Appendix K, ILS Purchased Services Standards Areas of Emphasis

Revision 23-1, Effective Nov. 13, 2023 

The following information give further technical guidance about implementation of the ILS Standards for Service Providers. These items apply to ILS Purchased Services contracts.

The technical guidance includes recommendations for written policies or procedures. Additionally, a written policy is required when the standards call for a “written policy,” “written documentation,” “procedure” or “plan.” “Policy” defines what the service provider’s plan or guiding principle is, relating to the required standards. “Procedures” are the process or steps the applicant takes to ensure the policy is carried out. Procedures should answer the questions of who, where and how a policy will be implemented. Policies and procedures are the service provider’s guiding principles and implementation process and should not restate a standard. Policy submissions that reflect a restatement of standards will not be accepted. Service provider may also need to develop additional policies to guide the delivery of services, even when not required by the standards.

  1. Service provider will make available an organizational chart of the entire service provider organization. This chart will include:
    • all job positions including filled, vacant and proposed;
    • clearly identified personnel who will be assigned to the ILS program and meet staff requirements in the ILS standards;
    • positions that will be responsible for making eligibility determinations and service delivery for the ILS program; and
    • positions that will have administrative or supervisory responsibility over the ILS program. 
  2. Service provider will inform HHSC of all changes in staff allocated to the ILS program within 10 business days of the change including termination, hiring and promotion.
  3. Service provider will provide HHSC staff with the qualifications of staff assigned to the ILS program, together with how the proposed staffing arrangement:
    • maximizes efficiency and effectiveness of the delivery and provision of IL services; and
    • how staff will provide services specifically for people who are:
      • blind or visually impaired;
      • deaf or hard of hearing; or
      • deaf and blind.
  4. Service provider will check the licensing authority website for any staff who hold a professional license to determine if there are any restrictions to the license. If staff transport people in either a service provider owned vehicle or private vehicle, annual driver license checks should be obtained.  
  5. Service provider must have a written safety policy that includes procedures for people served and employees in emergency situations, such as severe weather or fire.
  6. Service provider will develop a policy with the proposed method of service delivery to all areas of the counties that the service provider serves. This policy will include the following:
    • how access to services will be provided in both rural and urban areas;
    • an estimate of the greatest distance a person would travel to access services;
    • the frequency of availability of services to be provided for the person; 
    • how services will be provided by staff in areas near (within 10 miles) and not immediately adjacent (greater than 10 miles) to the service provider’s physical location;
    • how the organization intends to provide services directly to people by service provider staff or a subcontractor; and
    • a plan to address the unique needs of people with significant disabilities and those who are blind.
  7. Service provider must have a written policy and procedure about a person’s participation in the cost of services, as well as the collection of their participation funds. This policy should be shared with the person at the time of application and before purchases are made. The policy must include the following:
    • discuss the person’s participation process during the application process;
    • discuss the person’s cost participation process before being determined eligible;
    • a person’s participation agreement as developed by the service provider that will be signed by the person and service provider representative;
    • A person’s participation will be collected before delivery of goods or services; and
    • the timeline for the person to receive goods or services after a person’s participation has been collected.
  8. Service provider must have a written policy and procedure to ensure that staff will enter timely documentation. At a minimum, the policy will include:
    • ILS DRS entry of services the requested services at the time of application, update services at the time the plan is written, and provide entry updates throughout the services phase of the case;  
    • entry of all case documentation including phase dates, case notes, requested services and service records, in the ILS Data Reporting System (DRS) and the CIL's case management system by the 5th business day of each month, as required in Chapter 10: Reporting and Quality Assurance; and
    • entry of all case documentation in the ILS DRS before the case is closed. Service records must be entered, including the paid date, and verified as accurate before the case is closed in the ILS DRS. The process should include who in the organization will review service records before case closure.
  9. Service provider will develop a written in-house training policy and procedure for ensuring each employee is trained on the following:

    • confidentiality;
    • data use agreement;
    • case management techniques and expectations;
    • ILS purchased services and outsource process;
    • case documentation requirements; and
    • HIPAA.

    The policy must also include:

    • documentation that each staff has participated in the training at least annually;
    • outline or curriculum of specific topics covered in the training;
    • other internal training available to direct service delivery staff; and
    • external training opportunities available to direct service delivery staff.
  10. Service providers who own, lease or use dedicated space where people receive or plan for ILS services are considered to have a physical location. Service providers must provide documentation of compliance with the Americans with Disabilities Act to HHSC upon application and within 30 days of relocation. Service Provider will have policies and procedures to describe the following:
    • building is accessible to all people;
    • services are accessible to all people;
    • universal staff accessibility;
    • communication is accessible to all people;
    • information related to services and providers is available and accessible to all people; and
    • a paper copy of the completed ADA Checklist for Existing Facilities kept on hand for the location.
  11. Service provider must have an incident reporting system in place. A form for staff reporting of incidents must be developed and, at a minimum, include the date, time and place of incident, nature of the incident, names of HHSC ILS people, witnesses or others involved, the name of person making the report, a description of incident, and actions taken and planned by the provider as a result of the incident. The service provider must report incidents involving HHSC Purchased Services people to their HHSC compliance specialists and keep records per the records retention policy.   
  12. Service provider will inform their staff and people requesting services that the HHSC Office of Ombudsman and Office of Inspector General (OIG) are available to report complaints or concerns about the provision of IL services.
  13. Service provider will ensure that a minimum of 25 percent of funds are expended in each purchased service category on a quarterly basis. In the event a category is underutilized, the service provider will document lack of requested services in that category or the amount of funds reserved to be expended in the purchased service category before requesting movement of funds from one purchased service category to another.
  14. Service provider will ensure that HHSC prior approved purchases are initiated within 60 days of prior approval notification.
  15. Service provider will demonstrate that a written policy and procedure is in place that, at a minimum, includes the following:
    • The service provider’s method for separating ILS Purchased Services funds from other funding streams, including accounting systems, financial documentation and software, and that allocations are tracked.
    • ILS Purchased Services contract funds are used only to serve people with an ILP in the ILS Purchased Services program or for the explicit exceptions in the ILS Standards for Providers Chapter 5 for people who have not completed an ILP. 
    • The service provider has procedures to track and manage funds appropriately, including submission of prior approval packets based on availability of funds.
    • There are implemented checks and balances for all types of expenditures.
  16. Service provider will have a bookkeeper, accountant or chief financial officer available to submit and communicate with HHSC staff about monthly RARs, quarterly advances, budget revisions and other financial reporting documents. This bookkeeper, accountant or chief financial officer will not serve in the role of executive director or interim executive director.
  17. Service provider will implement an intake and referral process for ensuring that services are not duplicated with comparable benefits such as health insurance and local, state and federal resources. The intake process should include asking people the names of other agencies where they receive services for the service provider to complete coordination of services with that entity(ies).
  18. Service provider accepts referrals from all community organizations on behalf of people. The service provider contacts the referred person to verify interest in services and get any information necessary to complete the initial contact.
  19. Service provider will develop and maintain a community resources list annually to be shared with staff and people, as appropriate.
  20. Service provider will ensure that staff attend a minimum of nine HHSC trainings or webinars, specific to the implementation of the ILS Purchased Services contract and ILS Standards for Providers, each fiscal year. The service provider is responsible for ensuring all staff receive the information from HHSC trainings or webinars. If all staff are not available to attend the HHSC trainings or webinars, the service provider should have staff in attendance provide the training information to those who were not in attendance.
  21. Service provider will collaborate and partner with community and state organizations including Texas Workforce Commission  Older Individuals Who Are Blind program, Deaf and Hard of Hearing Center, Lighthouse for the Blind, Texas Workforce Commission Rehabilitation Services, Hadley School for the Blind, and American Foundation for the Blind, to help with developing staff’s skills and to increase availability of services for blind or visually impaired, deaf or hard of hearing, and people who are deafblind.
  22. Service provider ensures staff in direct service delivery positions attend trainings such as in-services, workshops, online trainings and seminars that address serving people who are blind or visually impaired, deaf or hard or hearing or deafblind.
  23. Service provider will have a written quality assurance program for review of program activities that evaluate compliance with the Independent Living Services rules and the Independent Living Services Standards. At a minimum, this will include the following and all areas listed in Chapter 10: Reporting and Quality Assurance.
    • Review a minimum of 10 percent of all people’s case files each fiscal year. The case reviews will be conducted by staff members not directly involved in the delivery of services under this contract.
    • Create and retain an ILS outsource specific case review form used to document all case reviews.
    • A process for managing and monitoring the performance of vendors and subcontractors that includes the quality of goods or services provided.
  24. Service provider will enter person’s success stories into the ILS DRS on a monthly basis, by the fifth day after the end of the previous month. These person’s success stories should include examples of people served with different disabilities, including those who are deaf or hard of hearing and blind or visually impaired.
  25. Service provider will obtain an annual financial audit conducted by an independent auditor in compliance with Generally Accepted Auditing Standards (GAAS), as published by the American Institute of Certified Public Accountants.
  26. Service provider must follow ILS Standards Chapter 6: Purchased Goods and Services, and ILS Standards Appendices. This is to provide purchased goods and services that are within the scope of the program and that best fit the person’s needs while observing efficient budgeting practices and standards.
  27. Service provider must adopt and implement procurement policies that address: 
    • conflict of interest situations; 
    • planning for procurement needs; 
    • separation of duties; 
    • criteria and situations for obtaining bids or proposals; 
    • purchasing of supplies and equipment; 
    • contracts for goods or services; and 
    • maintenance of procurement records.
  28. Service provider will document coordination of purchases with any comparable benefit, resource or service available before expending funds from the contract in compliance with the Uniform Grant Guidance.
  29. Service provider will have a written policy and procedure detailing how confirmation of delivery and installation of equipment is completed. At a minimum, the policy and procedure should include:
    • The service provider staff or position who will confirm that installed equipment is working and that the person was trained on the use of the equipment issued.
    • The requirement for the service provider to get an itemized delivery ticket signed by the person for each item delivered and installed.
    • The requirement for the service provider to confirm delivery and installation with the person before payment of a vendor’s invoice.
    • Information detailing who will repair or replace damaged or faulty equipment when a warranty is applicable and when the warranty or service agreement has expired.
    • The service provider policy for including information about warranties, service repair and return of equipment in disrepair or good condition in purchase agreements with vendor.
  30. Service provider must refer to and follow guidance provided in Chapter 5, Service Delivery Process, and Section 5.9, Waiting List. This includes having a written policy that is consistent with Section 5.9: Waiting List. The policy should include a method of contact with people and a time frame to follow up about continued need for the requested services that are on the ILP. These contacts with people must be documented in the ILS DRS to show when a person is moved to the waiting list due to lack of funding, as well as the projected date for follow-up contact to inform the person of funding availability.
  31. Service provider will establish a code of conduct for staff who perform home visits and will provide training on the code of conduct to staff assigned to the ILS Purchased Services contract.
  32. Service provider will monitor, through performance evaluations, direct observations and other allowable methods, allowable interactions of IL staff with people. Internal monitoring should be performed at minimum on an annual basis, per service provider personnel policies.
  33. Service provider will report on all community outreach and education specific to the ILS Purchased Services contract annually. The community outreach should include specific contacts in underserved or unserved areas of their ILS Purchased services contract area and underutilized categories of purchased services.
  34. Service provider must utilize the communication preference of people with all types of disabilities including people who are deaf and hard of hearing, either by subcontractor or direct service provider.
  35. Service provider will utilize certified or qualified ASL interpreters and collaborate with the Deaf and Hard of Hearing Access Specialist to get information about hiring appropriate interpreters.