Revision 19-1, Effective March 1, 2019
The Independent Living Services (ILS) Program funds a continuum of goods and services designed to support consumers in meeting established independence goals in accordance with their independent living plan. A service provider may choose to provide a service with existing staff members or to contract for a service. When contracting for a good or service, the service provider must follow standards related to these purchases.
The contract budget percentages of the total spent in each category for complex rehabilitation technology are allocated as follows:
- Hearing Aids – 25 percent
- Home Modifications – 10 percent
- Power Wheelchairs and Scooters – 18 percent
- Prosthetics – 15 percent
- Vehicle Modifications – 32 percent
The work plan includes corresponding targets for funds budgeted and expended for consumer goods and services. These parameters are set to ensure that sufficient funds are available and spent for certain goods and services for consumers served by the ILS Program.
The service provider must provide purchased goods and services that are within the scope of the program and that best fit consumer's needs while observing efficient budgeting practices and standards.
The service provider must adopt and implement procurement policies that address:
- conflict of interest situations;
- planning for procurement needs;
- separation of duties;
- criteria and situations for obtaining bids or proposals;
- purchasing of supplies and equipment;
- contracts for goods or services; and
- maintenance of procurement records.
Written procurement policies are required to align with standards and procedures under 2 Code of Federal Regulations (CFR), Subtitle A, Chapter II, Part 200, Subpart D, §200.318 general procurement standards. These procurement policies must be followed in purchasing goods and services for consumers.
All purchases should be coordinated with any comparable benefit, resource, or service available before expending funds from this contract. Consumer participation fees must be collected by the time the service and goods are delivered according to the participation agreement.
6.2 Authorized Services
The service provider should establish a purchase or service order system for authorizing consumer goods and services.
Vendors and subcontractors should not begin some services without proper authorization and HHSC approval for the purchase, which are described below.
The service provider is not authorized to receive payment for some services or conditions that do not have impact or are not relative to the independent living goals agreed to by the consumer or addressed by comparable benefits.
Other services not authorized include:
- gym memberships or home exercise equipment, including home equipment for water therapy or strengthening;
- general medical care (that is, medical or surgical services that are not directly related to the consumer’s independence goals or do not support other independent living services);
- maternity care;
- medical or surgical treatment associated with:
- active tuberculosis;
- sexually transmitted diseases;
- organ transplantation;
- AIDS; or
- end-stage renal disease;
- payment for transportation that is not associated with a necessary evaluation or specific good or service provided for under this contract; and
- payment of consumer’s rent, mortgage, security deposits, homeowner’s or renter’s insurance or property taxes.
Goods and services that are not authorized will be unallowable for reimbursement.
6.3 Description of Purchased Services
The appendices provide a description of purchased services under the Independent Living Services (ILS) Program. The descriptions include vendor qualifications, required procedures, and other requirements applicable to these services.
The services include:
- Appendix A: Assistive Technology
- Appendix B: Counseling
- Appendix C: Complex Rehabilitation Technology
- 1 - Hearing Aids Devices and Services
- 2 - Home Modifications
- 3 - Prosthetics
- 4 - Vehicle Modification Consumer Service
- 5 - Wheelchairs and Scooters
- Appendix D: Diabetes Self-Management Education Services
- Appendix E: Independent Living Skills Training (Individualized Skills Training Only)
- Appendix F: Interpreter, Translator, and Communication Services
- Appendix G: Orientation and Mobility Services
- Appendix H: Physical Rehabilitation and/or Therapeutic Treatment
- Appendix I: Services for Individuals Who Are Deafblind
- Appendix J: Vision Services
6.4 Services Requiring HHSC Program Approval
When the consumer is ready to participate in receiving purchased services on the independent living plan and there is funding for receiving these services, the service provider must obtain prior approval by the HHSC Independent Living Program manager before certain purchased services can be funded and reimbursed under the contract.
The purchased services that require prior approval includes:
- Hearing Aids Devices that cost over $2500 per ear or $5000 bilaterally and Video Magnification Devices that cost $1500 or more;
- Home Modifications that cost $5000 or more;
- Prosthetics that cost $12,500 or more;
- Vehicle Modification that cost $5000 or more;
- Wheelchairs and Scooters that cost $5000 or more; and
- Any single item purchase over $5,000, such as, portable patient lifts, specialty beds or other devices.
To request approval of these services, the service provider will prepare a packet of information, including:
- any and all required evaluations, including diagnosis of the disability;
- related documentation, including the service justification and the relationship to the consumer’s established independent living goals;
- specifications for the recommended service, including any certificate of title, lienholder information, and waivers, if applicable;
- cost estimates or quotes from the proposed service provider;
- any other report or document contributing to the support of the goal; and
- consumer cost participation agreement.
Additionally, the ILS Data Reporting System should contain up to date information including completion of requested services and ILS goals as well as entry of phase dates.
The service provider submits the consumer prior approval packet for independent living services to the assigned HHSC staff member to confirm the soundness and completeness of the packet. The packet will then be forwarded to the HHSC Independent Living Program Manager or their designee for approval.
Within four business days of receipt, HHSC will coordinate information and notify the service provider about:
- the need for additional information;
- the approval decision; or
- the denial of use of funds.
The HHSC prior approval of services is valid for 60 days, unless additional time has been requested in the prior approval packet submitted for review. If a purchase has not been initiated within 60 days, the prior approval packet must be re-submitted for review. All prior approval purchases must be complete within 90 days.
6.5 Scope of Available Services
The scope of purchased services available under this contract includes federally defined and state implemented services for independent living according to the Rehabilitation Act of 1973, as amended, and the rules for independent living services. Some services require special consideration in decision making, vendor qualifications, documentation, and approval. The categories of services and references for such consideration are listed in 6.5.1 – 6.5.10.
6.5.1 Assistive Technology
Assistive technology evaluations are conducted to determine the most effective assistive technology to meet the consumer's independent living needs. Assistive technology training is provided to prepare a consumer to use assistive technology effectively in the home, community, or other independent living setting. Training may be provided at a facility, on-site at a consumer's home, in a service provider’s office, or in a community resource center. Group training may be provided by facility-based trainers or on-site trainers. See Appendix A: Assistive Technology, for information on the standards related to these services.
6.5.3 Complex Rehabilitation Technology
Home modifications, hearing aids, prosthetics, power wheelchairs and scooters, and vehicle modifications are considered complex rehabilitation technology due to their component or volume expense and/or complexity in coordination and purchasing of items. Complex rehabilitation technology requires certain considerations, up to and including special pre-approval by the HHSC Independent Living Program manager. See Appendix C: Complex Rehabilitation Technology, sections 1 through 5, for information on the standards related to these services.
6.5.4 Diabetes Self-Management Education Services
Consumers may need education about diabetes self-management.
Diabetes self-management education services are used to:
- assess the consumer's ability to independently manage the disease at home, in the community, and in other independent living settings;
- assess the consumer's ability to participate in intensive rehabilitation training for persons who are blind, such as the training sessions and mini-training sessions;
- prepare a consumer to make informed choices about his or her diabetes; and
- help the consumer develop the confidence and skills to implement his or her choices.
See Appendix D: Diabetes Self-Management Education Services, for information on the standards related to these services.
6.5.5 Independent Living Skills Training (Individualized Skills Training Only)
Independent living skills training is designed to accommodate for the consumer's vision loss in daily living activities. See Appendix E: Independent Living Skills Training (Individualized Skills Training Only), for information on the standards related to these services.
6.5.6 Interpreter, Translator, and Communication Services
Interpreter, Translator, and Communication Services are designed to facilitate consumer communication. Interpreter services are provided by qualified personnel and include sign language and oral interpretation for persons who are deaf or hard of hearing and tactile interpretation for persons who are deafblind. See Appendix F: Interpreter, Translator, and Communication Services, for information on the standards related to these services, including qualifications of personnel.
6.5.7 Orientation and Mobility Services
Orientation and Mobility (O&M) vendors offer complex, interrelated services designed to promote independent travel skills for people who are blind or visually impaired.
O&M training prepares consumers to travel independently with competence and confidence. Orientation is the process of using the available senses to establish one's position and relationship within the environment. Mobility is the ability to travel in the environment with the help of an established tool (including white canes, dog guides, and electronic travel aids). See Appendix G: Orientation and Mobility Services, for information on the standards related to these services.
6.5.8 Physical Rehabilitation and/or Therapeutic Treatment
On occasion, consumers need assistance in accessing services to address physical issues. A continuum of services from physical and occupational therapy, medication, outpatient services, and so on, are necessary to assist in the support of the agreed-upon independent living goals. See Appendix H: Physical Rehabilitation and/or Therapeutic Treatment, for information on the standards related to these services.
6.5.9 Services for Individuals Who Are Deafblind
Consumers who are deafblind may need assistance for independent living or communication access to be able to participate in deafblind services training. See Appendix I: Services for Individuals Who Are Deafblind, for information on the standards related to these services.
6.5.10 Vision Services
Vision services are designed to accommodate for the consumer's vision loss when engaged in daily living activities.
Consumers who need assistance with glasses, contact lenses, low vision aids, video magnifiers, or other devices and services to maximize their access to visual input may receive a variety of services to support their independent living needs. Services are designed to assist in mitigating, remedying, or accommodating the impact of vision loss. See Appendix J: Vision Services, for information on the standards related to these services.