SPI).
In addition to the requirements above, the service provider complies with the information and security and confidentiality requirements in the contract uniform terms and conditions.
8.4 Staff Qualifications
8.4.1 General Independent Living Services Staff Requirements
The service provider organizational and personnel assignment practices, as documented in written board policy, must comply with Section 503 of the Act, including taking affirmative action to employ and promote qualified individuals with significant disabilities.
A service provider must also document that the majority of its staff members, including members in decision-making positions, are people with disabilities.
18.104.22.168 Staff Qualifications
The service provider staff members must include specialists in developing and providing independent living services and in developing and supporting a service provider. To the greatest extent possible, staff should be available who are able to communicate
- with individuals with significant disabilities who rely on alternative modes of communication, such as manual communication, nonverbal communication devices, braille, or audiotapes;
- with people who apply for or receive independent living services under Title VII of the Act; and
- in the native languages of individuals with significant disabilities whose English proficiency is limited and who apply for or receive independent living services under Title VII of the Act.
22.214.171.124 Staff Training and Development
The service provider must establish and maintain a program of staff development for those involved in providing independent living services. Staff development programs should emphasize improving the skills of staff members directly responsible for providing independent living services, including knowledge and practice of the independent living philosophy. The service provider must provide training to its staff on how to serve unserved and underserved populations, including minority groups and urban and rural populations, as evidenced by in-service training records.
126.96.36.199 Contractors Standards of Conduct
Service providers must maintain and implement written standards of conduct for staff members.
Service providers are expected to perform contractual services in a professional manner at all times to include:
- interaction with consumers and HHSC staff in a professional manner;
- appropriate dress (generally business casual attire) when providing services;
- maintaining the confidentiality of all consumer information in full compliance with state and federal regulations and in accordance with sound professional practices;
- obtaining a confidentiality release for any person attending the meeting with the consumer who is not the consumer's legal guardian;
- accepting liability for the actions and/or contract performance of all individuals, sub-contractors, and other personnel who may be working for the contractor; and
- not performing acts which are or could be perceived as being inappropriate behavior with any consumer or consumer's family member, including, but not limited to:
- abuse of any consumer or consumer's family member;
- negative impacts to the health, safety, or welfare of any consumer or consumer's family member;
- relationships with consumers or HHSC staff that would impair the contractor's objectivity in performing their duties or that would endanger confidentiality;
- allowing the presence of any third party when meeting with the consumer at their home or business unless that third party is an attendant to the contractor; or
- contacting the liaison for verification of confidentiality releases when other parties are present.
188.8.131.52 Conflict of Interest
Service providers and potential contractors may not offer, give, or agree to give HHSC staff anything of value. This includes, but is not limited to, prepared foods, gift baskets, promotional items, gift cards or meals. If a violation occurs, corrective action may be required, up to and including contract termination or disqualification from receiving a future contract.
8.4.2 Qualifications for Staff Members Who Provide Services to Individuals With Significant Disabilities
Staff members managing independent living services cases, determining eligibility, writing independent living plans and providing or coordinating services for adults who have a significant disability, must have a bachelor’s degree in an appropriate field. This qualification additionally requires a minimum of one year of experience in rehabilitation services or two years of experience in providing similar independent living services, such as education, human services, or counseling, for individuals who have a significant disability.
The qualifications for subcontractor and vendor staff members are covered in the Appendices for Purchased Services, as referenced under 6.3 Description of Purchased Services.
8.4.3 Qualifications for Staff Members Who Provide Services to Individuals Who Are Deafblind
Staff members must have a bachelor's degree in education or a related field, with a working knowledge of the following:
- The medical, psychological, social, and independent living issues faced by persons who are deafblind, visually impaired and/or hard of hearing, or otherwise disabled with a dual sensory loss
- Assessment techniques and tools
- American Sign Language, augmentative communication, manual communication, and other appropriate communication systems, as well as knowledge of agencies, individuals, and facilities that serve people who are deafblind (with or without additional disabilities) or serve the culture and adaptive needs of people who are deafblind
The ability to:
- adapt teaching methods to the needs of persons who are deafblind and/or multiply disabled and are elderly;
- assist consumers to adapt or modify common items in the home to make the items accessible; assess, formulate, organize, and implement an individualized program of instruction with consumers; teach consumers to read and write all aspects of uncontracted braille;
- communicate using American Sign Language, including tactile sign language;
- teach assistive technology, as required for the consumer’s access to independent living skills; and
- deliver, install, and set up adaptive aids and/or devices.
8.4.4 Qualifications for Staff Members Who Provide Orientation and Mobility (O&M) Services
Staff members will need to meet one of the following requirements:
- The service provider is certified by either the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) or the National Blindness Professional Certification Board (NBPCB).
- The service provider is not certified at the start of employment, but he or she:
- has a degree in O&M from an accredited college or university with an established O&M training curriculum and will be certified within one year of the contract date by ACVREP or NBPCB; or
- has at least two years of full-time work experience teaching O&M skills for a recognized entity, such as a rehabilitation center, Veterans Affairs Hospital, or educational system; and also:
- has three professional references indicating the person's ability to teach O&M skills to blind or visually impaired people; and
- will be certified within one year of the hire date by ACVREP or NBPCB.
8.4.5 Qualifications for Staff Members Who Provide Diabetes Education or Self-Management Skills Training
Staff members must be health professionals who meet all of the following requirements:
- Be licensed or registered, as required by the staff members profession
- Have completed the basic academic requirements for his or her field
- Have practiced for at least one year
- Have one year of diabetes education experience
A diabetes educator must be a registered nurse (RN), registered dietician (RD), or certified diabetes educator (CDE). For RNs and RDs, the educator must keep a copy of the employee’s active license on file. For a CDE, the educator keeps a copy of the service provider’s current certification from the National Certification Board for Diabetes Education or the American Association of Diabetes Educators on file.
Through academic preparation, continuing education, or on-the-job training, the employee will have developed:
- a knowledge and understanding of diabetes and its management, including the nutritional and pharmaceutical aspects of care;
- a knowledge and understanding of basic educational and behavioral science;
- a knowledge of the evidence-based nutritional, pharmaceutical, and therapeutic care needed for a person with diabetes; and
- the additional skills necessary to work in a thorough and efficient manner, such as planning, organizing, communicating, cooperating, delegating, and working without direct supervision.
A CDE, RN, or RD must have at least one year of paid experience providing diabetes education. RNs and RDs must have completed 15 hours of continuing education units (CEUs) on diabetes from an accredited agency within the 12 months immediately preceding employment. A CDE must have completed 10 hours of CEUs on diabetes from an accredited agency within the 12 months immediately preceding employment.
The CEUs must be from an agency approved by the individual's licensing or certifying body.
8.5 Voter Registration
Based on federal and state laws, a service provider must establish a written policy to ensure that consumers are offered an opportunity to register to vote when they first apply for services or when they report a change of address. Federal and state laws require HHSC to provide voter registration services to consumers.
Federal and state laws include the following:
The policy applies to consumers who are at least 17 years and 10 months of age.
The voter registration coordinator for HHSC serves in a liaison role to the Office of the Secretary of State regarding training and compliance. The voter registration coordinator for HHSC ensures that the service provider receives the approved State Voter Registration Card (English and Spanish versions available). The service provider must use the State Voter Registration Card provided by the voter registration coordinator for HHSC. This State Voter Registration Card contains an identification number associated with HHSC for compliance monitoring.
The service provider offers the consumer the opportunity to register to vote at the time of application for services or when the consumer reports a change of address.
Service providers are prohibited from:
- influencing a consumer’s political preference or party registration;
- displaying political preference or party affiliation;
- making any statement or taking any action to discourage a consumer from registering to vote; and
- documenting in the consumer case file the response and action that the consumer takes after being given the opportunity to register to vote.
Service providers must refer consumers to the Elections Office of the Secretary of State, 1-800-252-8683, and to the County Voter Registration Officials for questions that HHSC employees cannot answer.
8.5.1 Procedures - Application for Services
When a consumer applies for services, the service provider:
- offers the consumer the opportunity to register to vote;
- provides a voter registration card for the consumer to mail or helps in filling out the voter registration card, if help is requested; and documents in the consumer’s case file that the consumer was given the opportunity to register to vote but does not document the consumer's response or actions.
8.5.2 Change of Address
When a consumer reports a change of address, the service provider:
- offers the consumer the opportunity to register to vote at the new address;
- mails the consumer a voter registration card when the change of address is reported by telephone, or provides a voter registration card for the consumer to mail (or helps the consumer fill out the voter registration card, if help is requested), when the change of address is reported in the service provider’s office or in the consumer’s home; and
- documents in the consumer’s case file that another opportunity to register to vote was given but does not document the consumer's response or action taken.
All services purchased by the service provider for consumers must be provided in an accessible manner.
Each service provider subject to the Independent Living Services Standards will provide the results of a self-evaluation along with a written explanation, if necessary, of how its services will be provided in an accessible manner:
- before being approved to provide services to consumers for the first time;
- before the renewal of the service provider’s contract;
- before being approved to provide services at a new address; or
- at the request of HHSC.
A self-evaluation instrument is available on the ADA Checklist for Existing Facilities page of the New England ADA Center’s website.
If HHSC receives a complaint regarding the accessibility of the services of a particular service provider, HHSC investigates to determine whether a violation of contract terms has taken place.
The Architectural and Transportation Barriers Compliance Board has issued ADA Accessibility Guidelines (ADAAG), which must be applied during the design, construction, and alteration of buildings and facilities covered by titles II and III of the Americans with Disabilities Act (ADA). These guidelines have been adopted by the U.S. Department of Justice as Appendix A to its ADA Title III rules.
The guidelines are published on the ADA Standards page of the United States Access Board’s website.
To obtain a copy of the ADAAG or other information from the U.S. Department of Justice, call 1-800-514-0301 Voice, (202) 514-0381 TTY, or 1-800-514-0383 TTY. For technical questions, contact the Architectural and Transportation Barriers Compliance Board at 1-800-USA-ABLE.
In addition, the Texas Department of Licensing and Regulation administers the state Architectural Barriers Act, Article 9102, Texas Civil Statutes. The Texas Accessibility Standards (TAS) are based on the ADAAG standards and apply to buildings and facilities constructed on or after April 1, 1994.
The TAS are published on the Architectural Barriers Texas Accessibility Standards page of the Texas Department of Licensing and Regulation’s website.
Copies of TAS can be purchased from the:
Office of the Secretary of State Texas Register Division
PO Box 13824
Austin, Texas 78711-3824
8.7 Financial Management System
The financial management system of the service provider must provide for the following:
- Identification, in its accounts, of all federal awards received and expended and the federal programs under which they were received. Federal award Catalog of Federal Domestic Assistance numbers will be provided as invoices are received and reimbursements are made.
- Accurate, current, and complete disclosure of the financial results of each federal award or program, in accordance with the reporting requirements set forth under 2 Code of Federal Regulations (CFR), Subtitle A, Chapter II, Part 200, Uniform Guidance, Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards §200.327 Financial reporting, and §200.328 Monitoring and reporting program performance.
- Records that identify adequately the source and application of funds for federally funded activities; contain information pertaining to federal awards, authorizations, obligations, unobligated balances, assets, expenditures, income, and interest; and are supported by source documentation.
- Effective control over, and accountability for, all funds, property, and other assets.
- Comparison of expenditures with budget amounts for each federal award.
- Written procedures to implement the requirements of 2 CFR, §200.305 Payment.
- Written procedures for determining the allowability of costs, in accordance with 2 CFR, Part 200, Subpart E—Cost Principles, and the terms and conditions of the federal award.
The service provider must maintain an accounting system and records in which separate records are maintained for each funding source provided by HHSC and other funding sources. A cost center objective must be set up for the Independent Living Services (ILS) Program contract separate from other HHSC grants or contracts.
The service provider must be able to account for ILS Program costs applicable to consumers served in accordance with the rules in the 40 TAC Chapter 104, Independent Living Services, and with the Independent Living Services Standards.
The methods used to account for these costs, as documented, recorded, and tracked, include:
- identifying the eligible consumers served and recording the services provided from intake to closure;
- setting up separate account codes for budget categories applicable to costs for the services provided and other non-purchased service costs
- establishing a system for employees to record the time and/or resources spent and the costs for salaries, wages and fringe benefits, based on records that accurately reflect the work performed;
- recording and allocating all expenses applicable to program activities by budget category;
- reporting separate expenses by funding sources on invoices that bill for ILS Program costs; and
- entering information in the Independent Living Services Data Reporting System, as required.
8.7.1 Request for Payment
Service providers can request payment as a cost reimbursement contract or an advance payment contract.
- Cost Reimbursement ─ Service providers classified as cost reimbursement contracts are reimbursed for allowable incurred costs. Monthly expenses will be reported using the HHSC ILS Invoice Workbook. Both the HHSC ILS Invoice Workbook and a signed monthly invoice should be submitted by the 10th day of the month following the month the expenses were paid. Service providers classified as cost reimbursement contracts are not eligible to receive advance payments.
- Advance Payment ─ Service providers classified as advance payment, that meet the contract requirements, may request advance payments. Advance payment for operating funds for no more than 90 days in advance may be requested each quarter. If advanced funds are not expended during the quarter of the request, they must be adjusted on the next request. Advance requests will be made using the HHSC ILS Invoice Workbook. The HHSC ILS Invoice Workbook and a signed Quarterly Advance, printed from the workbook, should be submitted when requesting an advance. In addition, the HHSC ILS Invoice Workbook and a signed monthly invoice should be submitted by the 5th day of each month.
If the service provider does not meet the requirements of the contract, HHSC may:
- adjust payments;
- reimburse based on actual costs already incurred;
- require additional supporting documentation to make payments; and
- take other action as appropriate.
If reimbursement funds are requested, the HHSC ILS Invoice Workbook must be submitted to HHSC within five days after the end of the month for which reimbursement is requested.
8.7.2 Cost Allocation
The service provider is reimbursed for allowable budgeted expenses incurred and is paid for providing services that are consistent with the terms of the contract.
Title 2 Code of Federal Regulations (CFR), Subtitle A, Chapter II, Part 200, Subpart E Cost Principles, part of the Uniform Guidance, provides for guidance for allowability of contract award costs. All costs are to be billed and reimbursed based on the approved cost allocation plan, during the contract application or updated after the award.
For facilities and administration (F&A) costs, the service provider may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC) or use a federally approved indirect cost rate. HHSC must be provided with a copy of the federally approved indirect cost rate in order to allow that rate. Any indirect cost rate in the contract budget should be included on the approved cost allocation plan.
8.7.3 Program Income
Program income is gross income earned and directly generated by a supported activity of the contract award. Program income will supplement the funds awarded by HHSC and expended during the contract term they are earned. Program income funds will be applied to purchases before HHSC funds are expended. Program income not expended in the term in which it is earned shall be refunded to HHSC or deducted from future payments.
When a consumer participates in the purchase of goods or services, as required by the Independent Living Services Standards (such as purchasing complex rehabilitation technology), the service provider is required to record the funds received from the consumer as program income applicable to the Independent Living Services Program.
The service provider must ensure that it has sufficient controls for:
- billing consumers for their share of financial participation;
- receiving the funds from the consumer;
- depositing the monies with other funds;
- properly recording the monies in Independent Living Services Program accounts; and
- reporting on the program income, as required.
The service provider must ensure that program income is spent during the current fiscal year to provide the independent living services that are outlined in Chapter 3: Scope of Independent Living Services, 3.1 Scope of Services.
Records must include:
- the sources of the program income;
- the amount of the program income received; and
- the quarterly financial reports, consistent with accounting records.
8.8 Records Management
The service provider must establish records management policies and procedures that ensure compliance with the HHSC contract and applicable recordkeeping requirements under 2 Code of Federal Regulations (CFR), Part 200, including applicable safeguards for confidential information.
The service provider’s records must fully disclose and document:
- the amount and disposition of grant funds;
- the cost of the project for which grant funding is given or used;
- the amount of project cost funding supplied by other sources, to include comparable services or benefits, insurance, and consumer financial participation; and
- compliance with the requirements of 29 U.S.C. 796c(m)(4) and 34 CFR §364.35, pertaining to maintenance and management of records.
The service provider’s recordkeeping system must contain data concerning the grant program's funds, including the information necessary to receive payment.
Other program records requirements are covered under the service delivery process.
8.9 Veterans Services
The service provider must include the following statement created by HHSC, based on Texas Senate Bill 1677, in the application process:
Men and women who serve or have ever served in any branch of the United States Armed Forces, including Army, Navy, Marines, Air Force, Coast Guard, Reserves or National Guard may be eligible for additional services. For more information, visit www.tvc.texas.gov, the Texas Veterans Portal or call TexVets at 800-252-8387.
8.10 Physical Locations
Any service provider that owns, leases or uses dedicated space in which HHSC consumers will be provided services is considered to have a physical location.
The service provider must complete the Services Provider Physical Location Information form for each facility.
8.10.1 Occupation Permit or Building Permit
Environmental safety must comply with local building occupancy codes. Providers must provide documentation of compliance to HHSC at application and to the liaison whenever the physical location changes. Renters should contact their landlords to obtain such documentation.
8.10.2 Fire Safety
Each provider must:
- comply with the local fire code to gain a fire inspection report, or gain an inspection by the fire marshal with local jurisdiction; and
- provide a copy of the appropriate certificate of compliance at application and to the HHSC liaison when updated.
Providers who rent must contact their landlords for appropriate documentation.
Most fire departments conduct inspections but need advance notice to schedule an inspection. If the contractor's local fire department does not conduct inspections, the contractor may request an inspection from the Texas Department of Insurance, State Fire Marshal's Inspection Services Division, 333 Guadalupe, Austin, Texas 78701, Telephone 512-305-7900.
In each physical location where services are provided, the provider must have:
- working smoke detectors;
- visible (flashing) and audible fire warning signals;
- fire extinguishers that are "in date" with annual inspections placed in accessible locations; and
- identified accessible fire escape routes free and clear of obstructions.
Each entity must have a policy that requires all fires to be reported to the HHSC liaison within one workday.
8.10.3 General Building Safety
Aisles and work safety zones must be accessible.
Hazardous or flammable materials must be appropriately identified, used and stored in a safe manner. These materials should be stored in a secured metal cabinet.
Machinery with moving parts must be equipped with appropriate protective guarding and instructions for safety.
Each facility and the entity headquarters must maintain a paper copy of the completed "ADA Checklist for Existing Facilities" found at ADA Checklist for Existing Facilities. HHSC staff members may inspect the physical location for accuracy of responses provided on the "ADA Checklist for Existing Facilities" and for compliance with meeting the consumer's needs related to accessibility. HHSC may also request access to the completed checklist at any time, such as at liaison visits and monitoring reviews.
If an item or location on the checklist is found to not be accessible, describe how the physical location will ensure services will be provided to HHSC consumers who will be using the area(s) found to not be accessible.
8.10.5 Safety Plan
Each provider must have a safety plan for each physical location that ensures the safety and health of the staff, the consumers, and the visiting public. The plan must include:
- quarterly fire drills;
- emergency evacuation procedures;
- emergency exit diagrams;
- procedures for obtaining emergency medical services from a doctor, hospital or emergency medical service unit; and
- special procedures for consumers with disabilities who require particular attention or action, including those whose behavior may be detrimental to the health, safety, or require assistance from others to successfully engage in services.
Each provider must have an incident reporting system in place. A form for staff reporting of incidents must be developed.
The minimum information required on the incident report form must include:
- date, time and place of the incident;
- nature of the incident;
- names of HHSC consumers, witnesses or others involved;
- name of the person making the report;
- description of the incident; and
- actions taken and planned by the provider as a result of the incident.
Upon request, copies of incident reports pertinent to HHSC consumers must be made available to HHSC staff members.
The following incidents must be reported to the referring HHSC liaison and program manager by close of business the next workday:
- emergency evacuations;
- emergency medical services (EMS);
- emergency room treatment;
- hospitalization; or
Chapter 9, Technical Assistance and Training
Revision 19-1, Effective March 1, 2019
Training and technical assistance shall be provided for service providers under the Independent Living Services (ILS) Program, in accordance with Texas Human Resources Code, §117.080(e), and Chapter 104 Independent Living Services.
HHSC evaluates the independent living services provided to consumers and gives technical assistance and training, as needed, to help the service provider offer a full range of independent living services according to the independent living services rules and the Independent Living Services Standards.
Documentation obtained from the contract application and monitoring activities provide input that can be used to develop or improve the technical assistance and training opportunities offered to individual service providers.
Contract managers and other HHSC staff members provide technical assistance, as needed, throughout the term of the contract. Technical assistance may include help to expand a service provider’s capacity to provide a full range of independent living services.
Technical assistance may be provided by phone, email, or during on-site visits, and can include circumstances such as:
- turnover in key agency or service provider staff members;
- difficulty with following contract terms and conditions, policies and procedures, or reporting requirements;
- clarification of health and human services agency policies;
- clarification of monitoring and oversight requirements;
- billing or payment issues;
- service delivery, including conducting assessments, direct delivery of services, and development of independent living plans and appropriate documentation; or
- other identified needs.
Technical assistance may be provided more frequently for new service providers or when significant program changes are being implemented. Technical assistance also may be necessary for improving contract performance, overseeing compliance, supporting successful contract outcomes, and clarifying expectations.
Technical assistance provided is documented by HHSC and communicated in writing to the service provider, as appropriate.
Training for independent living service providers under this program may include information on:
- the independent living philosophy;
- methods for training and assessing the needs of individuals who are blind;
- training techniques and service delivery methodologies for special populations; and
- the administration, operation, evaluation, and performance of independent living services according to the rules for independent living services, the Independent Living Services Standards, and the contract requirements.
Training opportunities will be developed and coordinated with HHSC and with service providers.
New service providers will be required to participate in comprehensive orientation that covers contract and program requirements, to be held shortly before or after the contract start date. Other training may include required and optional training opportunities for program improvement.
Chapter 10, Reporting and Quality Assurance
Revision 19-1, Effective March 1, 2019
Each service provider must develop a written quality assurance program for review of program activities that evaluate compliance with the independent living services rules and the Independent Living Services Standards. That system must, at a minimum, include regular reviews of case service records, entry in the Independent Living Services (ILS) Data Reporting System, eligibility determinations, and adherence to purchasing procedures. A minimum of 10 percent of all case service records must be reviewed annually by staff members who are not directly involved in the delivery of services under this funding source.
An ILS Data Reporting System was developed for the Independent Living Services Program to gather, track, and monitor program performance and financial data. Each service provider will be required to enter data into this system at least monthly and in accordance with the training and instructions provided in the system user manual.
Other reporting requirements are addressed in the approved work plan and standard assurances, as part of contract requirements.
The written quality assurance review system must include:
- conducting annual self-evaluations;
- obtaining consumer satisfaction surveys;
- completing case reviews;
- supervising program staff members;
- monitoring vendors and/or contractors for purchased goods and services;
- maintaining records to track and measure performance compared to targets established in the approved work plan;
- making process improvements; and
- implementing corrective actions in response to HHSC monitoring reviews.
10.1 Annual Self-Evaluation
Entities must collect data and review to track performance. When data indicates improvements are necessary to enhance the entity's performance and consumer satisfaction, an action plan must be created and monitored until improvement is made to a successful level measured by goals in the action plan.
10.1.1 Consumer Satisfaction Surveys
Consumer satisfaction measures input from consumers about benefits received from provider services.
Each provider may develop its own survey instrument and procedure. However, at a minimum, the survey instrument must use a Likert scale and include the following statements:
- I was treated in a friendly, caring, and respectful manner by the staff of [insert provider name].
- Services were provided in a timely manner.
- The services met my needs.
- I was satisfied with the services provided.
|3||Neither agree nor disagree|
All consumers, both successful and unsuccessful, must be given the opportunity to respond.
The provider must calculate an average consumer rating on the Likert scale for each of the four required statements.
10.2 Required Reports
A service provider that receives funding under the contract must submit program and financial reports, as described below. The service provider’s records must support all of the data reported, including information entered into the Independent Living Services Data Reporting System and recorded on fiscal reports matching amounts in accounting records.
10.2.1 Program Reports
The service provider is required to enter or upload data into the Independent Living Services (ILS) Data Reporting System by the fifth day of the following month in accordance with the user guide instructions. The ILS Data Reporting System captures program performance and financial data about each ILS Program contract, including data on:
- waiting lists;
- monthly consumer participation;
- successful and unsuccessful case closures; and
- consumer purchases service records.
HHSC will use information in this data reporting system to monitor the ILS Program contracts. The database will provide information for the following:
- Key performance measures, including:
- the number of consumers receiving independent living services;
- the average number of people receiving an independent living service; and
- the number of consumers who achieve independent living goals.
- Work plan targets, including:
- a certain percent of consumers served who are deaf or hard of hearing;
- a certain percent of consumers served who are blind or visually impaired; and
- the minimum percent of the approved budget to be spent on purchased goods and services, including complex rehabilitation technology.
On a monthly basis (also by the fifth day after the end of the previous month), service providers also will be required to enter consumer success stories into the Independent Living Services Data Reporting System. These consumer success stories should include examples of consumers served with different disabilities, including consumers who are deaf or hard of hearing and blind or visually impaired.
10.2.2 Financial Reports
The service provider is required to complete financial reports for the Independent Living Services Program contract, to include the original annual budget, Form 3001, Quarterly Financial Report, Form 3003, Quarterly Program Income Report, and Form 3000, Budget Revision Request. The Budget Workbook, based on an Excel template, is used for completing these quarterly or annual financial reports.
A service provider submits Form 3001 to the HHSC contract manager within 30 days after the end of the quarter. Form 3001 for the fourth quarter will be due within 45 days after the end of the year.
The financial reports are linked in the Budget Workbook to facilitate completion of the reports and to support ongoing budget oversight, including a comparison of actual-to-budgeted funds. When a financial report is completed, it should be saved separately, named appropriately, and submitted to the contract manager according to the instructions.
10.2.3 HHSC ILS Invoice Workbook
As described under 8.7.1: Request for Payment, the HHSC ILS Invoice Workbook is used to request funds for contract costs.
The HHSC ILS Invoice Workbook must be completed and submitted within five days after the end of the reporting month and must be approved before the advance is paid. The service provider can receive advance funds (that is, funds received before the expense is incurred) for an amount equal to 90 days of operating funds or less, if the contract requirements are met.
In the case of a request for reimbursement, the costs should reflect allowable costs for the period billed.
10.2.4 Audit Requirements
In accordance with contract assurances, all service providers are required to obtain an annual financial audit conducted by an independent auditor in compliance with Generally Accepted Auditing Standards (GAAS), as published by the American Institute of Certified Public Accountants.
The service provider must arrange for a financial and compliance audit (Single Audit), if required, in accordance with 2 Code of Federal Regulations (CFR), Part 200, Uniform Guidance, Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards and/or Uniform Grant Management Standards (UGMS) State of Texas Audit Circular.
If a Single Audit is not required, the service provider shall obtain an annual audit of its financial statements.
The service provider will be given instructions for audit submission to the HHSC.
Chapter 11, Contract Monitoring
Revision 19-1, Effective March 1, 2019
Contracts with service providers that provide independent living services under the Independent Living Services (ILS) Program will be monitored in accordance with the Health and Human Services System Contract Management Handbook (CMH) published pursuant to Texas Government Code, §2261.256, on the Texas Comptroller of Public Accounts webpage.
Contract monitoring is the systematic review of a service provider’s records, business processes, deliverables, and activities to ensure compliance with the terms and conditions of the contract. The goal of contract monitoring is to protect the health and safety of consumers who receive services, to ensure delivery of quality goods and services, and to protect the financial interest of the state. Monitoring includes planned, ongoing, periodic, or unscheduled activities that cover financial, programmatic, and administrative components.
The assigned contract manager will be primarily responsible for oversight and monitoring of the contract, based on risk, to include:
- a contract award approved budget and work plan;
- uniform terms and conditions;
- any special provisions or restrictions;
- deliverables and performance measures or targets; and
- billing or invoicing for costs with actual-to-budget trends.
The Independent Living Services Program and compliance staff will have roles and responsibilities for monitoring Independent Living Services Program contracts in accordance with the Health and Human Services System CMH. These responsibilities will include monitoring and quality assurance requirements of the Independent Living Services Standards.
A monitoring team is comprised of representatives from HHSC staff. When a contractor is selected for an announced monitoring review, the lead monitor sends a letter announcing the review, providing information about the scope of the review, and providing instructions on how to prepare for the review.
The monitoring review typically consists of three parts:
- entrance conference;
- records review; and
- exit conference.
At the entrance conference, the lead monitor:
- introduces the monitoring team members;
- briefly explains the monitoring process, purpose and scope of the review;
- requests that the contractor assign a person who will be accessible to and work with the team; and
- ensures the team has an acceptable work area to use while conducting the review, if conducted at the service provider’s facility.
During the records review, the monitoring team:
- completes appropriate monitoring tools;
- reviews the contractor's files;
- compares information in the contractor's files with information in the HHSC files; and
- may conduct consumer interviews or observations.
The exit conference is held at the conclusion of the review. At the exit conference, the lead monitor verbally provides the contractor with:
- preliminary review results;
- any anticipated recoupment amount;
- notice that HHSC will send the contractor a findings report, if applicable; and
- information on the time frames and process for the contractor's response and the importance of meeting deadlines.
For routine monitoring reviews, the lead monitor sends the service provider written notice of the results of the monitoring review through either a monitoring review closeout letter or a findings report, if instances of noncompliance were noted.
The findings report:
- includes findings of noncompliance with program or financial standards; and
- asks the service provider to either:
- offer a corrective action plan, or
- provide further documentation to help resolve the findings.
If HHSC has requested the service provider submit a corrective action plan, the contractor must, by the date requested in the report of findings:
- submit a corrective action plan, including financial restitution, if required; or
- rebut a finding and submit documentation that substantiates the rebuttal.
HHSC reviews the corrective action plan and may accept the corrective action plan or recommend changes.
If the service provider does not submit an acceptable corrective action plan or make financial restitution when required, HHSC may take adverse action against the contractor, which can include contract termination.
If there are no findings, or when the monitoring team accepts the corrective action plan, HHSC sends the contractor a letter to close the monitoring review.
Contract Noncompliance and Performance Deficiencies
HHSC may temporarily suspend a contractor from providing services for reasons such as:
- suspected fraud;
- suspected consumer abuse;
- failure to meet contract specifications; or
- failure to perform according to the terms and conditions of the contract.
Depending on the type and severity of the noncompliance, HHSC may require the contractor to take corrective action to return to compliance before the contractor is allowed to resume providing services.
HHSC may impose adverse actions in conjunction with, or instead of, requesting a corrective action plan. For example, HHSC may recoup overpayments from a service provider as part of a corrective action plan. Some situations may require HHSC to impose a more serious adverse action, such as contract termination and debarment, without allowing the service provider to take corrective action.
As described under Chapter 10 Reporting and Quality Assurance, the service providers that provide independent living services under the ILS Program are required to generate and provide performance monitoring data pursuant to Texas Human Resources Code, §117.080(d). The service provider will be required to submit contract performance data through methods established by HHSC. This will include periodic reporting of financial and performance data through standard reports or direct entry into an independent living data reporting system.
If a service provider also contracts with organizations or other persons to provide independent living services under the ILS Program, the service provider must establish and document a process for monitoring its contracts.
Texas law requires that allegations or incidents of abuse, exploitation, or neglect of persons with disabilities be immediately reported to the appropriate investigatory agency (see the table below), or, if taking place in other than a residential situation, the local law enforcement agency. If a licensed professional is involved, report to the appropriate professional licensure agency and the local law enforcement agency.
The service provider must develop written policies and procedures regarding the recognition and appropriate reporting of such allegations or incidents. These procedures must also require notification of the appropriate HHSC staff member within one working day. Procedures must also ensure cooperation with investigations conducted by the HHSC Ombudsman Office.
The appropriate investigating agency's toll-free number and the HHSC Ombudsman Office number 877-787-8999 or Relay Texas for people with a hearing or speech disability, 7-1-1 or 800-735-2989, must be posted in a location that is readily accessible to consumers and staff members.
|If the alleged abuse, exploitation, or neglect occurs in residential situations such as:||then report the incident to the HHSC Ombudsman Office and to the:|
|a Texas Health and Human Services Commission (HHSC) licensed assisted living facility, nursing home, adult day care facility, intermediate care facility for individuals with an intellectual disability or related conditions, or adult foster care||Texas Health and Human Services Commission Complaints Management and Investigations
P.O. Box 149030, Mail Code E-340
Austin, Texas 78714-9030
|a Texas Department of State Health Services licensed substance abuse facility or program||Texas Department of State Health Services Substance Abuse Compliance Group Investigations
1100 West 49th Street
Austin, Texas 78756, Mail Code 2823
|a Texas Department of State Health Services licensed hospital||Texas Department of State Health Services Facility Licensing Group
1100 West 49th Street
Austin, Texas 78756
Complaint Hotline 888-973-0022
a Texas Department of Family and Protective Services licensed childcare operation, including
Texas Department of Family and Protective Services Statewide Intake Division
Appendix A, Assistive Technology
Revision 19-1, Effective March 1, 2019
Evaluating Assistive Technology
Assistive technology evaluators must:
- have earned a degree from an accredited college or university with a specialization in computer science, education, rehabilitation, or a related field, with one year of work experience in the education or rehabilitation of persons who have visual disabilities and/or other disabilities; or have earned a high school diploma or passed a General Educational Development (GED) test, with four years of progressively responsible work experience in the education or rehabilitation of persons who have visual disabilities and/or other disabilities;
- be knowledgeable about computers and assistive technology, the applications of technology, and the methods of evaluating technology for persons who are blind or visually impaired;
- possess the ability to simulate computer and technological environments, similar to the situations that an individual may encounter on the job or in school;
- have the ability to conduct objective evaluations; and
- have the ability to make objective recommendations.
Assistive technology evaluations must be conducted one-on-one, with one evaluator assigned for each consumer.
Assistive technology evaluations determine the most effective assistive technology for meeting the consumer's independent living goals.
Assistive technology evaluations give consumers who are blind access to:
- the services of a knowledgeable assistive technology evaluator; and
- the latest assistive equipment.
Minimum Assessment Requirements
To meet the minimum requirements, the consumer must have:
- a typing speed of at least 30 words per minute (WPM), if the independent living goal is related to the purchase of computer software such as ZoomText, Window-Eyes, or JAWS; and
- a braille reading speed of 50 WPM in Grade 2 (uncontracted braille) using braille devices, when braille is the preferred reading format, if the independent living goal is related to the purchase of a braille display or braille note taker.
These minimum assessment requirements are evaluated on a case-by-case basis. For example, these requirements may be waived for consumers who have secondary disabilities that limit the use of one or both hands and for consumers who have sustained a traumatic brain injury. The evaluator should discuss these circumstances with the consumer's service provider as appropriate.
Evaluation Period for Assistive Technology
The length of time required to complete an assistive technology evaluation is based on the consumer's individual circumstances; therefore, there are no set time requirement for each evaluation. It is recommended, however, that the evaluator plan for about 2.5 hours.
Conducting the Evaluation
The evaluator must:
- remain impartial and objective throughout the evaluation process;
- not express personal opinions, make other comments, or take other actions that may be mistaken for bias or promoting one product over another during the evaluation;
- show consumers only the products that will assist the consumer in meeting his or her independent living goals;
- conduct the evaluation (including the evaluator's interview with the consumer) in a confidential manner; and
- not grant any person permission to observe the evaluation, unless:
- the consumer expressly agrees to allow the person to be present; and
- the observer agrees not to ask questions, make suggestions, or otherwise comment during the evaluation process.
Assistive technology evaluations include the following three components:
- A private interview is held with the consumer to discuss the individual's background and to review information developed by the service provider.
- The consumer's ability (or potential ability) to use assistive technology equipment and to benefit from the service provider's recommendations is assessed and observed.
- A closing interview is held to summarize the results of the evaluation process and is documented in the evaluation report.
Interview Process—Evaluation of Video Magnification Systems
The evaluator asks the following questions during evaluation interviews for video magnification systems (including closed circuit televisions or CCTVs):
- Is color identification critical to the consumer’s independent living goal?
- What specific tasks will the consumer be completing with a video magnification system; for example, reading (only) or reading and writing?
- Is the consumer able to read in an efficient manner using magnification of a video system? What level of magnification is required to read using the video magnification system?
- Does the consumer use a computer at home?
Interview Process—Evaluation of Scanners
During evaluation interviews for scanners, the evaluator should determine:
- whether the consumer has significant eye fatigue;
- whether the consumer has video magnification that is too large to be productive;
- whether the consumer feels nauseous when using the video magnification system;
- what the nature of the consumer's degenerative eye condition is;
- whether the consumer is fully aware of other resources, such as:
- the Texas State Library; and
- reader services (oral reading or related services for individuals who are blind); and
- what the consumer's computer needs are for using braille or speech-related features and any tasks that the consumer will perform using a scanner, including:
- entering scanned documents into a computer (Has the consumer brought samples of documents to be scanned or can he or she describe the documents?); and
- manipulating scanned documents on a computer.
Interview Process—Evaluation of Computer Applications
The following areas are addressed during evaluation interviews for screen magnification devices, refreshable braille display devices, and screen reader systems:
- If the consumer is using a computer to meet his or her independent living goals, the evaluator notes:
- the kind of computer the consumer is using;
- the software the consumer is using; and
- the access equipment the consumer is using.
- The evaluator discusses as many aspects of the consumer's independent living goal as possible, takes notes, and rechecks the consumer file for discrepancies. If possible, the evaluator uses information documented in the file to elicit additional details about the consumer's independent living tasks.
- The evaluator documents the consumer's skill level, including:
- typing speed;
- accuracy; and
- keyboard familiarity.
- The evaluator notes the consumer's previous computer experience, including:
- the type of computer used;
- the type of software used;
- where and when the consumer acquired the experience; and
- whether the experience was acquired before the loss of vision.
- The evaluator asks whether the consumer has experience with:
- computer access equipment;
- video magnification systems, including CCTVs;
- computer braille devices;
- refreshable braille display devices; and/or
- synthesized speech devices.
When the interview and product evaluations have been completed, the assistive technology evaluator:
- discusses with the consumer the evaluator's equipment recommendations and the consequences of the recommendations; and
- answers any questions the consumer has about the recommendations and/or the evaluation process.
The service provider also reminds the consumer that:
- the purpose of the evaluation is to enable the evaluator to make recommendations; and
- the only decision that the consumer’s evaluator can make is whether to purchase (or not to purchase) assistive technology equipment.
Documenting the Assessment
Documentation of the assessment should contain the following:
- Information about any specific evaluation requirements for the type of assistive technology evaluated.
- Minimum assessment requirements addressed (such as typing speed or braille reading speed) or the reason for waiving the requirement.
- A list of the products that were evaluated with the consumer.
- Any previous experience the consumer has had with assistive technology.
- The final recommendation and an explanation how the assistive technology will assist the consumer in meeting his or her independent living goals.
Providing Training on Assistive Technology
Training is provided to prepare a consumer to use assistive technology effectively to meet the consumer’s independent living goals. Training may be provided at a facility, on-site at a consumer's home, or in a community resource center. Facility-based trainers or on-site trainers can provide group training.
Assistive technology trainers must:
- have a high school diploma or GED;
- be knowledgeable about computers and assistive technology that is designed for people who are blind or visually impaired;
- be familiar with computer and assistive technology applications for people who have visual disabilities and/or other disabilities;
- be familiar with appropriate instructional methods for people who have visual disabilities and/or other disabilities and participate in required training as developed that may include confidence builder training or its equivalent;
- have the ability to vary training to meet the specific needs of each consumer; and
- demonstrate proficiency in assistive technology training on specific assistive equipment, in accordance with HHSC standards and any periodic proficiency tests required by HHSC.
For conducting group training on assistive technology, the staff-to-consumer ratio may not exceed one staff member to three consumers (1:3).
Scope of Services
Assistive technology trainers provide the following services:
- Baseline assessment
- Training that includes:
- basic computer hardware and software, including keyboarding (for approved facilities only), introduction to computers, introduction to application software, use of the Internet, and printing and faxing using computers that are equipped with assistive software and designed for users who have low-vision or are blind;
- advanced computer software, including advanced skills training in computer hardware and software applications; and
- assistive technology, including training in specific assistive technology products
- Post-training assessment
The assistive technology trainer administers a basic skills test to each consumer who is referred for assistive technology training. The baseline assessment is used to determine the level of training required for each consumer.
Assistive technology refers to mechanical aids that substitute for or enhance physical or mental functions that are impaired. Assistive technology can be any item—whether homemade, purchased off the shelf, modified, or commercially available that is used to help an individual perform a task of daily living. The Individuals with Disabilities Education Act, as amended, defines assistive technology device. See 34 CFR, §300.5, Assistive technology device.
Using assistive technology can increase a person’s level of independence by:
- improving the quality of life;
- increasing productivity;
- expanding educational options;
- increasing opportunities for success;
- reducing the need for support services; and
- increasing participation in activities.
Assistive technology helps persons with disabilities become independent. It improves self-esteem and quality of life.
Assistive Technology Services
Assistive technology services help an individual with a disability select, acquire, or use an assistive technology device.
The services can include:
- assessing the individual's need for assistive technology;
- training the individual to use the assistive technology;
- training the family and/or supervisor to use the assistive technology for reinforcement and backup; and
- fitting, adapting, maintaining, and repairing the assistive technology, as needed.
Examples of Assistive Technology
Assistive technology includes low-, mid-, and high-tech devices or equipment.
Low-tech Assistive Technology
Low-tech assistive technology refers to devices or equipment that does not require much training, that is relatively inexpensive, and that does not have complex or mechanical features.
Handheld magnifiers, large print text, canes or walkers, color coding, automatic lights, and specialized pen or pencil grips.
Mid-tech Assistive Technology
Mid-tech assistive technology refers to devices or equipment that may have complex features, may be electronic or battery-operated, or may require training to use. Mid-tech devices and equipment are also more expensive than the low-tech devices and equipment.
Talking spell-checkers, manual wheelchairs, electronic organizers, closed-caption televisions, amplifiers, text pagers, larger computer monitors, books on tape, remote controls for the user’s environment, and an alternate mouse or keyboard for a computer.
High-tech Assistive Technology
High-tech assistive technology refers to the most complex devices or equipment. High-tech items have digital or electronic components, may be computerized, will likely require training and effort to learn to use, and cost more than low- and mid-tech items.
Power wheelchairs or scooters, prosthetic devices, digital hearing aids, computers with specialized software such as voice recognition or magnification software, electronic aids to daily living, voice-activated telephones, and communication devices with voices.
Assistive Technology Can Reduce Barriers
Using assistive technology reduces barriers and increases independence. It allows a person with disabilities to perform essential functions. Many consumers know what type of assistive technology device is needed to accomplish a task. If a consumer does not know, talking with the consumer and trying available low tech items may help figure out what will work best. Other times, obtain a formal assistive technology evaluation to assess the person’s circumstances and abilities and to determine what assistive technology device or equipment is needed. Finally, talking with someone who has been through a similar experience may help you figure out which assistive technology device to use.
One Size Does Not Fit All
People with the same disability do not always have the same functionality. An assistive technology that works for one person may not work for another. It is best to work with rehabilitation professional to obtain an assessment before buying a high-tech item. Many low- or mid-tech items can be purchased off-the-shelf from a vendor of durable medical equipment.
Resources for Obtaining Information on Assistive Technology
To obtain advice before purchasing assistive technology, contact an unbiased resource, such as the Assistive and Instructional Technology Lab at the University of Texas Austin. Many vendors can offer professional advice, as well; however, use caution and consider whether a less-expensive product will meet an individual’s needs.
Appendix B, Counseling
Revision 19-1, Effective March 1, 2019
Cognitive Rehabilitation Therapy
A cognitive rehabilitation therapist provides cognitive rehabilitation therapy.
Cognitive rehabilitation therapy focuses on the development of the cognitive skills (that is, the ability to perceive, recognize, conceive, judge, imagine, and reason) that are lost or altered as a result of neurological damage. The aim of treatment is to enhance functional competence in real-world situations.
The therapy includes:
- direct retraining;
- use of compensatory strategies; and/or
- use of cognitive tools.
The therapist must be licensed as one of the following:
- A psychologist licensed by the State Board of Examiners of Psychologists
- A psychiatrist licensed by the State Board of Medical Examiners
- An occupational therapist licensed by the Executive Council of Physical Therapy and Occupational Therapy Examiners
- A speech and language pathologist certified by the State Committee of Examiners for Speech and Language Pathologists and Audiologists
The required procedures are as follows:
- Evaluation and recommendation by a psychologist or psychiatrist
- Approved treatment plan limited to achieving independent living (IL) goals with specific intervention (ordinarily no more than 12 sessions)
Vendor Qualifications and Required Procedures
A licensed marriage and family therapist (LMFT) provides goal-oriented or problem-centered counseling services.
An LMFT must be licensed by the Texas State Board of Examiners of Marriage and Family Therapists.
The required procedures are as follows:
- Evaluation and prescription by a psychiatrist or psychologist
- Approved treatment plan limited to achieving IL goals with specific intervention (ordinarily no more than 12 sessions)
A licensed professional counselor provides goal-oriented or problem-centered counseling services. The counselor must be licensed by the Texas State Board of Examiners of Professional Counselors.
The required procedures are as follows:
- Evaluation and prescription by a psychiatrist or psychologist
- Approved treatment plan limited to achieving IL goals with specific intervention (ordinarily no more than 12 sessions).
A psychiatric-mental health advanced practice nurse provides evaluation, goal-oriented or problem-centered counseling services, and/or medication management. The nurse must be licensed by the Texas Board of Nursing.
A psychologist provides or supervises the provision of psychological services. When an individual under the supervision of the licensed psychologist provides services, the licensed psychologist must sign all reports. The psychologist must be licensed by the Texas State Board of Examiners of Psychologists or licensed to practice in the state where the service is rendered (unless exempt).
A licensed clinical social worker provides goal-oriented or problem-centered counseling services. The social worker must be licensed by the Texas State Board of Social Work Examiners.
The required procedures are as follows:
- Evaluation and prescription by a psychiatrist or psychologist
- Approved treatment plan limited to achieving IL goals with specific intervention (ordinarily no more than 12 sessions)
Note: Community-based behavioral health and developmental disability services centers and some state agencies are exempt from the licensing act.
Mental Health Wellness and Recovery Action Planning
Wellness and Recovery Action Planning (WRAP) facilitators
The WRAP program is for adults with a severe mental health disability. The program's primary goal is to help consumers identify and learn to use wellness tools (coping strategies and resources) when they experience triggers or early warning signs that their mental health is worsening or when things are breaking down.
WRAP facilitators must:
- be well grounded and actively committed to his or her own recovery;
- not be a family member of the consumer who receives peer support services;
- have completed a 40-hour WRAP facilitator training provided by a qualified, current Advance Level WRAP facilitator recognized by the Copeland Center; and
- have completed the Mental Health Recovery: WRAP Facilitator Certification from the Copeland Center. The prerequisites for the WRAP facilitator certification can be met by taking the Mental Health Recovery Correspondence Course.
Provided only to adults who have a severe mental illness.
To be eligible, a consumer must meet the following criteria:
- Be at least 18 years old
- Have a mental illness such as schizophrenia, major depression, manic-depressive disorder (bipolar), or other severely disabling mental disorder that meets the diagnostic criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). (Substance abuse disorders and developmental disorders are excluded, unless they co-occur with another diagnosable severe mental illness.)
- Have functional impairments resulting from the mental illness that substantially interfere with or limit two or more major life activities
- Require crisis resolution and long-term support and treatment to manage the mental illness
The primary deliverable for the session for the participant is a comprehensive action plan to help manage his or her own illness.
WRAP services can be delivered either individually or in a group setting. In a group setting, the ratio between WRAP facilitators and consumers cannot be greater than one WRAP facilitator to eight consumers.
Facilitators must follow the Copeland Center's WRAP values and ethics, process, and concepts.
Facilitators must use the evidence-based model recognized by the Substance Abuse and Mental Health Services Administration.
Facilitators follow the WRAP Facilitator's Training Manual and use the PowerPoint presentation slides and CD.
Appendix C, Complex Rehabilitation Technology
Revision 19-1, Effective March 1, 2019
C 1 Hearing Aid Devices and Services
C 1.1 Hearing Aids
C 1.1.1 Qualifications
Audiologist – Provides audiological examinations, may dispense hearing aids, and may provide basic audiometric assessments. Must be licensed by the State Board of Examiners for Speech-Language Pathology and Audiology. To dispense hearing aids, the audiologist also must be licensed by the State Committee of Examiners in the Fitting and Dispensing of Hearing Instruments.
Hearing aid specialist – Dispenses hearing aids, may provide basic audiometric assessments, and may provide hearing aid evaluations. Must be licensed by the State Committee of Examiners in the Fitting and Dispensing of Hearing Instruments.
C 1.1.2 Required Procedures
Hearing aids are designed to be:
- monaural (involving one ear); or
- binaural (involving both ears).
Hearing aid models may be described as:
- in-the-ear (ITE);
- behind-the-ear (BTE); or
- complete-in-canal (CIC).
Hearing aids may only be purchased based upon the medical recommendation of a physician or audiologist.
Once the purchase of a hearing aid has been recommended by the physician or audiologist, evaluation services may be purchased to determine which hearing aid model is most appropriate based on the consumer's individualized needs and informed choice.
Evaluation services may be purchased from a physician, audiologist, or licensed hearing aid fitter and dispenser.
Evaluation services should always include:
- a complete hearing aid evaluation;
- identification of the most appropriate hearing aid by manufacturer and model; and
- identification of recommended accessories (if needed).
Ear mold impressions are generally required. Contact the vendor to determine if this service will be completed at the time of the hearing aid evaluation or at a later date (for example, after the vendor has submitted a written report and received approval for the purchase.)
Schedule and purchase the initial fitting as soon as it is verified that the dispenser has the correct product.
C 1.2 Cochlear Implant Components
Cochlear implants may be authorized when they are expected to improve the consumer’s ability to participate in activities in the home and community according to the consumer’s planned independence goals. Document the expected outcomes, such as an improved ability to understand spoken communication or respond to environmental cues clearly. Place the documentation in the case file as part of the assessing and planning process.
In addition, before planning to provide the consumer with cochlear implant services, ensure that the consumer has:
- good general health, as evaluated by a general history and physical examination;
- no serious medical problems that would preclude surgery or participation in the aural rehabilitation program;
- a significant-to-profound hearing loss in both ears and is unable to effectively use a hearing aid in the implanted ear; and
- been evaluated by an otologic surgeon who is active in cochlear implant surgery.
The evaluation report completed by the otologic surgeon must:
- include diagnosis;
- include recommendations for treatment;
- include a prognosis; and
- ensure that:
- consultation with a licensed medical provider has occurred;
- an effective aural rehabilitation program following surgery is available; and
- the consumer, through counseling and guidance:
- understands the prescribed cochlear implant program and is willing and able to complete it;
- is aware of the potential side effects from receiving a cochlear implant and is aware of the availability of communication enhancements that are similar to the cochlear implant, such as tactile stimulation instruments, but elects to receive the cochlear implant to stimulate hearing; and
- has expressed realistic expectations that the implant:
- may be enhanced by a hearing aid in the better ear and/or the use of other assistive listening devices; and
- can create the perception of sound, but will not restore normal hearing.
C 1.3 Hearing Aid Repair
The costs for repairing a hearing aid, including the costs for labor, shipping and handling, should not exceed the cost of buying a new hearing aid.
Reprogramming hearing aids is allowable, especially if necessary to allow the consumer to make use of other training being provided.
C 1.4 FM System
Purchase a frequency modulation (FM) system directly from a manufacturer or an audiologist.
The required procedures are as follows:
- Do not pay a fitting and dispensing fee when purchasing an FM system through an audiologist.
- When additional training is needed for an FM system, and if the necessary training is not available from a comparable benefit, negotiate payment for the time to train the consumer to use an FM system.
C 2 Home Modifications
Qualified vendors may purchase an assessment from a licensed occupational therapist, physical therapist, or professional engineer specializing in assistive technology.
Rehabilitation Engineering Services - Only licensed professional engineers may provide rehabilitation engineering services. Consider using an engineer's services when the service includes design or modification of a product.
The required procedures include the following:
- A full assessment of the consumer’s needs, followed by consideration of accommodation alternatives, including the need for consumer training and/or education regarding the use of rehabilitation technology. Assessment services identify options that will allow the consumer to function as independently as possible.
- Adaptive equipment may require installation, but usually does not result in permanent structural changes. Household equipment may be specially designed, selected, or altered to enable the consumer to perform independently in the home despite his or her functional limitations.
- Modifications are limited to equipment that can be removed from the residence without permanent damage to the property should the consumer move, fail to cooperate in achieving the planned objective, and so on.
- A written agreement from the property owner, before equipment such as a porch or ramp is attached (for example, bolted or nailed) to the property.
- For purchases over $1,000, the service provider must develop policies and procedures that include an approval process, internal controls, and an oversight process.
- The purchase of a lien examination from either a title insurance company or other source such as a law office. If there is a lien, notify the lien holder of the proposed modification and request that the lien holder expressly disclaim in writing any interest in the equipment installed in the residence. If the lien holder will not sign the disclaimer, get legal advice to determine whether it is advisable to continue with the plan for modification.
- Related documentation, to be kept in the consumer’s case file.
C 3 Prosthetics
C 3.1 Qualifications
Prosthetist and Orthotist – Fabricates and supplies prostheses and orthotics. Must be licensed by the State Board of Orthotics and Prosthetics.
Pedorthist – Fabricates and supplies below-the-ankle orthotics. Must be certified by the Board for the Certification in Pedorthics.
Occupational therapist – Must be licensed by the Executive Council of Physical Therapy and Occupational Therapy Examiners to practice in the state where services are rendered.
Physical therapist – Must be licensed by the Executive Council of Physical Therapy and Occupational Therapy Examiners to practice in the state where services are rendered.
Oculist – Must have board certification from the National Examining Board of Ocularists.
C 3.2 Required Procedures
Ocular prosthesis should be provided by an Ocularist that is a member of the American Society of Ocularists. Members of this organization adhere to the society’s standard operating procedures for the fitting and fabrication of custom-made ophthalmic prosthetics. To find a list of ocularists in Texas, see the American Society of Ocularists website.
Before agreeing to purchase any ocular prosthesis, the service provider must have verification from an ophthalmologist that treatment has been completed and the consumer is ready to be fitted for a prosthesis. Additionally, the service provider must obtain a written estimate from the ocularist detailing the expenses to be incurred in the process of fitting and fabricating the artificial eye.
For other prosthetics, based on the prescription, the orthotist or prosthetist recommends the design of a device that best meets the consumer's needs.
For orthoses, a physician's examination is required before the purchase of an initial orthosis or if the consumer is having difficulty using the current orthosis.
- orthopedic shoes;
- splints; and
- artificial muscles.
For prostheses, an orthopedist's or physiatrist's examination is required before the purchase of the first prosthesis. If the consumer has difficulty using his or her current prosthesis, an orthopedist's or physiatrist's evaluation is required before planning the purchase of a second prosthesis.
All vendors of orthoses and prostheses must:
- be currently licensed by the Texas Board of Orthotics and Prosthetics;
- perform all measurements, fittings, alignments, and final checkouts for purchased devices;
- fabricate or directly supervise the fabrication of these devices; and
- provide final delivery and instructions for use.
Consider purchasing more technologically advanced devices or components only if required by the consumer's unique independent living or medical needs.
If the cost is $12,500 or more, prior approval by the HHSC Independent Living Program manager is required.
The vendor should agree to replace, without cost to the service provider or the consumer, defective parts and materials within 90 days of the consumer receiving the completed orthosis or prosthesis.
The following are not covered by—and do not create exclusions to—the vendor’s warranty:
- Straps, evidence that the device has been altered by anyone other than the vendor; or
- changes in the consumer's condition that affect the use of the device.
The vendor honors the manufacturer warranties and pays all costs associated with warranty replacements.
The consumer pays all costs associated with extended warranties.
Repair the current orthosis or prosthesis unless the repair cost is more than 60 percent of the replacement cost.
Arrange training in the use of above-knee prosthesis to consumers who:
- have not worn one previously;
- will have a different type of prosthesis than previously; or
- have not worn one for a prolonged period.
A prosthetist may provide training in the use of a below knee prosthesis. If the prosthetist recommends additional training, arrange for it from a qualified physical or occupational therapist.
A qualified physical or occupational therapist may provide training in the use of an upper extremity prosthesis.
C 4 Vehicle Modification Consumer Service
Service providers and installers must adhere to health and safety standards that can be found at the Texas A&M Transportation Institute (TTI) website: https://tti.tamu.edu/twc. Service providers must obtain prior approval by the HHSC Independent Living Program manager or designee for vehicle modifications that the cost $5,000 or more. Oversight, planning and inspection is subject to review by and must be coordinated with TTI or similar entity by contract with the service provider/Independent Living Center.
Modifying a consumer’s vehicle may be necessary when all other options for transportation have been explored and exhausted and the consumer cannot meet the planned goals for independence without the adaptive equipment. Procedures for evaluating the consumer’s ability to operate or travel safely as a passenger in a modified vehicle must be developed before agreeing to provide a modification service. These procedures must be guided by the TTI requirements and ILS requirements outlined in these Standards related to vehicle modification and detailed in the consumer’s Independent Living Plan. Consumers must be fully informed of the evaluation process, and those interactions should be clearly documented in case management software, before the consumer is instructed to purchase a vehicle. Some vehicles cannot be modified and maintain their structural integrity; therefore, safety standards must be strictly followed. Vehicle modifications range in cost from less than $1,000, for simple hand controls, to many thousands of dollars for van conversions with complex steering controls.
Deciding that vehicle modification is reasonable and necessary requires careful consideration of numerous factors, including:
- available transportation alternatives;
- consumer's financial ability to purchase vehicle, insurance and maintenance;
- effect of vehicle selection on the cost of modification;
- cost of the modification; and
- complexity of the modification.
Carefully guide the consumer through the entire process, including making an informed choice.
To guide the consumer:
- provide the consumer with information regarding:
- vehicle selection;
- vehicle modification rebate programs; and
- the need to visually inspect any used vehicle before agreeing to pay for modifications;
- obtain the consumer's written commitment to maintain the vehicle and the installed modifications and ensure that the consumer has the resources to do so;
- counsel the consumer on the ultimate cost of replacing the vehicle and modifications (consumers should plan to drive the vehicle for the life of the adaptive equipment, which averages seven to 10 years); and
- ensure and document that the consumer has the financial resources to:
- make vehicle and insurance payments; and
- maintain the vehicle and adaptive equipment.
C 4.1 Overview of Vehicle Modification Equipment
This appendix applies to contracted vehicle modification equipment (VME) purchased by ILS service providers. Contracted VME items purchased for customers by ILS includes, but is not limited to:
- lowered floor conversions;
- mobility aid hoists;
- mechanical and electronic primary control systems (i.e., hand controls);
- reduced effort powered steering;
- access battery systems;
- seating systems;
- driver and passenger restraint systems.
A complete list of vehicle modifications accepted for purchase can be found at the TWC/TTI website: https://tti.tamu.edu/twc/.
C 4.2 Limitations on Vehicle Modification Services
Do not sponsor vehicle modification or purchase equipment available from the vehicle manufacturer or dealer ( e.g. air conditioner, automatic transmission, power steering, power windows, or power brakes) for:
- a vehicle that is not owned by the consumer or an immediate family member of the consumer, such as a spouse or parent;
- a vehicle without a current Texas state vehicle inspection; or
- appearance rather than function.
Carefully weigh the specific vehicle modification against:
- the consumer's functional abilities; and
- intended use of the vehicle.
C 4.3 Service Provider Requirements
The ILS service provider is required to coordinate with Texas A&M Transportation Institute (TTI) to ensure that the vehicle modification proposed to be purchased is an accepted vehicle (for lowered floor conversions) or an acceptable product. The coordination includes obtaining a pricing review from TTI by submitting the driving evaluation, service estimate from the vehicle modification vendor and the consumer’s medical reports. Upon completion of an installation of a vehicle modification, the ILS service provider is required to coordinate with TTI to purchase an inspection when the cost is $9,000 or higher, or the service provider will provide or coordinate an inspection of the vehicle modification when the cost is less than $9,000. Any inspection, by service provider or TTI, will occur prior to delivery of the vehicle to the consumer.
The ILS service provider’s sub-contracted vendors must meet the following requirements:
- be an authorized dealer of the VME being provided or serviced;
- have a National Mobility Equipment Dealers Association (NMEDA) certified technician on staff for the VME being installed/purchased; and
- have an American Welding Society (AWS) certified welder to perform any welding that may be necessary during VME installation.
C 4.4 Evaluating the Driver
Once written recommendation or a prescription is obtained from a licensed practitioner for a driver’s evaluation, evaluate the consumer's ability to drive using the services of a certified driving rehabilitation specialist. This evaluation also includes recommendations for the assistive equipment that will be necessary for a consumer to drive a vehicle. This evaluation is provided to the vehicle modification vendor for their cost estimate as well as to TTI for their pricing review.
The consumer must complete a driver evaluation and training with the appropriate equipment, if the consumer has:
- never driven;
- never driven with adaptive equipment;
- progressive disabilities; or
- significant changes in his or her condition.
The consumer should have a valid driver's license with appropriate restrictions before a beginning a vehicle modification. It is required that the ILS service provider obtain a front and back copy of the consumer’s current and valid Texas Driver’s License with restrictions.
If a valid Texas Driver’s License with appropriate restrictions has not been obtained, the ILS service provider can purchase additional driving training from a certified driving rehabilitation specialist who will be able to arrange for the consumer to take the driving test in the modified vehicle.
If the consumer currently drives a modified vehicle, this may be verified by obtaining a copy (front and back) of the valid Texas Driver’s license with appropriate restrictions listed.
C 4.5 Evaluating Used Vehicles
An ASE certified mechanic must evaluate the used vehicle before it is modified to ensure the sound mechanical condition of all major components when:
- the cost of the modification is $1,000 or more; and
- the vehicle has more than 50,000 miles or is more than four years old.
The service provider pays for the cost of the evaluation and obtains a detailed report from the mechanic.
C 4.5.1 Evaluating Used Vehicles for Lowered Floor Conversions
Consult the TTI website for acceptable vehicles for lowered floor conversions.
Due to manufacturer requirements for lowered floor vehicle conversions, they will only be completed on vehicles that:
- have fewer than 30,000 miles;
- pass a mechanic’s inspection; and
- show no evidence of the vehicle ever having been in a wreck or damaged from flooding or other disasters.
The service provider pays for the cost of the evaluation and obtains a detailed report from the mechanic.
C 4.6 Obtaining the Modification Proposal
The service provider and the consumer will select a vehicle modification vendor. The service provider gives the consumer a list of approved vehicle modification vendors in the consumer's geographic area.
At no cost to the service provider or consumer, the vehicle modification vendor prepares a proposal for the modification. The vehicle modification vendor should be provided with a copy of the completed driver’s evaluation in order to estimate the cost of exact equipment necessary for the consumer’s modification. If the consumer currently drives an adapted vehicle and a driving evaluation was not required, the vehicle modification vendor may determine assistive equipment needs based on the existing vehicle modification being used by the consumer.
After the proposal is received, decide with the consumer which modifications are reasonable and necessary for achieving the planned goal.
C 4.7 Reviewing the Modification Plan Before the Vehicle Is Purchased
Before the consumer purchases a vehicle, the service provider should have processes in place for internal management to review a plan for modifications that cost more than $1,000. If the vehicle modification requires HHSC prior approval, this approval should be obtained before the consumer purchases a vehicle.
Review the information gathered to obtain a TTI pricing review and determine whether the:
- vendor’s quoted cost of the modification equipment is reasonable;
- modification prescribed by the service provider appears to meet the consumer's needs; and
- specifications for equipment meet the standards.
Before issuing the authorization to modify, verify that the vehicle purchased is the same vehicle described in the quote and in the modification plan.
For modifications costing $1,000 or more, review a copy of:
- the certificate of title; or
- the tax collector's receipt for the Texas title application, registration, and motor vehicle tax.
The consumer or an immediate family member (such as the consumer’s spouse or parent) must own the vehicle.
If there is a lien on the vehicle, obtain in writing the lien holder’s expressed disclaimer of any interest in the installed equipment.
If the lien holder agrees and later reclaims the vehicle for any reason, the service provider may:
- remove the installed equipment; and
- repay the lien holder for any vehicle damage caused by the installation of equipment.
Procedures, which may include contacting a legal resource for advice, must be developed by the service provider when a lien holder will not sign the disclaimer.
C 4.8 Insuring the Vehicle
When providing vehicle modification services, the consumer must obtain, at the consumer's expense, insurance that covers the replacement cost of the sponsored modifications. Encourage the consumer to carry comprehensive coverage on the vehicle. The service provider must have a policy regarding proceeding with modifications for vehicles that do not have comprehensive coverage.
Obtain and file a copy of:
- the paid insurance policy (front and back); or
- verification from the insurance company that the consumer is eligible for insurance when the modification is completed.
C 4.9 Purchasing Equipment and Modification Repairs
The service provider may fund repairs to adaptive equipment and vehicle modifications.
The service provider may also fund repairs to adapted vehicles, when warranted.
Consider and document in a consumer case file that:
- the vehicle is:
- owned by the consumer or a family member; and
- the consumer's primary means of transportation;
- vehicle repair is a best-value decision to meet the consumer's transportation needs; that is, the decision is based on the:
- vehicle's overall condition (ongoing repairs are not expected); and
- fact that repair costs do not exceed the vehicle's fair market value;
- there are no comparable services and benefits available to meet this consumer's transportation needs, such as public bus service; and
- the consumer has a plan for meeting transportation expenses after case closure.
To fund equipment repairs:
- obtain a price quote from an adaptive equipment specialist or certified mechanic;
- ensure the safety of the modification (for example, the provision of tie downs); and
- inspect the work before delivery to the consumer or payment for completion.
Do not reclaim equipment that is broken, outdated, or no longer under warranty.
All modifications must meet the standards required by TTI and will be subject to pricing review and/or inspection as required in the TTI/service provider memorandum of understanding.
C 5 Wheelchairs and Scooters
C 5.1 Required Procedures
When the service provider determines that the assistive device has no salvage value, the service provider may decide to relinquish ownership. The service provider must develop and follow policies and procedures that address relinquishing ownership of the assistive device.
Written recommendations are required for:
- the initial purchase of medical assistive devices and supplies; and
- replacement items when the medical condition is progressive.
If required to obtain a written recommendation and/or prescription, place the written recommendation and/or prescription for the assistive device in the consumer case file. This should be obtained from:
- a physician;
- a physician assistant;
- an advanced practice nurse;
- a dentist; or
- an optometrist.
When the written recommendation and/or prescription does not describe the item, obtain a letter of specification from an appropriate, certified paramedical specialist (such as a physical or occupational therapist, orthotist, or prosthetist).
Replacement wheelchairs require that the service provider obtain from the local vendor of wheelchair repair services an estimate of the cost for refurbishing the original chair.
Consider whether repair or replacement is the more cost-effective course.
When a replacement chair that differs in size and other features from the chair previously prescribed and currently in use by the consumer, request that the consumer be reevaluated by a physiatrist or physical or occupational therapist.
Sports chairs generally do not purchase non-folding competition sports chairs intended primarily for sports-related activities.
When a consumer requests a non-folding chair that appears appropriate for the consumer's needs:
- ensure that the consumer can use the non-folding chair as effectively as a folding chair in all activities related to completing the independence goal; for example, when:
- driving; and
- loading and unloading the chair into an automobile;
- observe (or ask a physiatrist or physical therapist to evaluate) the consumer's ability to drive using a non-folding chair and load and unload the chair into an automobile; and
- ensure that purchasing a non-folding chair will not result in additional expense, such as modifying a van or home to accommodate the new chair.
Lightweight chairs – Purchase a lightweight chair when appropriate for the consumer's needs.
Do not purchase:
- more than one set of front casters (for example, 5" hard or 8" pneumatic);
- more than one set of arm rests (for example, desk type or sloped); or
- sports-related options (for example, spoke guards and anti-tip front casters).
Wet weather guards are not considered sports-related items.
Wheelchair accessories – Except for power units and controllers or seating and positioning systems, replacement parts can be purchased as needed.
Appendix D, Diabetes Self-Management Education Services
Revision 19-1, Effective March 1, 2019
Diabetes self-management education services are used to:
- assess the consumer's ability to independently manage his or her diabetes at home;
- assess the consumer's ability to independently manage his or her diabetes in the workplace;
- prepare a consumer to make informed choices about his or her diabetes; and
- help the consumer develop the confidence and skills to implement his or her choices.
Diabetes self-management education services are provided by a vendor who instructs and counsels the consumer and family through individual and/or group skills training.
Education and Experience Requirement
A vendor is a health professional, who:
- is licensed or registered, as required by his or her profession;
- has completed basic academic requirements for his or her field;
- has practiced for at least one year; and
- has one year of diabetes education experience.
A vendor must be a registered nurse (RN), registered dietician (RD), or certified diabetes educator (CDE). For RNs and RDs, the service provider keeps a copy of the active license on file. For a CDE, the service provider keeps a copy of the current certification from the National Certification Board for Diabetes Education (NCBDE) or the American Association of Diabetes Educators (AADE) on file.
Through academic preparation, continuing education, or on-the-job training, the vendor will have developed:
- a knowledge and understanding of diabetes and its management, including the nutritional and pharmaceutical aspects of care;
- a knowledge and understanding of basic educational and behavioral science;
- a knowledge of evidence-based nutritional, pharmaceutical, and therapeutic care of the person with diabetes;
- the additional skills necessary to work in a thorough and efficient manner, such as planning, organizing, communicating, cooperating, delegating, and working without direct supervision; and
- a knowledge of visual impairment and blindness.
A vendor (CDE, RN, or RD) must have at least one year of paid experience providing diabetes education. RNs and RDs must have completed 15 hours of continuing education units (CEUs) on diabetes from an accredited agency within the 12 months immediately preceding the application date. A CDE must have completed 10 hours of CEUs on diabetes from an accredited agency within the 12 months immediately preceding the application date. The CEUs must be from an agency approved by the service provider's licensing or certifying body.
A diabetes vendor is determined to be qualified if the vendor holds a contract in good standing with the Texas Workforce Commission’s vocational rehabilitation program.
The service provider must verify the education and experience requirements and make that verification available to HHSC at any time and in any format requested.
The vendor must attend required training as developed that may include training about visual impairment or blindness.
If travel is necessary in order to attend the required training, the vendor is responsible for paying all travel costs including transportation, food, and lodging.
Technical Skills Requirement
A vendor must:
- be able to assess a consumer's educational needs and clinical status;
- have public speaking skills;
- offer interactive teaching techniques for individuals;
- be able to communicate technical medical information at a level appropriate for the learner;
- be able to create a positive and accepting learning environment;
- be able to relate positively to all consumers;
- believe in the capabilities and independence of people with disabilities;
- have good verbal and written communication skills;
- have basic computer skills, including word processing; and
- have a private email address, which will not be given to non-approved staff members.
The potential vendor must be able to demonstrate knowledge about diabetes and behavioral change as well as demonstrate skill in the use of the adaptive techniques that are available to individuals who are blind or visually impaired.
Scope of Services
Up to 15 hours of individual diabetes self-management education services are considered standard. The 15 hours include the initial assessment, skills training, and post training assessment.
Diabetes self-management education services include:
- an initial assessment (generally up to two hours);
- skills training on diabetes self-management (generally up to 12 hours); and
- a post training assessment (generally up to one hour).
Individual skills training on diabetes self-management is divided into short segments (two-hour blocks) to reduce travel costs and ensure that the consumer maintains the physical and intellectual stamina needed to benefit from the skills training.
HHSC only reimburses providers for its vendor’s time spent teaching consumers about diabetes.
Vendors are not reimbursed for:
- travel time;
- planning time;
- office interaction time; or
- time spent completing and submitting the required paperwork.
Assessing Diabetes Self-Management Education Services
The vendor ensures that the individualized education plan (which includes the initial assessment, instructional and skills training methods, and teaching materials) is appropriate for each consumer, based on the consumer's:
- type of diabetes (type I or II) and duration;
- cultural influences; and
- learning abilities.
The initial assessment for each consumer must include the consumer's:
- relevant medical history;
- cultural influences;
- health beliefs and attitudes;
- diabetes knowledge;
- self-management skills and behaviors;
- readiness to learn;
- cognitive ability;
- physical limitations;
- level of family support;
- financial status;
- employment issues related to diabetes, if any; and
- current or potential need for adapted diabetes devices, including talking monitors for blood sugar or blood pressure, syringe magnifiers, and count-a-dose aids.
As part of the initial assessment, the vendor recommends the specific skills training that the consumer may need.
The training may include information on:
- the pathophysiology of diabetes (an overview);
- exercise and activity;
- blood glucose monitoring and use of the monitoring results;
- diabetes-related complications;
- management of sick days;
- medical treatment;
- foot, skin, and dental care;
- preconception care, pregnancy, and gestational diabetes;
- use of the health care system;
- community resources;
- stress and psychosocial adjustment;
- goal setting;
- employment issues and/or barriers to employment, as related to diabetes; and
- adaptive diabetes self-management equipment and tools.
If an initial assessment was conducted within the previous 12 months and there has been no significant change in the consumer’s medical status (no new medications prescribed, no new complications reported, and so on), and the vendor believes that there is adequate information to begin skills training, then training may begin immediately based on that evaluation.
If it has been more than 12 months since the previous assessment, or if there has been a significant change in the consumer’s medical status, another initial assessment must be conducted to evaluate the consumer’s current medical status and educational needs.
Training and Assessment Tool Kit
It is highly recommended that the service provider have a tool kit of adaptive equipment to demonstrate during assessment and training.
The items suggested for the tool kit are as follows:
- Blood glucose meter
- Meal Measure
- Insulin pen (or other injectable for demonstration purposes)
- Talking blood pressure monitor
It is also recommended that the disposable supplies needed to demonstrate the adaptive equipment (such as test strips, syringes, and insulin) be made a part of the training tool kit.
Skills Training for Diabetes Self-Management
The number of skills training hours recommended for individual diabetes self-management is based on:
- the initial assessment; and
- the topics covered that are related to the consumer’s independent living goals.
Skills training on diabetes self-management must include:
- goals for behavioral change; and
- participation in healthy lifestyle changes.
A copy of the current diabetes education materials is provided to the consumer in the consumer’s preferred medium (for example, large print, CD, and so on).
Other education materials, resources, and referrals are documented on the required forms.
Diabetes self-management education is primarily intended to:
- provide knowledge and skills training; and
- help the consumer identify barriers, solve problems, and develop coping skills to achieve effective self-care and behavior change.
The initial assessment and subsequent skills training on diabetes self-management is based on the seven self-care behaviors identified by the American Association of Diabetes Educators (AADE).
The AADE’s seven self-care behaviors (known as AADE7) are:
- healthy eating;
- being active;
- taking medications;
- healthy coping;
- problem solving; and
- reducing risk.
Confidentiality of Consumer Information
To protect the integrity and dignity of each consumer, the service provider must keep consumer information confidential, as required by the Health Insurance Portability and Accountability Act (HIPAA), as applicable. The service provider must have policy and procedures in place that facilitate access to confidential records.
The vendor must develop and use physical safeguards for confidential records and ensure that the records are available to authorized staff members only.
Post-training (follow-up) assessments are conducted by the vendor at least one month (30 calendar days) after the skills training is completed.
As part of the post-training assessment, the vendor:
- reviews the skills training provided; and
- reinforces the behavioral changes.
If a post-training assessment is provided before one month (30 calendar days) after the skills training is completed, the vendor must secure approval from the referring service provider.
The service provider's initial assessment, skills training, equipment follow-up assessment, and other findings for each consumer are documented using forms developed and provided by the service provider.
When speaking by phone or in person to the independent living service provider about differences in service delivery, including changes in a service authorization or no-show request, the service provider's call or in-person discussion should be documented in an email between all parties.
Appendix E, Independent Living Skills Training (Individualized Skills Training Only)
Revision 19-1, Effective March 1, 2019
Independent living skills training is designed to accommodate for the consumer's vision loss in daily living activities.
Vendors providing independent living skills training must have earned a bachelor's degree from an accredited college or university in rehabilitation, education, psychology, sociology, or a related field and:
- have one year of work experience in rehabilitation teaching, rehabilitation, or education of people with disabilities, or have two years of work experience in general education or a related field; or
- have been included on the list of independent living skills trainers who previously held contracts with the Department of Assistive and Rehabilitative Services to provide this service.
Scope of Services
Independent living skills vendors provide the following services in the consumer's home or local community, at the discretion of the consumer. The vendor may provide one or more of the following services, as authorized by the service provider:
The needs assessment is for individuals who are blind and is completed with the consumer to identify the barriers that prevent him or her from functioning independently. This process is completed face-to-face with the consumer by vendor staff or a subcontractor and should occur after the consumer is determined eligible for services. The service provider uses the needs assessment to develop the independent living plan (ILP).
Independent living skills training is training in techniques that enable a consumer to perform the skills of daily living in alternative ways.
These skills are divided into the following categories:
- Personal management—including grooming, eating, maintaining health, staying safe, identifying and coordinating clothing, and managing medication
- Home management—including sewing, cleaning clothing, keeping house, preparing meals safely in the kitchen, planning for grocery shopping, and performing minor home repair
- Communication—including telling and managing time, using the telephone, managing money, writing, organizing, and using adaptive devices
- Information access and technology—including using magnifiers, video magnification systems (including closed circuit televisions), and other low-vision devices, as well as adapting computers and other types of technology for the consumer’s use
Service Provider Responsibilities
The service provider:
- sends referrals to the vendor;
- determines the consumer’s eligibility for independent living services;
- refers eligible consumers to the vendor for the needs assessment if this service is subcontracted;
- develops the ILP with the consumer and enters it into the Independent Living Electronic Data Reporting System;
- authorizes independent living skills training hours;
- manages case records;
- reviews documentation of services provided by the vendor;
- authorizes the purchase of recommended equipment and services;
- documents the purchase of equipment and services in the consumer's ILP; and
- arranges for or provides more complex services, including braille instruction, orientation and mobility training within the consumer's community, and diabetes education.
- conducts a needs assessment, if this sub-contracted by the service provider;
- provides services as directed by the service provider and as described under Scope of Services, above;
- submits the appropriate documentation for each type of service to the service provider for review and approval;
- provides training in basic independent living skills, as described in the needs assessment and ILP;
- assesses periodically the consumer's progress toward goals and timelines with the service provider;
- submits appropriate recommendations for purchasing products and services for the consumer to the service provider; and
- provides the service provider with a written report of each contact that includes details of the assessment or the service provided and the outcome.
The vendor must contact a consumer who is referred for a needs assessment within 30 calendar days of the referral.
The vendor must document the needs assessment on the form provided by the service provider. The recommendations section of the form must contain a summary of the independent living skills training and services that the vendor has identified for inclusion in the ILP.
Independent Living Skills Training
After the service provider has developed the ILP, the vendor provides monthly training services as authorized by the service provider. The services are documented monthly using a progress report developed by the service provider.
The monthly report must:
- detail the services provided to the consumer;
- document the outcome of each service; and
- include any recommendations for changes to the ILP.
Appendix F, Interpreter, Translator, and Communication Services
Revision 19-1, Effective March 1, 2019
An interpreter conveys messages between people without contributing to the dialogue.
Use interpreter services to facilitate consumer communication in the independent living process. Qualified personnel provide interpreter services and include the use of sign language and oral interpretation for persons who are deaf or hard of hearing and tactile interpretation for persons who are deafblind.
Maintaining Consumer Confidentiality
The service provider informs the interpreter and consumer that information provided is maintained in confidence.
Using Certified Interpreters
The service provider uses certified interpreters when possible.
For a list of certified interpreters, refer to the Texas Health and Human Services Commission (HHSC) Office of Deaf and Hard of Hearing (DHHS) Resources page.
A certified interpreter holds at least one of the following current certificates of competency from one of the following organizations:
- Registry of Interpreters for the Deaf (RID)
- Interpreter Certificate
- Transliteration Certificate
- Reverse Skills Certificate
- Comprehensive Skills Certificate
- Master Comprehensive Skills Certificate
- Legal Skills Certificate
- Board for Evaluation of Interpreters, HHSC Office for Deaf and Hard of Hearing Services (DHHS):
- Level I
- Level II
- Level III Certificate
- Level IV Certificate
- Level V Certificate:
Additional information is available on the DHHS page Situations and Recommended Interpreter Certification Levels.
Using Noncertified Interpreters
Use a noncertified interpreter who is otherwise competent to interpret when a certified interpreter is not available. In these cases, get the consumer's written approval before hiring the interpreter.
Do not use a noncertified interpreter in the following settings:
Purchasing Interpreter Services
Make every effort to plan service delivery according to the regular (day) rates. The service provider will need to establish a contract with a local interpreter service.
Provide translator services for the consumer:
- in the native language of the consumer, if the consumer’s ability to speak English is limited; and
- in the mode of communication that the consumer uses.
The service provider must maintain a list of translators by name, address, phone number, and language spoken and must update the list at least annually.
The service provider informs the translator and consumer that information provided will be maintained in confidence.
Guidelines for Translator Services
When the consumer has a limited ability to speak English, make every effort to locate a translator who:
- can effectively communicate in the person's native language;
- is impartial;
- maintains the confidentiality of the consumer’s information; and
- is acceptable to the consumer.
Obtain help in identifying translators from organizations such as high schools, colleges, universities, the local chamber of commerce, churches, or private translator services, where representatives of the consumer's particular ethnic group may be found.
Use a speakerphone to communicate with the translator when it is not practical for the translator to be present.
When the service provider sponsors a training program or other group services, ensure that the consumer who has a limited ability to speak English receives adequate help from:
- the translator;
- an individual volunteer;
- a community organization; or
- other resources.
Appendix G, Orientation and Mobility Services
Revision 19-1, Effective March 1, 2019
Function of Orientation and Mobility Vendors
Orientation and Mobility (O&M) vendors offer complex, interrelated services designed to promote independent travel skills for people who are blind or visually impaired.
O&M training prepares consumers to travel independently with competence and confidence. Orientation is the process of using the available senses to establish one's position and relationship within the environment. Mobility is the ability to travel in the environment with the help of an established tool (including white canes, dog guides, and electronic travel aids).
Qualifications and Requirements
The O&M service provider must ensure that each person approved to provide O&M services to independent living consumers meets one of the following requirements:
- The vendor is certified by either the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) or the National Blindness Professional Certification Board (NBPCB).
- The vendor is not certified at the start of the contract, but he or she:
- has a degree in O&M from an accredited college or university with an established O&M training curriculum and will be certified by ACVREP or NBPCB within one year of the contract date; or
- has at least two years of full-time work experience teaching O&M skills for an entity that the service provider recognizes, such as a rehabilitation center, Veterans Affairs (VA) hospital, or educational system; and also
- will be certified by ACVREP or NBPCB within one year of the contract date.
To continue contracting for independent living services, all O&M vendors under the contract must maintain ACVREP or NBPCB certification.
In addition to meeting the education, training, and experience requirements described above, all prospective O&M vendors must participate in required training developed by HHSC. Each vendor is responsible for all costs related to attending the training.
O&M vendors who use interns to serve consumers must:
- observe a minimum of 12 lessons during the internship;
- document the observations; and
- make the observations available for monitoring review by the service provider who may request them in any format for HHSC monitoring.
O&M interns must:
- attend confidence builders training or its equivalent (interns are responsible for all training-related expenses);
- be supervised by a certified O&M vendor for the duration of the internship;
- be observed by the certified O&M vendor for a minimum of 12 lessons during the internship;
- follow all standards for O&M services in this document; and
- sign and forward reports to the supervising O&M vendor for his or her approval.
Scope of Services
Orientation and Mobility (O&M) services include:
- an initial assessment of the consumer's O&M skills (if any) including strengths, challenges, and existing competency levels;
- a review of the assessment results and training recommendations with the consumer; and
- O&M skills training as agreed upon by the consumer, the service provider, and the O&M vendor.
The O&M vendor must remain impartial and objective.
Before contacting the consumer, the O&M vendor receives referral information from the service provider.
Assessments may be conducted using the consumer's functional vision, which is an opportunity for consumers to recognize that their vision may not meet all of their travel needs.
The initial assessment includes an evaluation of the consumer's O&M skills in multiple situations, which may include:
- the consumer's home and immediate surrounding area;
- public areas, such as a church, park, or college campus;
- commercial areas, such as a bank, store, or mall;
- transit systems, such as paratransit or taxis (if available);
- local buses and similar public transportation (if available);
- rural areas (if applicable);
- residential areas (those with light vehicle and foot traffic and some stop signs);
- small business areas (those with heavier traffic and simple traffic lights);
- downtown areas (those with heavy vehicle and foot traffic and complex traffic lights);
- commercial transportation systems, such as buses, trains, and airplanes (if applicable); and
- travel using low-vision devices (if applicable).
Following the initial assessment, the O&M vendor reviews the results with the consumer and answers any questions that he or she may have about the recommended training. A meeting with the consumer, service provider, and O&M vendor is strongly recommended, so that all parties can agree on the overall O&M training plan.
Documenting the Initial Assessment
Initial assessment reports must be documented and submitted to the service provider in accordance with the service provider’s requirements.
The assessment report includes the:
- O&M vendor's observations and comments;
- recommendations for O&M skills training in each of the areas included in the initial assessment;
- number of recommended training hours for each area;
- total number of training hours being recommended;
- anticipated period (beginning and ending dates) for recommended training;
- consumer’s signature on the consumer's acceptance or rejection of the training recommendations;
- height of the rigid cane that is most appropriate for the consumer (using the measurement between the consumer's chin and nose when standing up); and
- description of all of the travel aids that the consumer uses or would benefit from using.
After submitting an assessment report, the O&M vendor must contact the service provider to discuss the initial assessment and get authorization to provide training services.
The topics covered during the discussion include:
- the vendor's recommendations for training (if any), including recommendations on the:
- O&M skills needed;
- proposed completion date of the training; and
- number of training hours authorized by the consumer's service provider;
- anticipated delays in services, if any;
- special considerations or extended dates for direct training, if any;
- the consumer's readiness to begin nonvisual O&M skills training; and
- the consumer's understanding of O&M skills training and its potential benefits.
Monthly Progress Reports
After receiving authorization to provide training services, the O&M vendor must document each consumer's monthly training progress.
Monthly progress reports must be submitted within 30 days of the end of each calendar month until the consumer's O&M services are completed or services are no longer recommended by the consumer's service provider.
Each consumer's monthly progress report must include:
- the number of training hours provided in each training area; and
- a detailed narrative of each skill area addressed during the reporting period and the training location for each lesson.
Training locations include:
- home (indoors and outdoors);
- public areas (bank, church, doctor's office, and so on);
- commercial areas (grocery store, mall, and so on);
- transit systems (public transportation, paratransit, taxi, and so on);
- rural areas;
- residential areas (light traffic and stop signs);
- small business areas (heavier traffic and simple traffic lights);
- downtown areas (heavy traffic and complex lights);
- commercial travel (trains, planes, and so on);
- a detailed explanation of anticipated training for the upcoming month;
- an explanation of deviations from assessment recommendations, if any; and
- a detailed narrative of cumulative progress, if training is complete.
Expectations of Training
It is expected that O&M training services for independent living consumers be conducted using nonvisual (blindfold) techniques and a rigid (nonfolding) cane. All exceptions must be discussed with the service provider before training services begin, and must be fully documented in the O&M vendor’s required reports.
O&M vendors will discuss the benefits of nonvisual training with each consumer. Role modeling and peer support for nonvisual training are encouraged.
The service provider provides one rigid, long, white cane for each consumer for O&M assessment and training, to be distributed by the O&M vendor. The O&M vendor conveys to the service provider the appropriate length for the consumer using the consumer’s height and other information.
If a consumer has a dog guide, the consumer is assessed by the O&M vendor to ensure that the consumer has proficient cane skills. O&M training can occur with either a cane or a dog guide.
The O&M vendor must include observations and recommendations of cane skills in the initial assessment. Recommended hours for training must include the consumer's travel needs, regardless of the mobility tool (dog or cane). Additional hours are not requested for training with a dog guide.
In addition, O&M vendors give information about cane purchasing to each consumer. Consumers are responsible for acquiring all replacement canes, cane tips, back-up canes, and so on.
O&M vendors may recommend additional travel aids or other items to the consumer's service provider; but the decision to purchase additional items rests solely with the service provider.
O&M vendors are not reimbursed for items provided to a consumer by the service provider.
The O&M training may not exceed the extent of services (type of training and total number of hours) authorized by the consumer's service provider.
O&M vendors cannot provide more than six hours of training on any given day, even if multiple consumers are served in that day. Lessons are approximately two hours long. Without prior authorization from a service provider, an individual consumer must not receive more than four hours of O&M instruction on any given day.
A consumer’s training lessons are approximately two hours long. Without prior authorization from a service provider, an individual consumer must not receive more than four hours of O&M instruction on any given day.
Consistent and frequent scheduling is recommended to maximize consumer learning.
For independent living consumers, the service provider authorizes two to three hours for the initial assessment. If training is recommended, the service provider allows no more than five hours of training per month. If additional training time is needed (because of safety-related concerns, secondary disability, or a specific consumer request), the O&M vendor sends a written request to the service provider, including the number of additional hours requested and the reason more hours are needed. Requests for additional training are made as part of the initial assessment, when possible.
Transporting consumers does not count toward training time. O&M vendors are not reimbursed for time spent in the car, even when a consumer is present.
The O&M vendor must notify the service provider within 24 hours about all:
- no-shows, cancellations, or rescheduled appointments;
- issues, concerns, or circumstances that might impact or delay planned services; and
- issues that might delay the completion of services.
O&M vendors must get written approval from the service provider before deviating from any of these standards during training (even when based on an individual consumer's needs).
If Services Are Interrupted
If training cannot be completed as planned or if services are postponed indefinitely because of unexpected circumstances, the O&M vendor must notify the service provider within 24 hours. The service provider will then document the postponed services.
Appendix H, Physical Rehabilitation and/or Therapeutic Treatment
Revision 19-1, Effective March 1, 2019
On occasion, certain medical professionals are needed to direct or support the provision of medical services.
The credentials required and the functions performed may include the following:
- Advanced practice nurse provides medical evaluation and/or treatment. Licensed by the Texas Board of Nursing.
- Certified registered nurse anesthetist (CRNA) administers anesthesia. Certified by the American Association of Nurse Anesthetists.
- Chiropractor provides manipulative treatment of the spine and functional capacity assessments. Licensed by the Texas Board of Chiropractic Examiners.
- Licensed surgical assistant provides assistant surgeon services. Licensed by the Texas Medical Board.
- Physician provides medical examinations and/or treatment. Exception: A podiatrist licensed in the state where services are rendered may provide medical or surgical services limited to foot conditions.
- M.D. (doctor of medicine) or D.O. (doctor of osteopathy) licensed by the Texas State Board of Medical Examiners to practice in the state where services are rendered.
- Physician assistant provides medical examinations, medication management, and/or treatment. Licensed by the Texas Physician Assistant Board.
- Podiatrist (doctor of podiatric medicine or DPM) provides medical examinations and treatment for foot conditions. Licensed by the Podiatric Medical Examiners Board.
- Registered nurse first assistant provides assistant surgeon services. Licensed by the Texas Board of Nursing.
- Specialist physician performs examinations, treatment, and/or surgery. Certified by an American Medical Specialty Board or the American Osteopathy Specialty Board, or has the training and experience to be eligible for examination by a specialty board.
- Physician providing surgery must be board certified or eligible for examination by a specialty board in the area of the physician's surgical specialty.
- Speech and language pathologist provides, with the concurrence of a physician, speech and hearing therapy after surgery or trauma affecting speech. Certified as a speech-language pathologist by the State Board of Examiners for Speech-Language Pathology and Audiology.
- Speech trainer provides speech training in both expressive (speech language production) and receptive (lip and speech reading) language. May also evaluate and provide training in the use of speech augmentation devices. Certified as a speech-language pathologist by the State Board of Examiners for Speech-Language Pathology and Audiology.
Outpatient services may include:
- physician visits;
- physical or occupational therapy;
- speech, language, or hearing therapy; or
- home health or nursing care.
Provide outpatient services only when prescribed by a physician and only if they are likely, within a reasonable period of time, to correct or modify substantially a stable or slowly progressive physical or mental impairment that constitutes a substantial impediment to independence.
If the service provider requests an extension of treatment beyond his or her initial recommendation, assess the consumer's potential for continued progress. Your assessment may involve reviewing notes on progress of the treatment and/or contacting the physician and/or service provider.
If continuing treatment is appropriate:
- clearly document in the case file how continued services are expected to contribute to achieving the independence goal;
- approve up to a total of 30 visits or therapy sessions; and
- obtain approval from the HHSC to extend treatment beyond 30 visits or therapy sessions.
Purchase physical therapy (PT) when required to increase:
- strength; or
- range of motion.
A physician recommends, and later reviews, the provision of PT. A licensed physical therapist provides the service.
Prescription Drugs and Medical Supplies
Provide prescription drugs and medical supplies, as needed, when a consumer cannot buy or obtain them from comparable sources.
When a consumer is discharged from a medical rehabilitation facility or hospital that has an in-house pharmacy, pay for a 30-day take-home supply of the prescription drugs and medical supplies that the consumer received while in the facility or hospital.
If prescription drugs and supplies are needed beyond the 30 days, arrange to purchase them from a pharmacy in the consumer's home area. Buy from the least-expensive available source. When specialized prescription drugs or supplies are not readily available from a local source, buy them from the hospital pharmacy.
Speech Therapy and Speech Training
Speech therapy provides treatment for disorders of:
- communication; and/or
- auditory processing.
A physician recommends, and later reviews, the provision of speech therapy. A licensed speech-language pathologist provides these services.
The speech-language pathologist may also provide:
- speech training in both expressive (speech and language production) and receptive (lip or speech reading) systems; and
- evaluation and training in the use of speech augmentation devices.
A physician's recommendation and review are not required for speech training.
Other Durable Medical Goods and Services
After an initial prescription is received, obtain the specifications for the prescription (that is, the type, size, and special features needed) by arranging for the consumer to be evaluated by:
- a physiatrist;
- a physical or occupational therapist; or
- another qualified service provider.
The following are definitions for different types of durable medical equipment.
Power wheelchairs: A power wheelchair is battery-operated. It has a base with four wheels and adjustable seat with armrests. It also has a controller (joystick or touch pad) attached to one armrest that allows the rider to control the movement of the chair. The chair can be disassembled for transport and usually comes with an on-board battery charger. The braking system is either automatic or electric. Powered wheelchairs can be customized with advanced technology and with several options, including seat size (width and depth), seat-to-floor height, foot rests, and leg rests.
Manual wheelchairs: A standard manual wheelchair may have a cross-brace frame that folds easily for transport or storage, or may be nonfolding, with a rigid frame. The chair may have built-in or removable armrests or footrests (optional) for ease of transfer, a mid- to high-level back, and push handles to allow a person outside of the car to propel the chair. The seat sizes may be customized for the user. The standard tire used for the rear wheels on most wheelchairs is a pneumatic tire, with a standard size of 24 inches. Pneumatic tires have wheel locks, sometimes called brakes, which can be applied by pushing a lever located on the sides, allowing the user to control the speed or come to complete stop.
Scooters: A scooter is a power-operated vehicle that has a seat on a long platform, moves on either three or four wheels, is controlled by a steering handle, and can be independently driven by a user. It has rear drive, uses a 24-volt system and an electronic or dynamic braking system, has high-to-low speed settings, and has tires designed for indoor and outdoor use.
Power units and controllers: A power unit and controller is a computer peripheral or general control device consisting of a hand-held stick that pivots about one end and transmits its angle in two or three dimensions to a computer, or to a touch pad that serves the same purpose. A power unit and controller is used to propel, brake, steer, negotiate, and maneuver a powered wheelchair or scooter around obstacles.
Seating or positioning systems: A wheelchair seating system is designed for the individual needs of the consumer to:
- provide postural support, thereby enabling the consumer to sit when the consumer does not have sufficient strength or control to do so unaided;
- provide correction to encourage normal postural development and to reduce the tendency to develop orthopedic deformities;
- enhance functionality, enabling the consumer to perform everyday tasks in the home or social setting in which the consumer would not otherwise be able to perform those tasks;
- manage the distribution of pressure to reduce the risk of tissue damage resulting from inappropriate loads being applied to the skin; and
- accommodate established orthopedic deformities.
The actual components and complexity of any particular wheelchair seating system depend on the problems that the system addresses. This definition includes parts (for example, cushions), as well as the complete system.
Patient lifts: Patient lifts are assistive devices used to help caregivers transfer a person safely back and forth from a bed to a chair when the person cannot transfer without assistance. Lifts fall into four broad categories: mobile lifts, sit-to-stand lifts, ceiling lifts, and wall-mounted lifts. The lifts can be operated hydraulically or electronically.
The definition of patient lifts does not include:
- lifts that require structural modification of a building; or
- lift chair recliners, sometimes referred to as easy chairs, with seats that raise an occupant to a standing position.
Hospital beds: A hospital bed consists of special features (a modified catch-spring assembly and bed ends with casters and manually operated foot-end cranks or an electric motor) that permit independent adjustment of the elevation of the head and knee sections. The bed can accommodate a standard trapeze bar when attached to the head end and other accessories. The bed should be equipped to accommodate side rails. This definition does not include special or customized mattresses.
Fabricated good: A fabricated good is a device constructed to meet a specific need.
Functional unit: A functional unit is the fully constructed or fabricated durable medical equipment that can be immediately used by the consumer for whom it was specified. For example, a wheelchair would include the frame, seating system, controls, batteries, or other parts necessary to make it immediately usable by the consumer.
Manufacturer's suggested retail price (MSRP): The MSRP is the published price that a manufacturer of a product suggests that retailers charge for the product.
Other medical goods and supplies: Other medical goods and supplies are all of the medical goods and supplies that are not defined as durable medical equipment.
Contractor-provided specification: A contractor-provided specification is a written detailed description of the exact product to be provided, including the cost of the product and the date by which the product will be delivered.
Appendix I, Services for Individuals Who Are Deafblind
Revision 19-1, Effective March 1, 2019
A vendor must meet the following qualifications:
- Hold a bachelor's degree in education or a related field.
- Have a working knowledge of the following:
- The medical, psychological, social, and independent living issues faced by persons who are deafblind, are visually impaired and/or hard of hearing, or are otherwise disabled
- Assessment techniques and tools
- American Sign Language, augmentative communication, manual signs, and other communication systems
- Knowledge of agencies, individuals, and facilities that serve people who are deafblind (with or without additional disabilities) and serve the culture and adaptive needs of people who are deafblind
- Have the ability to do the following:
- Adapt teaching methods to the needs of persons who are elderly and either deafblind or deafblind and multiply disabled
- Help consumers adapt or modify common items in the home to make the items accessible
- Assess, formulate, organize, and implement an individualized program of instruction with consumers
- Teach consumers to read and write all aspects of uncontracted braille
- Communicate using American Sign Language, including using tactile sign language
- Teach assistive technology, as needed, to enable a consumer to access independent living skills
- Deliver, install, and setup adaptive aids and/or devices
Services must not begin until the service provider has been notified of approval.
Deafblind Services Vendor Responsibilities
The deafblind services vendor:
- completes an assessment of needs;
- submits the appropriate documentation for each type of service to the service provider for review and approval;
- submits to the service provider appropriate recommendations for purchasing products and services for each consumer;
- installs and trains consumers who are deafblind to use adaptive equipment, including visual alarms and vibrating alerting systems; and
- provides the service provider with a written report of each contact and includes details of the assessment or service provided and the outcome.
The deafblind services vendor must make the initial contact with a consumer who is referred for deafblind services training within 15 working days of the referral.
Appendix J, Vision Services
Revision 19-1, Effective March 1, 2019
Eyeglasses and Contact Lenses
An ophthalmologist must be licensed by the Texas Medical Board.
An optometrist must be licensed by the Texas Optometry Board.
Once a recommendation and a prescription from a licensed optometrist or ophthalmologist has been received, purchase lenses and frames according to the following procedures:
- Single vision, bifocal, and trifocal glasses or contact lenses may be purchased using available funds.
- Lenses may have tint and/or be impact-resistant, if prescribed.
- Frames must be the least expensive serviceable type available. The consumer may supplement the additional cost for frames, if the cost of the consumer’s choice exceeds the minimum cost for a functional frame.
- Compare the cost of contact lenses with the cost of glasses before purchasing contact lenses, to determine the most economical way to meet the required need for the consumer.
Low Vision Services
Low vision services may be provided to eligible individuals whose visual acuity cannot be improved by conventional prescription eyeglasses. Low vision evaluations should be provided by an Optometrist or Ophthalmologist who has received specialized low vision training.
Optical Low Vision Devices
Optical low vision devices are complex optical aids designed by a specialist for a specific consumer, based on the consumer’s functional vision and optical prescription.
Examples of optical low vision devices include highly sophisticated bioptic, telemicroscopic, and reversed telescopic optical systems, as well as other single or compound optic systems.
Non-Optical Low Vision Devices
Individuals with low vision may benefit from low-tech adaptations, such as modifications in lighting or the use of contrasting colors (such as using a place mat that contrasts in color with the plate) as well as non-optical low vision devices.
Non-optical low vision devices include the following:
- Readily available independent living aids such as 20/20 pens and bold line paper
- Video magnification devices, including closed circuit television (CCTV)
- Non-prescription optical devices, such as hand-held magnifiers and telescopes
A technology evaluation or a low vision specialist recommendation is required for technology purchases of $2,500 or more (for example, some video magnification systems (CCTV) and stand-alone scanners).
To purchase a non-optical low vision device:
- obtain the price for each item; and
- consider the needs for accessibility, training, and installation;
- document the specific information about the item, such as the:
- model number or version; and
- monitor size; and
- purchase as needed.
Appendix K, ILS Purchased Services Standards Areas of Emphasis
Revision 19-1, Effective March 1, 2019
The following information provides further technical guidance related to implementation of the ILS Standards for Service Providers. These items apply to ILS Outsource Service contracts.
The technical guidance includes recommendations for written policies or procedures. Additionally, a written policy is required when the standards call for a “written policy,” “written documentation,” “procedure,” or “plan.” “Policy” defines what the Service Provider’s plan or guiding principle is, as related to the required standards; “procedures” are the process (or steps) the applicant takes to ensure the policy is carried out. Procedures should answer the questions of who, where and how a policy will be implemented. Policies and procedures are the service provider’s guiding principles and implementation process and should not restate a standard. Policy submissions that reflect a restatement of standards will not be accepted. Service Provider may also need to develop additional policies to guide the delivery of services, even when not required by the standards.
1. Service provider will make available an organizational chart of the entire service provider organization. This chart will include:
- all job positions (including filled, vacant and any proposed);
- clearly identified personnel who will be assigned to the ILS program and meet staff requirements in the ILS Standards;
- positions that will be responsible for making eligibility determinations and service delivery for the ILS program; and
- positions that will have administrative or supervisory responsibility over the ILS program.
2. Service provider will inform HHSC of all changes in staff allocated to the ILS program within 10 business days of the change (e.g., termination, hiring, promotion).
3. Service provider will provide HHSC staff with the qualifications of staff assigned to the ILS program, together with how the proposed staffing arrangement:
- maximizes efficiency and effectiveness of the delivery and provision of IL services; and
- how staff will provide services specifically for consumers who are:
- blind or visually impaired;
- deaf or hard of hearing; or
4. Service provider will check the licensing authority website for any staff who hold a professional license in order to determine if there are any restrictions to the license. If staff transport consumers in either a service provider owned vehicle or private vehicle, annual driver license checks should be obtained.
5. Service provider must have a written safety policy that includes both consumer and employee safety in emergency situations, such as severe weather or fire.
6. Service provider will develop a policy with the proposed method of service delivery to all areas of the counties that the service provider serves. This policy will include the following:
- how access to services will be provided in both rural and urban areas;
- an estimate of the greatest distance a consumer would travel to access services;
- the frequency of availability of services to be provided for the consumer;
- how services will be provided by staff in areas near (within 10 miles) and not immediately adjacent (greater than 10 miles) to the service provider’s physical location;
- how the organization intends to provide services directly to consumers by service provider staff or a subcontractor; and
- a plan to address the unique needs of individuals with significant disabilities and those who are blind.
7. Service provider must have a written policy and procedure regarding consumer participation in the cost of services, as well as the collection of consumer participation funds. This policy should be shared with the consumer at the time of application and before purchases are made. The policy must include the following:
- discuss the consumer participation process during the application process;
- discuss the consumer cost participation process prior to being determined eligible;
- consumer participation agreement as developed by the service provider that will be signed by the consumer and service provider representative;
- consumer participation will be collected prior to delivery of goods or services; and
- the timeline for the consumer to receive goods or services after consumer participation has been collected.
8. Service provider must have a written policy and procedure to ensure that staff will enter timely documentation. At a minimum, the policy will include:
- ILS DRS entry of services the requested services at the time of application, update services at the time the plan is written, and provide entry updates throughout the services phase of the case;
- Entry of all case documentation (e.g., phase dates, case notes, requested services and service records) in the ILS Data Reporting System (DRS) and the CIL's case management system by the 5th business day of each month, as required in Chapter 10: Reporting and Quality Assurance; and
- Entry of all case documentation in the ILS DRS before the case is closed. Service records must be entered, including the paid date, and verified as accurate before the case is closed in the ILS DRS. The process should include who in the organization will review service records prior to case closure.
9. Service provider will develop a written in-house training policy and procedure for ensuring each employee is trained on the following:
- data use agreement;
- case management techniques and expectations;
- ILS purchased services/outsource process;
- case documentation requirements; and
The policy must also include:
- documentation that each staff has participated in the training at least annually;
- outline or curriculum of specific topics covered in the training;
- other internal training available to direct service delivery staff; and
- external training opportunities available to direct service delivery staff.
10. Service providers who own, lease or use dedicated space in which HHSC consumers will be provided services are considered to have a physical location. Service providers must provide documentation of compliance with the Americans with Disabilities Act to HHSC upon application and within 30 days of relocation. Service Provider will have policies and procedures to describe the following:
- building is accessible to all individuals;
- services are accessible to all individuals;
- universal staff accessibility;
- communication is accessible to all individuals;
- information related to services and providers is available and accessible to all individuals; and
- a paper copy of the completed "ADA Checklist for Existing Facilities" found at https://www.adachecklist.org/ kept on hand for the location.
11. Service provider must have an incident reporting system in place. A form for staff reporting of incidents must be developed and, at a minimum, include: the date, time and place of incident; nature of the incident; names of HHSC ILS consumers, witnesses or others involved; the name of person making the report; a description of incident; and actions taken and planned by the provider as a result of the incident. The service provider must report incidents involving HHSC ILS Outsource consumers to their HHSC compliance specialists and keep records in keeping with the records retention policy.
12. Service provider will inform their staff and consumers that the HHSC Office of Ombudsman and Office of Inspector General (OIG) are available to report complaints or concerns regarding the provision of IL services.
13. Service provider will ensure that a minimum of 25 percent of funds are expended in each purchased service category on a quarterly basis. In the event a category is underutilized, the service provider will document lack of consumer requested services in that category or the amount of funds reserved to be expended in the purchased service category before requesting movement of funds from one purchased service category to another.
14. Service provider will ensure that HHSC prior approved purchases are initiated within 60 days of prior approval notification.
15. Service provider will demonstrate that a written policy and procedure is in place that, at a minimum, includes the following:
- The service provider’s method for separating ILS Purchased Services funds from other funding streams (e.g., accounting systems, financial documentation and software) and that allocations are tracked.
- ILS Purchased Services contract funds are used only for ILS Purchased Services program consumers.
- The service provider has procedures to track and manage funds appropriately, including submission of prior approval packets based on availability of funds.
- There are implemented checks and balances for all types of expenditures.
16. Service provider will have a bookkeeper/accountant/chief financial officer available to submit and communicate with HHSC staff about monthly invoice/workbooks, quarterly advances, budget revisions and other financial reporting documents. This bookkeeper/accountant/chief financial officer should not serve in the role of executive director.
17. Service provider will implement an intake/referral process for ensuring that services are not duplicated with comparable benefits (i.e., health insurance and local, state and federal resources). The intake process should include asking consumers the names of other agencies from which they receive services in order for CIL to complete coordination of services with that entity(ies).
18. Service provider will accept referrals from all community organizations on behalf of individuals. The service provider will contact the referred individual to verify interest in services and obtain any information necessary to complete the initial contact.
19. Service provider will develop and maintain a community resources list annually to be shared with staff and consumers, as appropriate.
20. Service provider will ensure that staff attend a minimum of nine HHSC trainings or webinars, specific to the implementation of the ILS outsource contract and ILS Standards for Providers, each fiscal year. The service provider is responsible for ensuring all staff receive the information from HHSC trainings or webinars. If all staff are not available to attend the HHSC trainings or webinars, the service provider should have staff in attendance provide the training information to those who were not in attendance.
21. Service provider will collaborate and partner with community and state organizations (e.g., Texas Workforce Commission Older Individuals Who Are Blind program, Deaf and Hard of Hearing Center, Lighthouse for the Blind, Texas Workforce Commission Rehabilitation Services, Hadley School for the Blind, American Foundation for the Blind, etc.) to assist with developing staff’s skills and to increase availability of services for blind or visually impaired, deaf or hard of hearing, and deafblind consumers.
22. Service provider will ensure staff in direct service delivery positions will attend trainings (e.g., in-services, workshops, online trainings, seminars, etc.) that address serving consumers who are blind or visually impaired, deaf or hard or hearing, or deafblind.
23. Service provider will have a written quality assurance program for review of program activities that evaluate compliance with the Independent Living Services rules and the Independent Living Services Standards. At a minimum, this will include the following and all areas listed in Chapter 10: Reporting and Quality Assurance.
- Review a minimum of 10 percent of all consumer case files each fiscal year. The case reviews will be conducted by staff members not directly involved in the delivery of services under this contract.
- Create and retain an ILS outsource specific case review form used to document all case reviews.
- A process for managing and monitoring the performance of vendors and subcontractors that includes the quality of goods or services provided.
24. Service provider will enter consumer success stories into the ILS DRS on a monthly basis, by the fifth day after the end of the previous month. These consumer success stories should include examples of consumers served with different disabilities, including consumers who are deaf or hard of hearing and blind or visually impaired.
25. Service provider will obtain an annual financial audit conducted by an independent auditor in compliance with Generally Accepted Auditing Standards (GAAS), as published by the American Institute of Certified Public Accountants.
26. Service provider must follow ILS Standards Chapter 6: Purchased Goods and Services for Consumers, and ILS Standards Appendices to provide purchased goods and services that are within the scope of the program and that best fit the consumer's needs while observing efficient budgeting practices and standards.
27. Service provider must adopt and implement procurement policies that address: conflict of interest situations; planning for procurement needs; separation of duties; criteria and situations for obtaining bids or proposals; purchasing of supplies and equipment; contracts for goods or services; and maintenance of procurement records.
28. Service provider will document coordination of purchases with any comparable benefit, resource or service available before expending funds from the contract in compliance with the Uniform Grant Guidance.
29. Service provider will have a written policy and procedure detailing how confirmation of delivery and installation of equipment is completed. At a minimum, the policy and procedure should include:
- The service provider staff or position who will confirm that installed equipment is working and the consumer was trained on the use of the equipment issued.
- The requirement for the service provider to obtain an itemized delivery ticket signed by the consumer for each item delivered and installed.
- The requirement for the service provider to confirm delivery and/or installation with the consumer before payment of a vendor’s invoice.
- Information detailing who will repair or replace damaged or faulty equipment when a warranty is applicable and when the warranty/service agreement has expired.
- The service provider policy for including information about warranties, service repair and return of equipment in disrepair or good condition in purchase agreements with vendor.
30. Service provider must refer to and follow guidance provided in Chapter 5: Service Delivery Process, and Section 5.8: Waiting List. This includes having a written policy that is consistent with Section 5.8: Waiting List. The policy should include a method of contact with consumers and a time frame to follow up regarding continued need for the requested services that are on the IL plan. These contacts with consumers must be documented in the ILS DRS to show when a consumer is moved to the waiting list due to lack of funding, as well as the projected date for follow-up contact to inform the consumer of funding availability.
31. Service provider will establish a code of conduct for staff who perform consumer home visits and will provide training on the code of conduct to staff assigned to the ILS Outsource contract.
32. Service provider will monitor (e.g., through performance evaluations, direct observations and/or other methods allowable) interactions of IL staff with consumers. Internal monitoring should be performed at minimum on an annual basis, per service provider personnel policies.
33. Service provider will report on all community outreach and education specific to the ILS Outsource contract annually. The community outreach should include specific contacts in underserved or unserved areas of their ILS purchased services/outsource contract area and underutilized categories of purchased services.
34. Service provider must utilize the communication preference of individuals with all types of disabilities including individuals who are deaf and hard of hearing, either by subcontractor or direct service provider.
35. Service provider will utilize certified or qualified ASL interpreters and collaborate with the Deaf and Hard of Hearing Access Specialist to obtain information about hiring appropriate interpreters.
ES = Spanish version available.
|3000||Budget Revision Request|
|3001||Quarterly Financial Report|
|3002||Quarterly Performance Report|
|3003||Quarterly Income Report|
|3008||Cost Share Collections/Refund Report|
|3153||Purchased Services Contract Monthly Complaint and Inquiries Report|
|3155||Base/Operational Grant Budget Revision Request|
|3157||Base/Operational Grant Quarterly Financial Report and Analysis|
|3160||Quarterly Program Performance Report|
|3161||Consumer Demographic Information|
|3455||Provider Staff Information|
|3470||Request for Advance or Reimbursement (RAR) Centers for Independent Living Base/Operational Grant|
19-1, Annual Revision
Revision Notice 19-1; Effective March 1, 2019
The annual revision of all sections of the handbook includes significant changes to the structure of the handbook. Chapters 12 and 13 have been removed and the information is now in the new Independent Living Base/Operational Grant Standards for Service Providers.