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.

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.

A

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.

B

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.

C

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
• married.

F

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.

H

HHSC – The Texas Health and Human Services Commission

I

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.

N

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.

P

Private – An agency, organization, or institution that is not under federal or public supervision or control.

S

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.

T

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.

V

Vendor – A person or organization that a service provider contracts with to deliver services or provide goods to consumers.

W

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.

Revision 19-1, Effective March 1, 2019

3.1 Scope of Services

All services provided in this section are subject to Chapter 7, Contract Application and Award, 7.1 Allotment of Funds.

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.

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: blindandgeneralindependentliving@hhsc.state.tx.us; 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.

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.

5.3 Eligibility

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:

1. 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;
2. 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;
3. assesses the consumer's ability to pay according to the federal poverty limit guidelines; and
4. 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)

5.3.1 Ineligibility

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:

• communication;
• 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:

1. collecting financial information;
2. calculating the consumer's household size and adjusted gross income;
3. assessing the consumer participation fee according to the published scale;
4. processing the consumer participation agreement with the consumer; and
5. 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.

5.6.3.1 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.

5.6.3.2 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.

5.6.3.3 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.

5.6.3.3.1 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.

5.6.3.3.2 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.

5.6.3.4 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).

5.6.3.5 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)

Background

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.

Revision 19-1, Effective March 1, 2019

6.1 Overview

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;
  • cancer;
  • 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.

6.5.2 Counseling

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.

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
• Travel
• 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.

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.

8.3 Records

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:

• invoices;
• 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.

8.4.1.1 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.

8.4.1.2 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.

8.4.1.3 Contractors Standards of Conduct

Service providers must maintain and implement written standards of conduct for staff members.

8.4.1.4 Professionalism

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.

8.4.1.5 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:

• National Voter Registration Act
• Election Code, Title 2, Chapter 20

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:

1. offers the consumer the opportunity to register to vote;
2. 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:

1. offers the consumer the opportunity to register to vote at the new address;
2. 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
3. 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.

8.6 Accessibility

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
512-463-5561
512-463-5569 (Fax)
800-735-2989 (TDD)

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.

8.10.4 Accessibility

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
• death.

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.

9.1 Technical Assistance

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.

9.2 Training

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.

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.

Likert Scale

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.

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.

11.1 Monitoring Team

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.

11.1.1 Monitoring 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.

11.1.2 Report of the Monitoring Results

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.

11.1.3 Corrective Action Plan

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.

11.1.4 Monitoring Closeout

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.

11.2 Allegations or Incidents of Abuse, Exploitation, or Neglect of Persons with Disabilities

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.

ES = Spanish version available.

For technical or accessibility issues with this handbook, email: form.handbook.request@hhs.texas.gov

For questions about the Independent Living Services Standards for Providers, email: blindandgeneralindependentliving@hhsc.state.tx.us