Revision 23-1, Effective Nov. 13, 2023

Person-centered practices must be used in the delivery of independent living services. There are four main components to being person-centered:

  • Focus on the person. They are at the center of the planning process. The person’s desires should be heard, honored, valued and reflected in the services received. A person should be offered the opportunity to include people who are important in their life as part of the planning process.
  • Choice and self-determination. People should make choices, with support if needed and wanted, about services and supports as well as decisions regarding their own health, well-being and life goals.
  • Community inclusion. People must have full access to the community and be treated with dignity and respect.
  • Availability of services and supports. People should have access to an array of individualized services that meet their needs.

Visit The Administration for Community Living’s person-centered practices page for information, tools, and resources.

5.1 Initial Contact

Revision 23-1, Effective Nov. 13, 2023

A person 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 person or referral organization with information about the person’s independence needs and form impressions about if the ILS Program meets those needs. The service provider must process all initial contacts received in a timely manner, regardless of the referral source. If the only services being requested are not allowable by the ILS program in the purchased services contract, the case may be closed and the person referred to the appropriate HHSC program or community resource. The service provider must gather the referred person’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 person to get necessary data to complete the initial contact.

The initial contact date is the first request for help 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 person may have previously contacted the service provider and received any or all of the independent living core services funded.

5.2 Application for Services

Revision 24-1, Effective Aug. 21, 2024

When a person 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. Note any circumstances delaying the completion of an application in the case file. The application may be completed by any service provider staff trained in the application process.

Applications must be completed in person whenever possible. Virtual or phone applications may be used during a government-directed order related to a pandemic, during a natural disaster as declared by the governor, or when specifically requested by a person. If an application is not taken in person, document the reason it was not able to be conducted in person. This must be documented and signed by the person or their representative and service provider staff. A person chooses the location of the application appointment that is most accessible for them. If they cannot go to the service provider’s office, service provider staff will meet the person in their home or in another confidential location in their community. Whether an application is taken in person, virtually, or by phone, the service provider must account for any communication accommodations the person needs, including translators or interpreters. Communication accommodations are provided at no cost to the person.

The service provider must develop and maintain an application process to provide, in accessible format, information related to:

  • individual rights;
  • rights to complain or appeal a process decision (Review 4.1.1 and 4.1.2);
  • disposition of confidential information;
  • permission to collect or release information;
  • assignment of a representative for minors or when the person chooses to be represented;
  • the consumer participation system, including a list of each service not requiring consumer participation (review 5.7.3);
  • need for financial records, if determined eligible to receive services;
  • voter registration information (review 5.3); and
  • additional services for veterans (review 8.8).

The service provider must develop a process for gathering information from the person about:

  • the person’s perspective, abilities, resources, limitations, and other issues that impact his or her ability to function in the home, family or community;
  • goals for independence;
  • services addressing independence goals;
  • existing service provider relationships; and
  • other considerations that support the eligibility decision.

Application documents and all other documents signed by the person require either a handwritten signature or an acceptable digital signature. Examples of acceptable digital signatures include:

  • Time-stamped signatures from third-party services, such as Adobe or DocuSign
  • Digitally captured signatures using a stylus or the person’s hand on a tablet or similar device
  • Cursive or custom signatures created by the person

Typed signatures are not accepted. If a person’s disability prevents them from signing a document in any of the methods above, ask them to designate a representative for this purpose. If the person does not have a suitable representative, the CIL case worker writes Person unable to sign on the document. A case note must be entered in the CIL case management system outlining why the person could not sign.

Information gathered will be documented in the individual case file for use in eligibility determination.

5.3 Voter Registration

Based on federal and state laws, a service provider must establish a written policy to ensure that people 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 applicants.

Federal and state laws include the following:

The policy applies to people who are at least 17 years and 10 months of age.

HHSC offers a printable voter registration card (Form H0025). Voter registration can also be completed online through the Texas Secretary of State website.

Service providers are prohibited from:

  • influencing a person’s political preference or party registration;
  • displaying political preference or party affiliation;
  • making any statement or taking any action to discourage a person from registering to vote; and
  • documenting in the person’s case file the response and action that the person takes after being given the opportunity to register to vote.

Service providers must refer people to the Elections Office of the Secretary of State, 800-252-8683, and to the County Voter Registration Officials for questions that HHSC employees cannot answer.

When a person applies for services, the service provider:

  1. offers them the opportunity to register to vote;
  2. provides a voter registration card for the person to mail or the link to the Texas Secretary of State website;
  3. offers to help the person fill out the card or the online application; and
  4. documents in the person’s case file that the person was given the opportunity to register to vote but does not want to and document the person’s response or actions.

When a person reports a change of address, the service provider:

  1. offers the person the opportunity to register to vote at the new address;
  2. mails the person a voter registration card when the change of address is reported by phone, or provides a voter registration card for the person to mail; or
  3. helps the person 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 person’s home; and
  4. documents in the person’s case file that another opportunity to register to vote was given but does not document the person’s response or action taken.

5.4 Eligibility

Revision 25-1, Effective Feb. 2, 2025

To be eligible for independent living services, a person must:

Eligibility is determined by the service provider, based on the documented diagnosis of a significant disability. The service provider may gain information obtained from a licensed practitioner, such as an MD, DO, nurse practitioner or advanced practice nurse, or information gathered from the person, to define his or her ability to benefit from services and reach independent living goals. A documented diagnosis from a licensed medical practitioner is not required to determine eligibility but is required before the purchase of goods and services. All source records gathered to document eligibility should be maintained as part of the person’s case file. A person is not required to participate in the cost of diagnostic assessments or evaluations for the purchase of goods and services.

The service provider must document the eligibility decision in the person’s case file. Medical records charges, diagnostic assessments, goods or services evaluations and support services required to complete a diagnostic assessment or evaluation including transportation, interpreters or translators, will be the only allowable purchases for a person without a documented diagnosis of a significant disability and ILP.

Once a person is determined to be eligible for services, the service provider:

  1. notifies the person of the eligibility decision and the need to gather financial information from the person 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 people 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 person’s ability to pay per the federal poverty limit guidelines; and
  4. notifies the person, or the person’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 5.7.3 Consumer Participation in Cost of Purchased Services.

5.4.1 Ineligibility

Revision 23-1, Effective Nov. 13, 2023

If a service provider determines that a person is not eligible based on the eligibility criteria in 5.4 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 person's case file along with any supporting documentation.

The service provider may determine a person is ineligible for independent living services only after consultation with the person or after providing a clear opportunity for consultation. See 5.8 Termination of Services.

5.5 Pre-Planning Assessment

Revision 23-1, Effective Nov. 13, 2023

Assessments and related evaluations required for planning services and ILP completion may be purchased after eligibility is determined and before the ILP’s signed date or waiver date. A person is not required to participate in the cost of diagnostic assessments and evaluations required for the purchase of goods or services.

5.6 Assessments for People Who Are Blind

Revision 23-1, Effective Nov. 13, 2023

All people requesting services related to a visual disability must have an assessment specific to the needs of the person with a significant visual impairment or blindness. The needs assessment for a visual disability must be conducted in the home. Service provider staff may conduct the assessment as part of the application or at any point before completion of the ILP. The assessment for services related to a visual disability is comprehensive to assess all areas of potential needs for a person with a visual disability. It is not part of an assessment for specific services such as orientation and mobility or diabetes education.

The assessment must address the following areas:

  • Daily living skills, such as a person’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 person’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 such as if the person needs a deafblind or hearing evaluation, diabetes education or help managing medication.
  • Ability to travel and transport, such as a person’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, if the person wants to attend orientation and mobility training and, if so, what their goals are for travel and mobility.
  • Support systems, such as the person’s natural support system, community resources and needed referrals.
  • Quality of life, such as the person’s leisure, volunteer, or recreational activities. For example, if the person wants to be more active and what training would improve their quality of life.
  • Adjustment to blindness, such as the person’s ability to cope with vision loss, their readiness to participate in services, and if they self-advocate and use adaptive techniques.
  • Future independence, such as if the person is at risk of going to a more dependent living environment if they do not receive services.

5.7 Development of the Independent Living Plan or Waived Independent Living Plan

Revision 23-1, Effective Nov. 13, 2023

After determining eligibility, the next step in the independent living services process is to develop the ILP or waived ILP.

The service provider uses all available information to complete person-centered planning with the person. The ILP process includes providing information about all options for goods and services available to help the person:

  • 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 person’s need in the most cost-effective way, minimizing expenditures for the person and the program.

The service provider must ensure that the person 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;
  • health insurance, third-party payers or other private sources; or
  • by other benefits that are available to the person and are commensurate in quality and nature to the services that they would otherwise receive from the service provider.

5.7.1 Identifying the Independent Living Goals

Revision 23-1, Effective Nov. 13, 2023

Suitable independent living goals relate directly to addressing the person’s functional needs and what the person wants to achieve to access their home, family or community.

Independent living goals are significant life achievements that:

  • enable the person to become more, or to remain, independent in the home, family or community; and
  • are made possible through independent living services.

A person 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.

5.7.2 Initiating an Independent Living Plan or Waived Independent Living Plan

Revision 23-1, Effective Nov. 13, 2023

A person’s ILP or waived ILP is initiated after the person’s eligibility is documented, per 5.4 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 person or a service being provided by staff or purchased for them. It indicates the anticipated duration of the service plan and the duration of each component service.

An ILP amendment is required when any changes to the original ILP or Waived ILP are completed with the person. The service provider develops written policies to address ILP amendments.

The ILP and any amendment are developed by the service provider and the person or the person’s representative. If the person signs a waiver, a waived ILP is developed by the service provider.

A copy of the independent living plan and any amendment is provided in an accessible format to the person or their representative and documented in the person’s case file. The waived ILP is also documented in the case file.

5.7.3 Consumer Participation in the Cost of Purchased Services

Revision 23-1, Effective Nov. 13, 2023

The service provider administers the consumer participation system per the Independent Living Services Standards and the contract requirements. The service provider gathers financial information about the person to determine their participation.

In summary, the service provider determines the person’s requirement and ability to participate in the cost of purchased services by:

  1. collecting financial information;
  2. calculating the person’s household size and adjusted gross income;
  3. assessing the consumer participation fee per the published scale;
  4. processing the consumer participation agreement with the person; and
  5. documenting the agreement in the person’s 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 person.

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.

5.7.3.1 Collecting Financial Information

Revision 23-1, Effective Nov. 13, 2023

When the person has been determined eligible for services, the service provider reviews information related to the person’s ability to pay.

The service provider gathers financial information about the person to determine their adjusted gross income and the percentage of the federal poverty level for that income. For planning purposes, the person is notified of his or her expected percentage fee for services after the eligibility notification. This allows the person to consider their percentage fee before agreeing to a plan of services and the opportunity to request a re-review and provide information about any exceptional circumstances or further documentation to assess the person’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.

5.7.3.2 Calculating the Person's Household Size and Adjusted Gross Income

Revision 23-1, Effective Nov. 13, 2023

Based on financial records provided by the person, the household size equals:

  • anyone living inside or outside of the home who is eligible to be claimed as a dependent of the person on the person’s federal income tax return; or
  • if the person is a minor, anyone else living inside or outside of the home who is eligible to be claimed as a dependent of the person’s parent or guardian on the parent or guardian's federal income tax return.

The person’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 person’s allowable deductions are limited to their expenses in the following categories:

  • Attendant care;
  • Rent or home mortgage payments;
  • Court-ordered child support payments made by the person 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 person paid during the previous 12-month period, per financial records provided by the person.

The person provides the most recent tax return available as proof of annual gross income and allowable deductions. If they have no tax return, the person provides bank statements, medical records, receipts, proof of benefits awards, and other documentation to demonstrate annual gross income and allowable deductions.

If the person does not provide documentation supporting the household's allowable deductions, the service provider determines the person’s fee for service based on their documented annual gross income with no allowable deductions.

5.7.3.3 Assessing the Consumer Participation Fee According to the Published Scale

Revision 23-1, Effective Nov. 13, 2023

Once the service provider calculates household size and adjusted gross income, the person’s financial situation is assessed to determine the percentage of federal poverty guidelines. The person’s fee, listed on the HHSC fee schedule, is then based on the corresponding percent of cost to be paid.

Factors that affect the person’s fee for service, as described above, are:

  • household size;
  • annual gross income; and
  • allowable deductions.

The person’s fee for service is equal to the amount on the HHSC sliding fee scale per the household's annual adjusted income. This 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 person’s fee for service.

As the ILP or waived ILP is developed, the service provider and person discuss cost of services so that the person is aware of the fee that will be due for agreed upon services and, if necessary, request a re-review and provide information about any exceptional circumstances.

The service provider charges the person a fee for each purchased service provided, per the person’s percentage of the federal poverty level. Support services are not charged consumer participation and therefore are not part of the consumer participation calculations.

5.7.3.3.1 Fee Schedule Amount

Revision 23-1, Effective Nov. 13, 2023

The service provider is required to use the HHSC fee schedule and instructions to calculate the person’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 goods or service, the service provider charges and collects the person’s fee for each purchased service provided, per 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 a.m. and 5 p.m. on business days. The fee schedule is also available on the HHSC Independent Living Services Program website and provided to the person.

5.7.3.3.2 Insurance Payments

Revision 23-1, Effective Nov. 13, 2023

If the person has medical insurance that covers an independent living service received by the person then their fee for service is either the deductible, copayment or coinsurance, or the amount calculated by the HHSC fee schedule, whichever is less.

The person pays the premiums for medical insurance. Neither HHSC nor the service provider pays the premiums.

The premiums for medical and dental insurance do not count toward meeting the person’s fee for service.

The service provider may not need to spend independent living service funds to help the person achieve their independent living goals. Before providing independent living services to a consumer, the service provider explores any possible comparable services or benefits and if those services and benefits are available to the consumer. The service provider records these services on the ILP or waived ILP as coordinated services.

All comparable benefits must be exhausted before funds are used for services covered under this contract.

5.7.3.4 Processing the Consumer Participation Agreement with the Consumer

Revision 23-1, Effective Nov. 13, 2023

The person or their 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 person’s fee for services and provides written agreement that:

  • the information provided by the person or the person’s representative about their household size, annual gross income, allowable deductions, and comparable services or benefits is true and accurate; or
  • the person or the person’s representative chooses not to provide information about their household size, annual gross income, allowable deductions, and comparable services or benefits.

The service provider does not initiate or authorize independent living services available in the purchased services contract until the person or the person’s representative signs the consumer participation agreement.

If the person chooses not to provide information on their household size, annual gross income, allowable deductions, and comparable services or benefits, the person agrees to pay the entire cost of services.

As soon as possible the person 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 participation agreement.

When the person signs a new participation agreement, the new amount of the person’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 person’s fee for service-based circumstances that are both extraordinary and documented. This may include assessing the person’s ability to pay the person’s fee for service.

Only the service provider's executive director or designee has authority to reconsider and adjust a person’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 when the consumer makes a request and provides supporting documentation.

The person’s calculated fee for service remains in effect during the reconsideration and adjustment process.

Blanket waiver polices by the service provider are not allowable. The decision to waive consumer participation must be on a case-by-case basis.

All people with a purchased service, excluding diagnostic assessments evaluations and supports for ILS related appointments such as interpreters, translation services, or transportation, must have a corresponding consumer participation entry in the ILS Data Reporting System, even if the participation fee was waived.

The service provider:

  • uses program income that is received from the consumer participation system only to provide the independent living services available in the purchased services contract; 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 person’s fee for service.

The consumer 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 such as hard copy, scanned copied transmitted by mail or electronically or during on-site visits.

5.7.3.5 Documenting the Agreement in the Individual Service Record

Revision 23-1, Effective Nov. 13, 2023

An individual case file is maintained for all applicants and eligible people 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 individual case file.

Each individual case file must minimally meet the requirements of 45 Code of Federal Regulations (CFR), Subtitle B, Part 1329, and provide documentation concerning:

  • intake information, including prescribed individual 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 and legal status verification documents;
  • eligibility or ineligibility determination;
  • records provided by a licensed practitioner of diagnosis of a significant disability;
  • services requested;
  • an ILP or a signed waived ILP;
  • the person’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 person and achieved by the person; and
  • summary case management log notes.

The individual case file may be in written or electronic form; however, the ILP or waived ILP must have an original or digital signature.

All documents received, such as medical records, assessment, quotes or legacy agency files, must be kept in their original format in a case file.

5.7.4 Completing the Independent Living Plan or Waived Independent Living Plan

Revision 23-1, Effective Nov. 13, 2023

Unless the person who will receive independent living services under the Independent Living Services Standards for Providers signs a waiver per the requirements of this section, the service provider works with the person to develop and periodically review an ILP per this section.

If the person knowingly and voluntarily signs a waiver stating that their participation in developing an ILP is unnecessary, the service provider develops a waived ILP. The service provider must follow person-centered care and planning processes to develop the waived ILP.

The service provider provides each independent living service per the ILP or waived ILP.

5.7.5 Reviewing Annually the Independent Living Plan or Waived Independent Living Plan

Revision 23-1, Effective Nov. 13, 2023

At least annually, the service provider must review and update the individual’s plan for services, including:

  • the person’s goals;
  • the services delivered and still needed;
  • opportunities for referral or coordination with other programs or resources;
  • the person’s income, allowable expenses, and any other factors impacting the consumer participation agreement; and
  • the review results documented in a summary note in the person’s service record.

The person reviews the independent living plan and, if necessary, revises it and agrees by signature to its terms.

Any time that the person’s financial situation changes, the person must provide documentation and renegotiate the consumer participation agreement. All changes and agreements will be captured in the person’s case file.

5.7.6 Coordinating with Vocational Rehabilitation, Developmental Disabilities, and Special Education Programs

Revision 23-1, Effective Nov. 13, 2023

The review of the ILP or waived ILP must be coordinated, to the extent possible, with all the following programs where the person 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

5.7.7 Coordinating with Independent Living Program for Older Individuals Who are Blind (ILS-OIB)

Revision 23-1, Effective Nov. 13, 2023

The ILS-OIB program is administered through the Texas Workforce Commission (TWC). OIB staff are in Workforce Solutions offices across the state and are assigned coverage areas by county. Visit the TWC website for a list of offices.

To be eligible for the ILS-OIB program, the person must be 55 years or older and have a significant visual impairment that creates barriers for the person to live independently.

Services that the ILS-OIB program provides to people 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 and low-vision devices.

People receive goods and services from both programs. To provide coordinated services for mutual people, 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 including hearing aids and medical equipment.
  • Discussion of ongoing progress with the mutual person.

People may benefit from one or both programs. Therefore, OIB staff and the service provider's IL staff are required to refer people to each respective program and ensure that this referral is correctly captured in the case management system.

5.8 Termination of Services

Revision 24-1, Effective Aug. 21, 2024

The service provider stops providing services and closes the case as goals met (successful) when the goals of the ILP are achieved. If a person notifies the service provider at closure of more requested services not included on the ILP, the current case is closed. The person must be notified that the new request is considered a new case and they would start the process over, including going to the bottom of the waiting list.

A person may achieve at least one goal with a purchased service, and decide to cancel other goals, to be closed as goals met (successful). The service provider reports successful case closures in the ILS Data Reporting System.

If a person does not meet the goals of the ILP 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 in the ILS Data Reporting System.

If a person achieves their goals with services that were provided outside of the purchased services contract, the provider records this in the ILS Data Reporting System.

For both successful and unsuccessful case closures:

  • the service provider notifies the person in writing of the action taken and informs the person about their rights and how they may appeal the action taken or file a complaint;
  • the service provider refers the person to other agencies and facilities, if appropriate, including referring them to the state's vocational rehabilitation program, and documents this referral in the person’s case file;
  • if a service provider determines that a person is ineligible for independent living services, the service provider reviews the person’s status again within 12 months of the determination and whenever the service provider determines that their status has materially changed; and
  • a review of an ineligibility determination is not needed if the person has refused one, they are no longer present in Texas, or their whereabouts are unknown.

5.9 Waiting List

Revision 23-1, Effective Nov. 13, 2023

Independent living services are provided when funding is available. When funding is not available, the person is considered waiting for purchased services.

A person is placed on a waiting list by the service provider when the person:

  • meets the eligibility requirements explained in 5.4 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 and therefore, the person is considered to be waiting for purchased services until funds are available.

The date the Independent Living Plan is completed with the person is used as the date the person began waiting for services, if applicable.

Plans for people who are waiting for purchased services are reviewed every six months by the service provider to determine if they are still eligible for or interested in services.

People are no longer considered waiting when funding becomes available for the purchased service, they are no longer eligible, or the person is no longer interested in the purchased service.

The service provider maintains the waiting list and determines the next person to be served. The service provider must have a waiting list policy that includes the methods used to select the next person to be served and priorities for services. The priority for services should focus on people who have been waiting the longest and assuring that all purchased services categories are adequately utilized during the fiscal year.

The Independent Living Services Program does not allow the use of an interest list which is a list of people who have shown interest in the program but are not entered in the ILS Data Reporting System. All people referred to the program must follow the process outlined upon receipt of referral including application, eligibility determination and development of an ILP. Once an ILP is completed, the person may be placed on the waiting list for the provision of services as appropriate.

5.9.1 If Funds Are Not Readily Available to Purchase the Service

Revision 23-1, Effective Nov. 13, 2023

If funds are not readily available to serve the person 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 ILP 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 person, purchase or get needed evaluations to determine actual costs and specifications.

5.10 If a Person Is Not Ready to Participate in Services

Revision 23-1, Effective Nov. 13, 2023

Sometimes people 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 person’s circumstances, the date they become "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 individuals every 60 days to determine if they are ready to engage in services, should remain inactive temporarily, or need to terminate services if they are not likely to engage in services.