Revision 23-1, Effective Nov. 13, 2023

The Independent Living Services Program provides independent living services that promote the integration and inclusion of people 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, Section 117.080. 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), Title 26, Part 1, Chapter 357;
• 45 CFR Parts 75 and 1329;
• the contract; and
• the Independent Living Services Standards.

Revision 23-1, Effective Nov. 13, 2023

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 a person can 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 a person 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 more 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 people 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 people 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.) Section 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 person and are commensurate in quality and nature to the services that the person 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 including oral, written, 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 the following:

• Case-related 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 – See Person.

Consumer participation – The financial contribution that a person may be required to pay for receiving independent living services.

Consumer participation system – The system for determining and collecting the financial contribution that a person may be required to pay for receiving independent living services.

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. Section 9902(2).

Fee – A percentage of the full cost for a purchased service that a person 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 (ILP) – A written plan in which the person and their service provider have collaboratively identified the services that are needed to achieve the person’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 person who applies for services.

P

Person – A person who has requested, applied for or is receiving purchased services through the Independent Living Services Program. Previously referred to as “Consumer” in older versions of the standards but changed to reflect person-centered language. Any remaining references to “Consumer” are either referring to groups of people, such as consumer participation or consumer satisfaction survey, or consumer was the wording originally used in the Act.

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

R

Representative – Anyone chosen by a person served in the ILS program, including their parent, guardian, other family member, or advocate. If a court has appointed a guardian or representative, that person is the representative. Unless documentation is provided showing otherwise, a parent or court-appointed guardian is presumed to be the representative for a minor who is:

• younger than 18 years old; and
• not emancipated or married.

Rural – Any population or territory with fewer than 2,500 people, as defined by the U.S. Census Bureau.

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 a person’s ability to function independently in the family or community, where 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 person may be required to pay for receiving independent living services. The scale is based on the federal poverty level guidelines.

Support services – Accommodations provided to a person to help them at an ILS-related appointment with the service provider or vendor. Examples include translators, interpreters, braille, large print, and transportation. Consumer participation may not be collected for support services.

T

Transition services – Services that:

• facilitate the transition of people with significant disabilities from nursing homes and other institutions to home and community-based residences, with the requisite supports and services;
• help people with significant disabilities who are at risk of entering institutions so that the people may remain in the community; and
• facilitate the transition of youth 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 people who have applied and been determined eligible to receive services.

W

Waived independent living plan – A written plan  which the service provider identifies for 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 23-1, Effective Nov. 13, 2023

3.1 Scope of Services

Revision 23-1, Effective Nov. 13, 2023

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 people who rely on alternative modes of communication.

The service provider provides each independent living service per the independent living plan (ILP) or waived ILP. 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 identified for this contract. Consult with the HHSC staff member assigned to the contract for questions about if a service is allowable.

The service provider may provide the following independent living services to people who are also receiving a service covered by this contract:

• 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.

Core services shall not be the sole services provided under the ILS Contract Services. Rather, include at least one service from the following list:

• Independent living services, which include:
  • counseling services, including psychological and psychotherapeutic services;
  • rehabilitation technology;
  • mobility training;
  • services and training for people with cognitive and sensory disabilities, including life skills training and interpreter and reader services;
  • education and training necessary for living in a community and participating in community activities;
  • 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) achieved through the covered purchased services in this handbook;
  • services for children;
  • federal, state, or local training, counseling, or other assistance designed to help people 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; and
  • other services, as needed, which are consistent with the goods and services allowed in this handbook and the provisions of the Act.

Revision 23-1, Effective Nov. 13, 2023

4.1 Complaint Process

Revision 23-1, Effective Nov. 13, 2023

4.1.1 Filing a Complaint with the Texas Health and Human Services Commission

Revision 23-1, Effective Nov. 13, 2023

A person, their 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 director or HHSC Office of the Ombudsman without having been filed with the service provider.

Contact the HHSC Office of the Ombudsman to file a complaint 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 director’s office by email or phone at 210-330-4300.

Get more information about the complaint process 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)

Revision 23-1, Effective Nov. 13, 2023

The Client Assistance Program (CAP) is federally funded and mandated under the Act to provide information, help, 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 person of his or her rights;
• providing information about services and benefits of the program;
• advocating for people in their relationship with the program;
• helping the person understand and use the appeals process;
• assisting the person 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 it 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 people 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 must notify people of the CAP at application, the development of the independent living plan, and anytime services are reduced, suspended or terminated.

A person or their 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.

File any complaints 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

Revision 23-1, Effective Nov. 13, 2023

Service providers must 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 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 23-1, Effective Nov. 13, 2023

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. Any circumstances delaying the completion of an application should be noted 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, the reason it was not able to be conducted in person 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. Regardless of 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 individual.

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 (see 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 and need for financial records, if determined eligible to receive services;
• voter registration information (see 5.3); and
• additional services for veterans (see 8.8).

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

• 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 considered to address independence goals;
• existing service provider relationships; and
• other considerations that support the eligibility decision.

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:

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

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 23-1, Effective Nov. 13, 2023

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

• have a significant disability as defined in Chapter 2 Definitions; and
• be present in Texas.

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 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 23-1, Effective Nov. 13, 2023

When the goals of an ILP are achieved, the service provider stops providing services and closes the case as goals met (successful). 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.

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

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.

Revision 23-1, Effective Nov. 13, 2023

7.1 Allotment of Funds

Revision 23-1, Effective Nov. 13, 2023

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 people served and cost of services provided by county.

The funds are administered by the designated service provider per the Independent Living Services Standards and the rules in the 26 TAC, Part 1 Chapter 357, Independent Living Services.

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

Revision 23-1, Effective Nov. 13, 2023

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

Revision 23-1, Effective Nov. 13, 2023

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 per the requirements in the Independent Living Services Standards for Providers and other activities specific to the contract application. The service provider is responsible 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.

Salaries and wages are to reflect actual hours worked on the grant. Individual salaries may be increased permanently for merit, to account for cost-of-living, or when an employee is promoted. 

One-time salary increases may only be provided for merit rather than as a distribution of unspent funds. HHSC may request unredacted performance evaluations to support a one-time merit increase.

To request a budget revision, the service provider must submit Form 3000, Budget Revision Request, for review and approval by the contract manager. The request must reflect the revised budget request and include the justification.

7.4 Administrative Rate

Revision 23-1, Effective Nov. 13, 2023

HHSC shall reduce the administrative budget amounts to achieve an administrative rate of 40 percent or less of annual budget by fiscal year 2026. In fiscal year 2024 the maximum allowed administrative budget amount will be 50 percent of the total contract budget, in fiscal year 2025 the maximum allowed administrative budget amount will be 45 percent of the total contract budget, and in fiscal year 2026, and subsequent fiscal years, the maximum allowed administrative budget amount will be 40 percent of the total contract budget. Grantees already below the maximum rate for a fiscal year may not raise their administrative budget amount to the maximum allowed for that fiscal year. The cost savings of the administrative rate reduction will be added to the purchased services budget to increase funds for service provision to individuals served by this contract.

7.5 Contract Award

Revision 23-1, Effective Nov. 13, 2023

HHSC develops an agreement with the service provider, upon approval of the original contract application. The basis for the agreement is the approved application and contract.

Base any commitment or expenditure of contract funds on the approved application and signed contract, including any subsequent, properly approved amendment.

An amendment to the contract is required when 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 45 CFR Part 75. 

7.6 Special Contract Provisions or Restrictions

Revision 23-1, Effective Nov. 13, 2023

The contract may include special provisions or restrictions based on an assessment of risk during the contract application process.

Factors considered in determining if 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 Texas 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 or technical assistance;
• more frequent financial or program performance reporting; and
• increased contract monitoring.

7.7 Service Provider Responsibilities

Revision 23-1, Effective Nov. 13, 2023

Service providers are: 

• responsible for providing required information about people, 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;
• required to accept full legal responsibility for the program, including fulfilling contract requirements;
• required to direct all program and administrative aspects through effective and sound management practices and policies;
• must provide fiscal and program management of the contract; and
• not to assign any portion of the contract in whole or in part without prior approval from HHSC.

Revision 23-1, Effective Nov. 13, 2023

8.1 Internal Controls

Revision 23-1, Effective Nov. 13, 2023

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 for Providers, 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

Revision 23-1, Effective Nov. 13, 2023

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 45 Code of Federal Regulations and assure that:

• specific safeguards protect current and stored personal information;
• all people applying for independent living services and, as appropriate, their representatives and other designated parties, are informed and the conditions for gaining access to and releasing this information; and
• all people and their representatives are informed about the service provider’s need to collect personal information, and the policies governing its use.

8.2.1 Data Encryption

Revision 23-1, Effective Nov. 13, 2023

HHSC policy and federal law mandates all emails containing personal or agency confidential information must be sent under encryption. Contractors must send confidential information securely when emailing information to HHSC employees or to any other person.

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 person 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

Revision 23-1, Effective Nov. 13, 2023

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 through this program.

Examples include, but are not limited to:

• invoices;
• service authorizations;
• 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, or Independent Living Services Standards.

8.3.1 Record Storage

Revision 23-1, Effective Nov. 13, 2023

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 using duplication or other forms of electronic media, if they are subject to periodic quality control reviews, provide reasonable safeguards against alteration and remain readable. However, the original paper record including invoices and 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

Revision 23-1, Effective Nov. 13, 2023

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 or personal computers must 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

Revision 23-1, Effective Nov. 13, 2023

8.4.1 General Independent Living Services Staff Requirements

Revision 23-1, Effective Nov. 13, 2023

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 people 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

Revision 23-1, Effective Nov. 13, 2023

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 can communicate:

• with people 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 people 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

Revision 23-1, Effective Nov. 13, 2023

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 and person-centered planning and services. The service provider must provide training to its staff on how to serve unserved and underserved populations, including minority groups, urban populations, rural populations, and underserved disabilities such as significant visual impairment and deaf-blindness, as evidenced by in-service training records.

8.4.1.3 Contractors Standards of Conduct

Revision 23-1, Effective Nov. 13, 2023

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

8.4.1.4 Professionalism

Revision 23-1, Effective Nov. 13, 2023

Service providers are expected to always perform contractual services in a professional manner including:

• interaction with people and HHSC staff in a professional manner;
• wearing appropriate, often business casual, attire when providing services;
• maintaining the confidentiality of all information in full compliance with state and federal regulations and per sound professional practices;
• obtaining a confidentiality release for anyone attending the meeting with the person who is not their legal guardian;
• accepting liability for the actions or contract performance of all people, 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 person or the person’s family member, including, but not limited to:
  • abuse of any person or person’s family member;
  • negative impacts to the health, safety, or welfare of any person or their family member;
  • relationships with a person 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 person 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

Revision 23-1, Effective Nov. 13, 2023

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 People with Significant Disabilities

Revision 23-1, Effective Nov. 13, 2023

Staff members managing independent living services cases, determining eligibility, writing ILPs and providing or coordinating services for people who have a significant disability, must have a bachelor’s degree in an appropriate field. This qualification also requires a minimum of one year of experience in rehabilitation services or two years of experience providing similar independent living services, such as education, human services or counseling, for people 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 People Who are Deafblind

Revision 23-1, Effective Nov. 13, 2023

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 people who are deafblind, visually impaired 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, people, and facilities that serve people who are deafblind with or without other disabilities, or serve the culture and adaptive needs of people who are deafblind

The ability to:

• adapt teaching methods to the needs of people who are deafblind or multiply disabled and are elderly;
• help people 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 people; 
• teach people 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 person’s access to independent living skills; and
• deliver, install, and set up adaptive aids or devices.

8.4.4 Qualifications for Staff Members Who Provide Orientation and Mobility (O&M) Services

Revision 23-1, Effective Nov. 13, 2023

Staff members must 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:
    • 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

Revision 23-1, Effective Nov. 13, 2023

Staff members must be health professionals who meet all 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 develops:

• 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 Accessibility

Revision 23-1, Effective Nov. 13, 2023

All services purchased by the service provider for people must be provided in an accessible manner.

Each service provider subject to the Independent Living Services Standards for Providers 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 the renewal of the service provider’s contract;
• before being approved to provide services to people for the first time or 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 about the accessibility of the services of a particular service provider, HHSC investigates to determine if 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.

Call 800-514-0301 for voice, 202-514-0381 or 800-514-0383 for TTY, to get a copy of the ADAAG or other information from the U.S. Department of Justice. Contact the Architectural and Transportation Barriers Compliance Board at 800-USA-ABLE for technical questions.

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)

8.6 Financial Management System

Revision 23-1, Effective Nov. 13, 2023

The financial management system of the service provider must provide 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, per  the reporting requirements set forth under 45 CFR Part 75.341-75.350.
• Records that identify adequately the source and application of funds for federally funded activities and contain information about 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 45 CFR Part 75.305.
• Written procedures for determining the allowability of costs, per 45 CFR, Part 75, Subpart E—Cost Principles, and the terms and conditions of the federal award.

The service provider must maintain an accounting system and records where 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 per the rules in the 1 TAC, Part 15, Chapter 392, Subchapter J, 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 people 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 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.

8.6.1 Request for Payment

Revision 23-1, Effective Nov. 13, 2023

Service providers can request payment as a cost reimbursement contract or an advance payment contract.  

• Cost Reimbursement – Service providers classified as cost reimbursement are reimbursed for allowable incurred costs. Monthly expenses will be reported using the HHSC ILS Request for Advancement or Reimbursement (RAR). The HHSC ILS RAR  must be submitted by the 10th day of the month following the month the expenses were incurred or paid. Service providers classified as cost reimbursement contracts are not eligible to receive advance payments.
• Advance Payment – Service providers classified as advance payment 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 RAR. The RAR must be submitted when requesting an advance. Service providers classified as advance payment must submit the RAR by the 5th day of each month, even if the service provider would not be owed money for that month. For both cost reimbursement and advance payment service providers, Form 3008, Cost Share Collections/Refund Report must be submitted with the RAR.   

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.

8.6.2 Cost Allocation

Revision 23-1, Effective Nov. 13, 2023

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 guidance for allowability of contract award costs. All costs are 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 can charge a de minimis rate of 10 percent of modified total direct costs (MTDC) or use a federally or state approved indirect cost rate. The service provider must submit a copy of the federally or state approved indirect cost rate to the HHSC provider mailbox to allow that rate. Any indirect cost rate in the budget workbook should be included on the approved cost allocation plan.

Service providers may submit a cost allocation plan for approval of a set rate or de minimis rate either to the Texas HHSC Federal Funds Office Landing Page or to the U.S. Health and Human Services Program Support Center. 

All service providers must maintain up-to-date cost allocation methodologies, which detail how all types of administrative costs benefitting more than one program will be allocated equitably.

8.6.3 Program Income

Revision 23-1, Effective Nov. 13, 2023

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 be expended for purchased services during the fiscal year it is earned. Program income funds will be applied to purchases before HHSC funds are expended. Program income not expended in the fiscal year it  is earned shall be refunded to HHSC or deducted from future payments.

When a person 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 must record the funds received from the people as program income applicable to the Independent Living Services Program.

The service provider must ensure that it has sufficient controls for:

• billing people for their share of financial participation;
• receiving the funds from the person; 
• depositing the monies with other funds;
• properly recording the monies in Independent Living Services Program accounts; and
• reporting on the program income, through cost share reports and quarterly financial reports 

The service provider must ensure that program income is spent during the current fiscal year to provide the independent living services outlined in Chapter 6 and the appendices. 

Records must include:

• the sources of the program income;
• cost share reports;
• the amount of the program income received; and
• the quarterly financial reports, consistent with accounting records.

8.7 Records Management

Revision 23-1, Effective Nov. 13, 2023

The service provider must establish records management policies and procedures that ensure compliance with the HHSC contract and applicable recordkeeping requirements under 45 CFR Part 75.361-75.370, 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 individual financial participation; and
• compliance with the requirements of 29 U.S.C. 796c(m)(4) and 45 CFR part 75, for 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.

8.8 Veterans Services

Revision 23-1, Effective Nov. 13, 2023

The service provider must include the following statement created by HHSC, based on Texas Senate Bill 1677, 85th Legislature, Regular Session, 2019, 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. Visit www.tvc.texas.gov, the Texas Veterans Portal or call TexVets at 800-252-8387 for more information.

8.9 Physical Locations

Revision 23-1, Effective Nov. 13, 2023

All service providers must maintain a physical location for serving people, whether that be through owning, leasing, or using dedicated space. HHSC must be notified within one business day when moving to a new location, adding another location, or emergency closures of the current location.

8.9.1 Occupation Permit or Building Permit

Revision 23-1, Effective Nov. 13, 2023

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.

8.9.2 Fire Safety

Revision 23-1, Effective Nov. 13, 2023

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
Phone: 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.

8.9.3 General Building Safety

Revision 23-1, Effective Nov. 13, 2023

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.

8.9.4 Safety Plan

Revision 23-1, Effective Nov. 13, 2023

Each provider must have a safety plan for each physical location that ensures the safety and health of the staff, the people 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 people with disabilities who require particular attention or action, including those whose behavior may be detrimental to the health, safety, or require help 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 people, 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 the ILS program 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.

8.10 HHSC Provider Mailbox

Revision 23-1, Effective Nov. 13, 2023

Direct email communications with HHSC to the ILS service provider mailbox. Service providers may copy specific HHSC staff when emailing the ILS service provider mailbox. The ILS service provider mailbox is checked multiple times per day and emails are forwarded to the appropriate HHSC staff.

Revision 23-1, Effective Nov. 13, 2023

Training and technical assistance is provided for service providers under the Independent Living Services (ILS) Program, per the Texas Human Resources Code, Section 117.080(e).

HHSC evaluates the independent living services provided to people and gives technical assistance and training, as needed, to help the service provider offer a full range of independent living services per the independent living services rules and the Independent Living Services Standards for Providers.

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

Revision 23-1, Effective Nov. 13, 2023

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, virtual meetings, 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 ILPs 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 may also be necessary for improving contract performance, overseeing compliance, supporting successful contract outcomes, and clarifying expectations.

Technical assistance that is provided is documented by HHSC and communicated in writing to the service provider, as appropriate.

9.2 Training

Revision 19-1, Effective March 1, 2019

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 23-1 Effective Nov. 13, 2023

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 for Providers. 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.

The ILS Data Reporting System is used for the service providers to gather, track, and monitor program performance and financial data. Each service provider is required to enter data into this system by the fifth of the month for the preceding month and per 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 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

Revision 23-1 Effective Nov. 13, 2023

Entities must collect data and review to track performance. When data shows 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

Revision 23-1 Effective Nov. 13, 2023

Consumer satisfaction measures input from people 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 people must be given the chance to respond to the consumer satisfaction survey.

The provider must calculate an average rating on the Likert scale for each of the four required statements.

The results of the consumer satisfaction must be submitted to HHSC ILS Program annually, 45 days after the end of the state fiscal year. The results must also be available to HHSC by request.

10.2 Required Reports

Revision 23-1 Effective Nov. 13, 2023

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 the data reported, including information entered in the Independent Living Services Data Reporting System and recorded on fiscal reports matching amounts in accounting records.

10.2.1 Form 3153 Complaint and Inquiries Report

Revision 23-1 Effective Nov. 13, 2023

The service provider must submit Form 3153, Complaint and Inquiries Report, to the provider inbox by the fifth day of each month. Service providers must record all complaints received for the contract, whether verbal or written, and enter them in the report. The status of previous complaints, general inquiries about the program, and legislative inquiries are also recorded. Corrective action may be implemented by HHSC to resolve a complaint if determined necessary.

10.2.2 Program Reports

Revision 23-1 Effective Nov. 13, 2023

The service provider must enter or upload data into the Independent Living Services (ILS) Data Reporting System by the fifth day of the following month per 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;
• goals met (successful) and unsuccessful case closures; and
• 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 people receiving independent living services; and
  • the number of people who achieve independent living goals.
• Work plan targets, including:
  • number of people 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, and by the fifth day after the end of the previous month, service providers are required to enter individual success stories into the Independent Living Services Data Reporting System. These 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.

The results of the consumer satisfaction surveys must be submitted annually to HHSC within 45 days of the end of the state fiscal year.

10.2.3 Financial Reports

Revision 23-1 Effective Nov. 13, 2023

The service provider must complete financial reports for the Independent Living Services Program contract, to include the contract Budget Workbook, Form 3000, Budget Revision Request, Form 3008, Cost Share Collections/Refund Report, and Form 3001, Quarterly Financial Report. When a financial report is completed, it should be saved separately, named appropriately, and submitted to the contract manager per the instructions.

10.2.3.1 Budget Workbook

Revision 23-1 Effective Nov. 13, 2023

The Budget Workbook is an Excel template distributed by HHSC to the service provider annually to record service provider projected budget use for the upcoming fiscal year. The service provider records their estimated expenses in each category based on the annual contract award and submits it to the HHSC provider mailbox. The budget workbook approved by HHSC serves as the initial budget. HHSC must be notified of all deviations from the line items of the Budget Workbook within three business days, especially those changes related to personnel, including adding or eliminating positions, adjustments of more than 25% of a staff’s time to the grant or merit increases.

10.2.3.2 Form 3000, Budget Revision Request

Revision 23-1 Effective Nov. 13, 2023

The service provider submits Form 3000, Budget Revision Request to the HHSC provider mailbox to request funds be moved from one category or another. The budget is not considered revised until approved by HHSC. Expenses incurred which exceed the approved budget in a category will be deemed unallowable. Revisions submitted after the deadline, provided annually by HHSC in writing, will not be accepted. See 7.3, Contract Work Plan and Budget for more information on budget revisions.

10.2.3.3 Form 3008, Cost Share Report

Revision 23-1 Effective Nov. 13, 2023

Submit Form 3008, Cost Share Collections/Refund Report monthly to the HHSC provider mailbox along with the Request for Advance or Reimbursement (RAR). The purpose of the report is to document the amount of cost share collected from people, refunds from a vendor, and the amount applied to each purchased services category. Refunds made to a person due to a lower amount of cost share than initially charged are not captured on this report. Those refunds are recorded as reductions in the individual participation entries in the ILS Data Reporting System. Whether the service provider uses accrual or cash-based accounting, the cost share amounts listed each month on the Cost Share Report should match the monthly individual participation amounts recorded in the ILS Data Reporting System.

10.2.3.4 Form 3001, Quarterly Financial Report

Revision 23-1 Effective Nov. 13, 2023

Form 3001, Quarterly Financial Report, is submitted to the HHSC provider mailbox within 30 days after the end of each quarter and within 45 days after the end of the state fiscal year. This report reflects actual, unrounded expenses and program income incurred from the beginning of the fiscal year through the last month of the quarter being reported. Amounts recorded in purchased services categories on the quarterly financial report should not include any deductions for applied cost share. Purchased services category amounts must match the service records entered in the ILS Data Reporting System.

10.2.4 HHSC Request for Advance or Reimbursement (RAR)

Revision 23-1 Effective Nov. 13, 2023

As described under 8.6.1, Request for Payment, the RAR is used to request funds for contract costs.

• Cost Reimbursement – Service providers classified as cost reimbursement are reimbursed for allowable incurred costs. Monthly expenses are reported using the HHSC Request for Advance or Reimbursement (RAR). The RAR must be submitted by the 10th day of the month following the month the expenses were incurred or paid. Service providers classified as cost reimbursement are not eligible to receive advance payments.
• Advance Payment – Service providers classified as advance payment, 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 RAR. The RAR must be submitted for a quarterly advance request and each month to record expenses. Service providers classified as advance payment must submit the RAR by the fifth day of each month, even if the service provider would not be owed money for that month. The service provider can receive advance funds meaning 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.

10.2.5 Audit Requirements

Revision 23-1 Effective Nov. 13, 2023

Per contract assurances, all service providers must obtain an annual financial audit. It must be 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, per 45 CFR Part 75.500-75.521.

If a Single Audit is not required, the service provider obtains an annual audit of its financial statements.

Each year, the HHSC Single Audit Unit notifies service providers they must submit a determination form to the single audit portal to identify whether a single audit or annual audit is required. All audit reports must be submitted to the single audit portal within nine months after the end of the service provider’s fiscal year or within one month after the service provider receives the audit report, whichever is less. Direct questions related to audit requirements, or the single audit portal to Single_audit_report@hhs.texas.gov.

Audits must be charged to the fiscal year that the audit was conducted rather than the fiscal year being reviewed in the audit.

Revision 23-1, Effective Nov. 13, 2023

Contracts with service providers that provide independent living services under the Independent Living Services (ILS) Program are monitored per the HHS Procurement and Contract Management Handbook (CMH) published pursuant to Texas Government Code, Section 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 people 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 is primarily responsible for oversight and monitoring of the contract, based on risk, and includes:

• 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 per the Health and Human Services System CMH. These responsibilities include monitoring and quality assurance requirements of the Independent Living Services Standards for Providers.

11.1 Monitoring Team

Revision 23-1, Effective Nov. 13, 2023

A monitoring team consists 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 instructions on how to prepare for the review.

11.1.1 Monitoring Review

Revision 23-1, Effective Nov. 13, 2023

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 interviews or observations with people who receive services.

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

Revision 23-1, Effective Nov. 13, 2023

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:
  • implement a corrective action plan; or
  • provide further documentation to help resolve the findings.

11.1.3 Corrective Action Plan

Revision 23-1, Effective Nov. 13, 2023

If HHSC has requested the service provider implement a corrective action plan, the contractor must, by the date requested in the report of findings:

• implement a corrective action plan, including financial restitution, if required; or
• rebut a finding and submit documentation that substantiates the rebuttal.

HHSC reviews the documentation of the implementation of the corrective action plan and may accept 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

Revision 23-1, Effective Nov. 13, 2023

If there are no findings, or when the monitoring team accepts the implemented 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 individual abuse;
• failure to meet contract specifications; or
• failure to perform per 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, Section 117.080(d). The service provider will be required to submit contract performance data through methods established by HHSC. This includes 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 People with Disabilities

Revision 23-1, Effective Nov. 13, 2023

Texas law requires that allegations or incidents of abuse, exploitation, or neglect of people with disabilities be immediately reported to the appropriate investigatory agency as shown in 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 people 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