6.4 Services Requiring HHSC Program Approval

When the consumer is ready to participate in receiving purchased services on the independent living plan and there is funding for receiving these services, the service provider must obtain prior approval by the HHSC Independent Living Program manager before certain purchased services can be funded and reimbursed under the contract.

The purchased services that require prior approval includes:

  • Hearing Aids Devices that cost over $2500 per year or $5000 bilaterally and Video Magnification Devices that cost $1500 or more;
  • Home Modifications that cost $5000 or more;
  • Prosthetics that cost $12,500 or more;
  • Vehicle Modification that cost $5000 or more;
  • Wheelchairs and Scooters that cost $5000 or more; and
  • Any single item purchase over $5000, such as portable patient lifts, specialty beds or other devices.

To request approval of these services, the service provider will prepare a packet of information, including:

  • any and all required evaluations, including diagnosis of the disability;
  • related documentation, including the service justification and the relationship to the consumer’s established independent living goals;
  • specifications for the recommended service, including any certificate of title, lienholder information, and waivers, if applicable;
  • cost estimates or quotes from the proposed service provider;
  • any other report or document contributing to the support of the goal, and
  • consumer cost participation agreement.

Additionally, the ILS Data Reporting System should contain up-to-date information, including completion of requested services and the ILS goals, as well as entry of phase dates.

The service provider submits the consumer prior approval packet for independent living services to the assigned HHSC staff member to confirm the soundness and completeness of the packet. The packet will then be forwarded to the HHSC Independent Living Program Manager or their designee for approval.

Within four business days of receipt, HHSC will coordinate information and notify the service provider about the:

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