Revision 23-1, Effective Nov. 13, 2023

6.1 Overview

Revision 23-1, Effective Nov. 13, 2023

The Independent Living Services (ILS) Program funds a continuum of goods and services designed to support people meet established independence goals per their independent living plan (ILP). 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 goods and services. These parameters help ensure that sufficient funds are available and spent for certain goods and services for people served by the ILS Program.

Based on the services requested by people, the service provider may submit a budget revision to move funds between the complex rehabilitation technology categories and the other purchased services categories in compliance with the ILS standards.

The service provider must provide purchased goods and services that are within the scope of the program and that best fit a person’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 45 Code of Federal Regulations (CFR). These procurement policies must be followed in purchasing goods and services for people.

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 per the participation agreement.

6.2 Authorized Services

Revision 23-1, Effective Nov. 13, 2023

The service provider should establish a purchase or service order system for authorizing 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 person or addressed by comparable benefits.

Other services not authorized include:

  • gym memberships or home exercise equipment, including home equipment for water therapy or strengthening;
  • services which contradict the recommendations of a physician or appropriate licensed professional unless authorized in writing by HHSC;
  • services which meet the criteria in section 6.4, Services Requiring HHSC Program Approval, without obtaining the required prior approval from HHSC;
  • dental services;
  • maternity care;
  • medical or surgical treatment, unless explicitly defined as allowable elsewhere in the standards, including diagnostics, evaluations and cochlear implant surgery;
  • personal assistance and nurse aid services;
  • payment of a person’s insurance premiums;
  • payment for transportation that is not associated with a necessary evaluation or specific good or service provided for under this contract; and
  • payment of a person’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

Revision 23-1, Effective Nov. 13, 2023

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 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, Therapeutic Treatment, and Durable Medical Equipment
  • Appendix I: Services for Individuals Who Are Deafblind
  • Appendix J: Vision Services

6.4 Services Requiring HHSC Program Approval

Revision 23-1, Effective Nov. 13, 2023

When the person 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 get prior approval by the HHSC Independent Living Program director to have certain purchased services funded and reimbursed under the contract.

The purchased services that require prior approval includes:

  • hearing aid devices that cost over $2,500 per ear or $5,000 bilaterally and video magnification devices that cost $1,500 or more;
  • home modifications that cost $5,000 or more;
  • prosthetics that cost $12,500 or more;
  • vehicle modifications that cost $5,000 or more;
  • wheelchairs and scooters that cost $5,000 or more; and
  • any single item purchase over $5,000, such as portable patient lifts, specialty beds or other devices.

The amounts above are for all the components combined related to the item, even if billed separately. For example, the price of the batteries, service charge, fitting fees, and other charges related to hearing aids would all be added together. To avoid disallowed costs or monitoring findings, submit questions about requirements for prior approval to the IL Provider Inquiries mailbox.

To request approval of these services, the service provider prepares 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 person’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 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 director or their designee for approval.

Within four business days of receipt, HHSC coordinates information and notifies the service provider about:

  • the need for more information;
  • the approval decision; or
  • the denial of use of funds.

The HHSC prior approval of services is valid for 60 days, unless more time has been requested in the prior approval packet submitted for review. If a purchase has not been initiated within 60 days, the service provider must request an extension, or the prior approval packet must be re-submitted for review. Complete all prior approval purchases within 90 days unless an extension has been requested and granted by HHSC.

Based on 2 CFR 200.320, all purchases over the micro-purchase threshold (currently $10,000) require more than one quote. This includes administrative and purchased services purchases over $10,000, even if they do not require prior approval from HHSC. Any vehicle modification purchase submitted to the Texas A&M Transportation Institute (TTI) for a pricing review is exempt from needing a second quote. Prior approval packets must include documentation of multiple quotes if over $10,000. If extenuating circumstances are present, preventing a second quote, such as a lack of providers in a particular area, the service provider must seek guidance from HHSC. Individuals must not be required to complete a second evaluation to obtain quotes.

Although multiple quotes are not required for purchases under $10,000, it is still recommended for service providers to perform this process. Receiving multiple quotes helps reduce costs and allows service providers to offer informed choice to individuals.

6.5 Services Requiring a Prescription

The following purchased services require a prescription or written order from a physician before being purchased for a person:

  • Scooters
  • Wheelchairs either manual or power
  • Glasses
  • Counseling. Prescriptions may come from a licensed professional counselor, licensed marriage and family therapist, psychologist or psychiatrist
  • Physical, speech or occupational therapy
  • Nursing services
  • Driver’ evaluation;
  • Oxygen concentrators or portable oxygen tanks
  • CPAP machines
  • Durable medical equipment such as nebulizers, hospital beds, walkers and lifts

Other medical equipment and medical services may also require a prescription. Contact HHSC to discuss individual situations.

6.6 Scope of Available Services

Revision 23-1, Effective Nov. 13, 2023

The scope of purchased services available under this contract includes federally defined and state implemented services for independent living per 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 6.6.1– 6.6.10.

6.6.1 Assistive Technology

Revision 23-1, Effective Nov. 13, 2023

Assistive technology evaluations are conducted to determine the most effective assistive technology to meet the person’s independent living needs. Assistive technology training is provided to prepare a person 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 person’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.

6.6.2 Counseling

Revision 23-1, Effective Nov. 13, 2023

A person may need therapeutic counseling or problem-centered counseling for a variety of reasons and conditions. Counseling services should be provided in support of agreed-upon independent living goals and must be problem-centered and short-term interventions. Depending on the issue and the person’s learning style, different types of services may be a best fit for the need. See Appendix B, Counseling, for information on the standards related to these services.

6.6.3 Complex Rehabilitation Technology

Revision 23-1, Effective Nov. 13, 2023

Home modifications, hearing aids, prosthetics, power wheelchairs and scooters, and vehicle modifications are considered complex rehabilitation technology due to their component or volume expense 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 director. See Appendix C, Complex Rehabilitation Technology, sections 1 through 5, for information on the standards related to these services.

6.6.4 Diabetes Self-Management Education Services

Revision 23-1, Effective Nov. 13, 2023

A person may need education about diabetes self-management.

Diabetes self-management education services are used to:

  • assess the person’s ability to independently manage the disease at home, in the community, and in other independent living settings;
  • assess the person’s ability to participate in intensive rehabilitation training for people who are blind, such as the training sessions and mini-training sessions;
  • prepare a person to make informed choices about his or her diabetes; and
  • help the person 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.

6.6.5 Independent Living Skills Training (Individualized Skills Training Only)

Revision 23-1, Effective Nov. 13, 2023

Independent living skills training is designed to accommodate for the person’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.

6.6.6 Interpreter, Translator, and Communication Services

Revision 23-1, Effective Nov. 13, 2023

Interpreter, translator, and communication services are designed to facilitate individual communication. Interpreter services are provided by qualified personnel and include sign language and oral interpretation for people who are deaf or hard of hearing and tactile interpretation for people who are deafblind. See Appendix F, Interpreter, Translator, and Communication Services, for information on the standards related to these services, including qualifications of personnel.

6.6.7 Orientation and Mobility Services

Revision 23-1, Effective Nov. 13, 2023

Orientation and Mobility (O&M) services offer complex, interrelated services designed to promote independent travel skills for people who are blind or visually impaired.

O&M training prepares people 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.

6.6.8 Physical Rehabilitation or Therapeutic Treatment

Revision 23-1, Effective Nov. 13, 2023

On occasion, people need help with services to address physical issues. A continuum of services from physical and occupational therapy, medication our outpatient services are necessary to help support the agreed-upon independent living goals. See Appendix H: Physical Rehabilitation, Durable Medical Equipment or Therapeutic Treatment, for information on the standards about these services.

6.6.9 Services for People Who Are Deafblind

Revision 23-1, Effective Nov. 13, 2023

People who are deafblind may need help for independent living or communication access to be able to participate in deafblind services training. See Appendix I, Services for People Who Are Deafblind, for information on the standards related to these services.

6.6.10 Vision Services

Revision 23-1, Effective Nov. 13, 2023

Vision services are designed to accommodate for the person’s significant visual impairment or blindness when engaged in daily living activities.

People who need help 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 help mitigate, remedy or accommodate the impact of significant vision loss. See Appendix J, Vision Services, for information on the standards related to these services.