Revision 19-0; Effective March 1, 2019

 

1.1 Overview

The Independent Living Base/Operational Grant Standards for Service Providers (ILBOGS) is specific to the centers that receive state funding for the provision of Independent Living Core Services. The focus of these Standards is on business practices, processes, and policies that are necessary for HHSC and the contractor to comply with federal, state, and agency laws, rules and requirements. Section 101(A)(6) of the Rehabilitation Act of 1973 provides that any state agency or contract service provider who receives federal funds must take affirmative action to employ, and advance in employment, qualified individuals with disabilities.

Contracted service providers must be in full compliance with the standards in this chapter and with all applicable clauses in each contract.

Depending on the types of services offered, contracted service providers must also be in full compliance with the applicable standards included in other chapters relevant to the services they provide.

The Independent Living Services Program does not license or certify providers.

Service providers and their staff and sub-contractors, if any, are not employees of the Texas Health and Human Services Commission (HHSC).

HHSC contracts for the services described in this manual only with providers who are in full compliance with the applicable standards. Each provider is required to undergo a review process and to comply with periodic monitoring activities to ensure continued compliance with the ILBOGS.

 

1.2 Purpose

The Independent Living Base/Operational Grant Standards for Service Providers (ILBOGS) helps to ensure that consumers receive quality services to assist them in achieving a successful outcome to their independent living goal. In addition, the ILBOGS helps to ensure taxpayer funds are spent wisely and each purchase paid for with public funds represents full value to the taxpayer. Each contractor is responsible for maintaining compliance with the most recent ILBOGS.

 

1.3 Definitions

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise, according to RSA 704 Report, Part II, Reporting Instructions.

Abuse – The negligent or willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical or emotional harm or pain; or sexual abuse, including any involuntary or nonconsensual sexual conduct that would constitute the offenses of indecent exposure or assault, committed by the person's caretaker, family member, or other individual who has an ongoing relationship with the person.

Act – The Rehabilitation Act of 1973, as amended.

Advocacy and Legal Services – Assistance or representation for a consumer in obtaining access to entitled benefits, services and programs.

Assistive Technology Services – Providing or helping with the selection, acquisition or use of any assistive technology; that is, any piece of equipment, product, or software or hardware system that is used to increase, maintain, or improve functional capabilities of individuals with disabilities and any assistive technology service that assists an individual with a disability.

Bilateral Contract – A legally binding document issued by HHSC that includes all terms and conditions and is signed by both HHSC and the contractor.

Billing Question Contact – The person authorized to make billing decisions for the contracted service provider.

Children's Services – Providing specific independent living (IL) services designed to serve individuals under the age of 14 with significant disabilities.

Communication Services – Services that enable consumers to better communicate, such as interpreter services, training in using communication equipment, braille instruction and reading services.

Confidential Information – Any communication or record (whether oral, written, or 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 of the following:

  • Consumer 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; and
  • 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.

Conflict of Interest – A situation that creates a risk that professional judgment or actions will be unduly influenced by a personal interest or relationship and creates substantial conflicts with the proper discharge of duties required by this contract and the public interest.

Consumer – Any individual with a significant disability who is eligible for IL services under 34 Code of Federal Regulations (CFR) Section 364.40(a).

Consumer Service Record (CSR) – Maintained for an eligible consumer receiving IL services and meeting the requirements of 34 CFR Section 364.53. In cases where IL services are provided to the parent or guardian of a consumer, the CSR is established for the consumer and the services provided are reflected in that CSR. (Active CSRs are those corresponding to consumers who were served during the reporting year.)

Contract Manager – Manages the service provider contracts for the Independent Living Services Program. Providers may contact the contract manager for any questions about their contract.

Contractor – An entity or person holding a written agreement with a purchasing entity to provide goods and services; or a recipient or sub-recipient holding a written agreement with a grantor or sub-recipient to carry out all or part of a program. Sometimes used interchangeably with the terms "provider" or "service provider."

Core Services – IL services defined in Section 7(17) of the Act, which include information and referral services, IL skills training, peer counseling (including cross-disability peer counseling), transition, and individual and systems advocacy.

Counseling and Related Services – Services that include information-sharing, psychological services of a non-psychiatric, non-therapeutic nature, parent-to-parent services and related services.

Designated State Unit (DSU) – Units identified under Section 101(a)(2)(B) of the Act. In Texas, HHSC is the DSU.

Enrollment Contracts – The result of the process in which HHSC awards contracts for the same or similar goods or services to all entities that meet qualifications established by HHSC.

Entity – The business requesting, or that has been granted, a bilateral contract with HHSC to provide services on behalf of HHSC consumers.

Exploitation – The illegal or improper act or process of a caretaker, family member, or other individual who has an ongoing relationship with a person with a disability, using the resources of the disabled person for monetary or personal benefit, profit or gain without the informed consent of the disabled person.

Family Services – Services provided to the family members of an individual with a significant disability, when necessary for improving the person’s ability to live and function more independently or to engage or continue in employment. Such services may include respite care.

Formal Competitive Procurement – A competitive procurement process for contracts with an estimated value of more than $25,000.

Headquarters – The location where an entity stores consumer records and performs administrative responsibilities, as required by a bilateral contract with HHSC. Each entity must have a designated headquarters location.

Housing, Home Modifications and Shelter Services – Services related to securing housing or shelter, adaptive housing services (including appropriate accommodations to, and modifications of, any space used to serve or occupied by individuals with significant disabilities). Note: A Center for Independent Living (CIL) may not provide housing or shelter as an IL service either temporarily or long term unless the housing or shelter is incidental to the overall operation of the CIL and is provided to any individual for no more than eight weeks during any six-month period.

Independent Living Plan (ILP) – A plan for the provision of IL services mutually agreed upon by an appropriate staff member of a service provider and by an individual with significant disabilities.

Independent Living Skills Training and Life Skills Training Services – Services that may include instruction in developing independent living skills in personal care, coping, financial management, social skills and household management. These may also include education and training necessary for living in the community and participating in community activities.

Information and Referral Services – Services such as information about available services, as well as referrals to other agencies or resources relevant to independent living.

Legally Authorized Representative – A person who is authorized to sign contracts and official documents for the entity and to otherwise bind the entity.

Liaison – An HHSC staff member who has been assigned to work with the provider to be the first point of contact when questions arise about the Independent Living Services Standards. Liaisons assigned to the provider will routinely monitor the provider to ensure compliance with the Standards.

Mental Restoration Services – Psychiatric restoration services including maintenance on psychotropic medication, psychological services and treatment management for substance abuse.

Mobility Training Services – A variety of services that involve helping consumers get around in their homes and communities.

Neglect – The failure of a consumer or their caretaker to provide the goods or services, including medical services, necessary to avoid physical or emotional harm or pain of the consumer.

Noncompetitive Procurement Process – A process in which competitive procurement process solicitation methods are not required, and a process typically involving a direct application or enrollment process.

Peer Counseling Services – Counseling, teaching, information-sharing and similar kinds of contact provided to consumers by other people with disabilities.

Personal Assistance Services – Services that include help with personal bodily functions; communicative, household, mobility, work, emotional, cognitive, personal and financial affairs; community participation; parenting; leisure; and other related needs.

Physical Restoration Services – Services including medical services, health maintenance, eyeglasses and visual services.

Preventive Services – Services intended to prevent additional disabilities or to prevent an increase in the severity of an existing disability.

Program Manager – A primary role for oversight and supervision of the review schedule and any changes to be promulgated, and responsible for approval of changes and change process steps. Manages all staff in the Independent Living Services Program and should be contacted to discuss any issues that cannot be resolved with the supervisors in the Independent Living Services Program.

Program Specialist for Policy and Reporting (PSPR) – A primary role for developing, writing and maintaining internal policy, standards and other regulatory information.

Prostheses, Orthotics and Other Appliances – Providing or helping a consumer to obtain an adaptive device or appliance that substitutes for one or more parts of the human body.

Provider – A term used to represent entities, either agencies or individuals, approved to provide services to individuals with disabilities served by HHSC. The term "provider" may be used interchangeably with the terms "service provider" or "contractor."

Recreational Services – Providing or identifying opportunities for consumers to participate in meaningful leisure time activities. These may include such things as participating in community affairs and other recreation activities that may be competitive, active or quiet.

Rehabilitation Technology Services – Providing or helping consumers obtain adaptive modifications, such as wheelchairs and lifts, that address the barriers confronted by individuals with significant disabilities, including barriers to education, rehabilitation, employment, transportation, IL or recreation.

Service Authorization – The means by which HHSC authorizes a contractor to supply goods or services based upon specified terms and conditions. A service authorization is the only valid authorization by which purchases are made. No goods or services can be provided to a consumer without a service authorization for the specific good(s) or service(s) approved to be provided only for the start date and end date of the specific service authorization. Previously known as a "purchase order (PO)."

Service Provider – A term used to represent entities, either agencies or individuals, approved to provide services to individuals with disabilities served by HHSC. Sometimes interchanged with the terms "provider" or "contractor."

Significant Disability – An individual with a significant disability means an individual with a severe physical, mental, cognitive or sensory impairment whose ability to function independently in the family or community or whose ability to obtain, maintain or advance in employment is substantially limited and for whom the delivery of IL services will improve the ability to function, continue functioning, or move toward functioning independently in the family or community or to continue in employment.

Sub-Contractor – An independent contractor performing services that can be controlled by the employer. For more information, see: https://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Independent-Contractor-Defined. Anyone who is issued an IRS1099 is considered a sub-contractor.

Therapeutic Treatment – Services provided by registered occupational, physical, recreational, hearing, language or speech therapists.

Training and Technical Assistance Supervisor – A primary role for contribution of content changes, field level feedback and communication of changes in training updates, as required.

Transportation Services – Providing or arranging for transportation.

Youth Transition Services – Any service that develops skills specifically designed for youths with significant disabilities between the ages of 14 and 24 to promote self-awareness and esteem, develop advocacy and self-empowerment skills and explore career options, including transitioning from school to such activities as post-secondary education, vocational training, employment, continuing and adult education, adult services, independent living or community participation.

Other Services – Any IL services not listed above.

 

1.3.1 HHSC Professional Standards

HHSC does not discriminate on the basis of age, race, color, creed, religion, sex, national origin, disability or veteran's status in the procurement of products or services.

HHSC shall maintain a written code of standards governing the performance of HHSC employees engaged in the procurement of products or services.

HHSC shall develop and maintain written policies covering the nature and scope of each of the products and services it purchases and the criteria under which each purchase shall be performed.

HHSC shall develop and maintain written policies to ensure best value purchasing practices based on a balance of quality, timeliness, cost and service after the sale.

HHSC policies shall ensure consumer products and services are provided in accordance with individual plans jointly developed with each consumer.

HHSC shall use appropriate procurement methods in accordance with federal and state laws and regulations.

HHSC shall maintain procurement procedures designed to ensure provider performance meets the terms, conditions and specifications of each purchase.

HHSC shall provide each consumer the opportunity to make informed choices regarding the product or service being purchased and the provider who will supply the product or service.

Full consideration of comparable services and benefits available to consumers must be considered by HHSC staff and used before HHSC funds can be expended to purchase consumer products and services.

 

1.4 Organizational Structure

The service provider's organizational and administrative structure must contribute effectively to the achievement of its goals.

A provider that is organized as a corporation must have a board of directors that establishes policy on property, funds management and operations. The corporation must maintain articles of incorporation and a certificate of incorporation (a charter) and must provide copies of all relevant documentation to HHSC upon request.

A provider that is organized as a not-for-profit entity must maintain documentation of non-profit status and must provide copies of all relevant documentation to HHSC upon request.

A provider that is organized as a sole proprietorship or partnership must provide copies of all relevant documentation to HHSC upon request. A provider may also be a partnership, limited partnership, limited Texas corporation, professional association, out-of-state corporation, limited liability corporation (LLC), state agency or university, or government agency.

The Open Enrollment Posting will contain a description of any additional documents that must be submitted by a provider at application. HHSC may request additional documentation when policy and standards are updated to comply with local, state and federal requirements.

 

1.5 Open Enrollment Contracts

In an enrollment process, HHSC enlists or enrolls contractors under a method that is open to all entities who meet qualifications established by HHSC. The enrollment process is conducted in an open and fair manner that reasonably provides interested, qualified entities equal opportunity to obtain a contract with HHSC.

The enrollment process helps HHSC create a contractor pool large enough to provide consumers a viable choice of service providers. The existence of a contract with HHSC does not guarantee that a contractor will receive business from HHSC or serve a specific number of consumers.

Typically, enrollment contracts do not have a specific dollar value. Open enrollment contracts are issued for all services and goods described in the Independent Living Base/Operational Grant Standards for Service Providers.

HHSC may choose not to contract with an entity because of prior history of non-compliance with HHSC or another state agency.

HHSC will not award a contract to entities that are debarred or excluded by the state of Texas from doing business with the state.

HHSC will not award a contract to entities listed on any of the following:

The contractor, contractor's employees, representatives, agents, and any sub-contractors shall serve as independent contractors with respect to HHSC in providing services under a contract. As such, the contractor's employees are not employees of HHSC, are not eligible for HHSC employee benefits and shall not represent themselves as HHSC employees.

The contractor is responsible for providing all legally required unemployment and workers' compensation insurance for the contractor's employees. The contractor accepts liability and retains responsibility for the performance of sub-contractors providing services under the terms of the contract. Sub-contractors providing services under the contract shall meet the same requirements and level of experience as required of the contractor. No sub-contract under the contract will relieve the contractor of the responsibility of ensuring the requested services are provided. The contractor accepts responsibility for compensating any party with whom they enter into a sub-contract relationship. If the contractor uses a sub-contractor for any or all of the work required, the following conditions will apply:

  • The Rehabilitative and Social Services director must provide permission in writing for the use of a sub-contractor;
  • Form 3455, Provider Staff Information, must indicate the individual is an approved sub-contractor by attaching the written approval granted by the Rehabilitative and Social Services director;
  • Contractors planning to subcontract all or a portion of the work to be performed shall identify the proposed sub-contractor;
  • Subcontracting shall be conducted solely at the contractor's expense;
  • HHSC retains the right to check a sub-contractor's background and approve or reject the use of submitted sub-contractor;
  • The contractor shall be the sole contact for HHSC; and
  • The contractor shall list a designated point of contact for all HHSC inquiries.

 

1.6 Open Enrollment Postings

All state agencies, including HHSC, are required to post solicitations for purchases of $25,000 or more on the Electronic State Business Daily (ESBD), which is maintained by the Texas Comptroller of Public Accounts. Entire open enrollment packages are posted for a minimum of 21 calendar days. To view state agency procurement opportunities of $25,000 or more, go to: https://comptroller.texas.gov/purchasing/publications/sam-epls.php

 

1.7 Applicants Eligibility

An Open Enrollment Application Packet is only considered to be acceptable and responsive if the responding entity's application packet:

  • meets all of the required criteria and specifications, including all forms, outlined in the open enrollment posting;
  • includes the documentation necessary to demonstrate compliance with applicable licensure, certification and credential requirements; and
  • includes all necessary signatures.

All applicants must follow all instructions for the specific open enrollment requisition number listed in the Electronic State Business Daily posting for which they are applying. Postings may further outline specifications and requirements that must be addressed in the application process.

Submission of an incomplete or inaccurate application packet may prevent the responding entity from being eligible for the potential award of a contract with HHSC, as described in the Open Enrollment Posting.

Failure to update incomplete or provide missing data from the application packet will prevent the responding entity from being eligible for the potential award of a contract.

 

1.8 Awarded Contract

Each service provider's contract(s) will include terms and conditions. Many HHSC contracts will offer the opportunity for renewals. Awarded contracts will describe the services and counties in which the provider has been approved to provide contracted goods or services. HHSC can terminate a contract for cause at any time. To view specific terms and conditions, providers should refer to their contract(s).

 

1.8.1 Data Use Agreement (DUA)

All contracts resulting from an Open Enrollment Posting solicitation will include a requirement that the contractor and any sub-contractors who access, create or maintain confidential information must execute a Data Use Agreement (DUA). A copy of the DUA can be found at: https://hhs.texas.gov/doing-business-hhs/business-contracting-opportunities.

 

1.8.2 Service Provider Orientation

HHSC requires all newly enrolled providers to attend a service provider orientation session as a condition of their contract.

Upon completion of the orientation session, each provider shall be provided with a copy of their contract, signed by both the provider and HHSC.

HHSC will not initiate contracted services until the provider completes the service provider orientation.

Service providers are responsible for keeping all forms on file with HHSC up to date. HHSC may require service providers to update forms to ensure current information is on file.

The liaison can provide a list of the forms that must be updated.

 

1.9 Renewals

1.9.1 Options on Existing Contracts

When renewal options exist and HHSC has a continued need for goods or services, the HHSC contract manager may process a renewal amendment for the contract before the date the contract expires. HHSC conducts a renewal assessment prior to renewing any contract. Renewal amendments must be signed by all parties before the current contract expires.

 

1.9.2 Renewal Assessment

HHSC decides whether renewing a contract is in the best interest of the consumer and HHSC.

The renewal decision is based on an evaluation of the:

  • contractor's past and current performance;
  • contractor's past and current compliance with the terms of the contract;
  • contractor's past and current compliance with the Independent Living Base/Operational Grant Standards for Service Providers;
  • contractor's past and current provision of goods or services;
  • need for the service or good based on changes in state or federal laws, rules or regulations;
  • availability of funds to support the use of the contract; and
  • availability of other providers providing the same or similar goods or services.

 

1.9.3 No Renewal Options in an Existing Contract

When an existing contract is expiring and there is no renewal provision, the contractor must respond to an Open Enrollment Posting on the Electronic State Business Daily found at: https://comptroller.texas.gov/purchasing/publications/sam-epls.php. When possible, the existing contractor should submit an application to a posting on the Electronic State Business Daily prior to their contract expiring to prevent a lapse in their ability to serve HHSC consumers.

 

1.10 Amendments

Any changes, deletions, extensions or amendments to a contract must be made in writing and signed by both parties, except for unilateral amendments issued by HHSC. A unilateral amendment may be provided in writing from the HHSC contract manager to the contractor under the following circumstances, including, but not limited to:

  • correct an obvious clerical error in the contract;
  • incorporate new or revised federal or state laws, regulations, rules or policies;
  • change the name of the contractor to reflect the contractor’s name, as recorded by the Texas Secretary of State; or
  • amend the contract name and address.

Amendments may be made if HHSC approves a change to the Independent Living Base/Operational Grant Standards for Service Providers (ILBOGS) that will apply only to providers meeting an identified need for a group of consumers that will not benefit from the services as currently described in the ILBOGS. When this occurs, the amendment will outline the scope, definitions, staff qualifications, deliverables and/or fees, as applicable, to which the contractor must adhere. The authorized representative of each party included in the amendment must sign the amendment.

 

1.10.1 Adding Services or Counties to an Existing Contract

If the services or counties the contractor wants to add were included in the original Open Enrollment Electronic State Business Daily Posting the contractor applied to, an amendment can be made to an existing contract if HHSC determines it has a current need for the goods or services.

If the services or counties the contractor wants to add were not included in the original Open Enrollment Electronic State Business Daily Posting, a new application must be completed that corresponds to an active Electronic State Business Daily Posting.

 

1.11 Base/Operational Grant Service Standards

1.11.1 Adherence to Standards

Contractors must comply with all standards in Chapter 1 and Chapter 2. Each contractor is required to be compliant with the most recent content in the Independent Living Base/Operational Grant Standards for Service Providers (ILBOGS); it is suggested that the contractor visit the ILBOGS website every 30 days to review any changes.

Revisions to the ILBOGS are made periodically.

Failure to follow applicable standards and contract requirements may have adverse consequences for the provider, such as denial of payments, recoupment of payments, suspension of service provisions to HHSC consumers, or loss of an awarded contract.

 

1.11.2 Exceptions to Contracted Service Descriptions

Infrequently, the description of the service to be provided may be changed to accommodate the needs of a consumer. Exceptions to contracted service may be approved only in situations where the exception is:

  • in the best interest of HHSC;
  • in the best interest of the HHSC consumer; and
  • determined not to be in violation of any state or federal laws.

When the service description, as defined in the ILBOGS, is changed or a fee is lowered, a Contracted Service Modification must be completed by HHSC staff, and signed by the contractor's legal representative and submitted for HHSC approval. HHSC staff submit the complete, accurate and signed Contracted Service Modification to the liaison for approval. After approval, the Contracted Service Modification is submitted to the contract manager, program manager and Office of Independent Living Services director.

If the contractor identifies a need for a possible exception to contracted service, the contractor should discuss the need with the consumer's contract manager. The contract manager makes the final decision whether to pursue requesting an exception to contracted service.

A copy of the approved Contracted Service Modification must be retained in the contractor's consumer file.

 

1.12 Staff Documentation

1.12.1 Staff Information Form

Each provider must have the following documents on file for all personnel who provide services directly to HHSC consumers, including the director:

  • Form 3455, Provider Staff Information;
  • supporting evidence of qualifications and experience, such as:
    • professional credentials;
    • copies of college transcripts;
    • certificates of specialized training;
    • statements from former employers or other documentation;
  • completed I-9 (U.S. Department of Justice Employment Eligibility Verification Form), as applicable (see http://www.uscis.gov/portal/site/uscis); and
  • signed IRS W-4 form.

Form 3455 must be submitted and updated 45 days prior for any of the following:

  • before hiring staff;
  • a significant change in a staff member's job duties;
  • a change in staff qualifications; or
  • termination of a staff member.

The service provider is responsible for ensuring all staff maintain qualifications and sign this form verifying the staff member's qualifications, as documented in the Independent Living Base/Operational Grant Standards for Service Providers. Staff qualifications are listed within the chapter in which the service is defined.

Form 3455 must be submitted both to the HHSC contract manager and the contract manager who manages the provider's contract.

 

1.12.2 Temporary Waiver of Director and Staff Services Credentials

When a service provider loses a credentialed staff member, a temporary exception to use a non-credentialed staff member to act as director or to provide contracted services may be approved. The waiver is specific to the provider and staff member named in the Temporary Waiver of Credentials. The Temporary Waiver of Credentials is submitted by completing an email with the following information:

  • position that the temporary waiver is being requested to fill;
  • name of the person to temporarily fill the position;
  • resume and verification of any credentials of the person who will temporarily fill the position; and
  • anticipated length of time the waiver will be required.

The Temporary Waiver of Credentials is allowed only when:

  • a provider's director leaves the entity;
  • there are no other qualified credentialed staff available to provide the service;
  • it is necessary to avoid a break in essential services being provided by the service provider to an HHSC consumer; and
  • the waiver is in the best interest of the consumer.

HHSC will only approve the Temporary Waiver of Credentials for individuals who fail to maintain their credentials on rare occasions. The Temporary Waiver of Credentials was developed to assist with the time needed to gain credentials for new staff.

A copy of the approved email requesting the Temporary Waiver of Credentials must be kept in the contractor’s file by the HHSC contract manager and by the service provider.

The Temporary Waiver of Credentials must be approved before the non-credentialed staff person provides any direct services to HHSC consumers.

 

1.13 Contractors Standards of Conduct

Contractors must maintain and implement written standards of conduct for the contractor's staff members. The Independent Living Base/Operational Grant Standards for Service Providers must incorporate all professional standards of conduct and ethics required by the licensing or credentialing entity for positions held by the contractor's staff.

 

1.13.1 Professionalism

Contractors are expected to perform contractual services in a professional manner at all times to include:

  • interaction with HHSC consumers and staff in a professional manner;
  • appropriate dress (generally business casual attire) when providing services;
  • maintaining the confidentiality of all consumer information in full compliance with state and federal regulations and in accordance with sound professional practices;
  • obtaining a confidentiality release for any person attending the meeting with the consumer who is not the consumer's legal guardian;
  • accepting liability for the actions and/or contract performance of all individuals, 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 consumer or consumer's family member, including, but not limited to:
    • abuse of any consumer or consumer's family member;
    • negative impacts to the health, safety or welfare of any consumer or consumer's family member;
    • relationships with consumers 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 consumer 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.

 

1.13.2 Conflict of Interest

Contractors 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.

Real or apparent conflicts of interest may occur when a former employee of HHSC becomes an employee or a contractor of an entity that has a bilateral contract with HHSC.

Each contract must have a Conflict of Interest Certification, https://apps.hhs.texas.gov/PCS/HHS0000066/Nondisclosure-Conflicts-Interest-Certification.pdf, on file.

 

1.14 Insurance Coverage

1.14.1 General or Business Liability

The contractor must have general or business liability insurance coverage that protects consumers, employees and visitors when the contractor conducts business in a building it owns, leases or uses in kind while providing services to HHSC consumers. The contractor is required to keep a current and accurate insurance form or its equivalent on file with HHSC. A state agency may be exempt from this requirement.

 

1.14.2 Professional Liability

It is highly recommended that the contractor have professional liability insurance, also called "professional indemnity insurance" or "errors and omissions insurance." Professional liability insurance protects service-providing individuals and companies from negligence claims made by a client and damages awarded in such a civil lawsuit. The contractor should keep a current and accurate insurance form or its equivalent on file with HHSC if this type of insurance is in place. A state agency may be exempt from this requirement.

 

1.14.3 Motor Vehicle Insurance

Contractors are not required to transport consumers. Contractors electing to transport consumers in motorized vehicles must meet the minimum liability requirements set forth by the Texas Department of Insurance. Contractors must maintain records of any staff who have transported or may transport consumers in vehicles. These records must provide evidence of a valid driver license, personal injury protection (PIP) and auto liability insurance coverage.

 

1.14.4 Workers' Compensation

The contractor must keep records showing evidence of compliance with current workers' compensation law.

 

1.15 Safe and Secure Environments

Contractors must support a safe and secure environment for their employees, HHSC consumers and visitors. The contractor must record all incidents in accordance with the entity's policies and procedures.

An "incident" is defined as an unusual or unexpected event that may compromise the health or safety of people or the security of property. The contractor is responsible for reporting any incident that involves an HHSC consumer, a contractor's staff person, (including sub-contractors) and/or the public. Examples of incidents include, but are not limited to:

  • violence, including domestic violence situations in which the abuser seeks out the victim;
  • an automobile accident;
  • physical or sexual assault;
  • serious medical emergency, death or suicide;
  • threat of harm to self or others;
  • breach of confidential information;
  • theft or loss or mischievous or malicious destruction of property on loan from, or purchased by, HHSC;
  • theft, loss, or mischievous or malicious destruction of property or other negative behaviors displayed by HHSC consumers;
  • fire or a hazardous materials event;
  • a service interruption that is due to an emergency or disaster;
  • threats by personal contact, letter, phone or email; and
  • abuse, neglect or exportation of a person with a disability.

All incidents must be reported within one business day to the following individuals:

  • HHSC consumer liaison; and
  • HHSC contract manager.

HHSC has a system in place to ensure employees report incidents, as required by Health and Human Services (HHS) policies.

 

1.16 Physical Locations

Any service provider that owns, leases or uses dedicated space in which HHSC consumers will be provided services is considered to have a physical location.

The service provider must complete the Service Provider Physical Location Information form for each facility.

 

1.16.1 Occupation Permit or Building Permit

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.

 

1.16.2 Fire Safety

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, telephone 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.

 

1.16.3 General Building Safety

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.

 

1.16.4 Accessibility

Each facility and the entity headquarters must maintain a paper copy of the completed ADA Checklist for Existing Facilities found at https://www.adachecklist.org/checklist.html. HHSC staff may inspect the physical location for accuracy of responses provided on the ADA Checklist for Existing Facilities, and for compliance with meeting a consumer's needs related to accessibility. HHSC may also request access to the completed checklist at any time, such as at liaison visits and monitoring reviews.

If an item or location on the checklist is found not to be accessible, describe how the physical location will ensure services will be provided to HHSC consumers that will be using the area(s) found to not be accessible.

 

1.16.5 Safety Plan

Each provider must have a safety plan for each physical location that ensures the safety and health of staff, consumers 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 consumers with disabilities who require particular attention or action, including those whose behavior may be detrimental to the health, safety or require assistance 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 consumers, 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 HHSC consumers 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 working day:

  • emergency evacuations;
  • emergency medical services (EMS);
  • emergency room treatment;
  • hospitalization; or
  • death.

 

1.17 Allegations or Incidents of Abuse, Exploitation or Neglect of Persons with Disabilities

Texas law requires that allegations or incidents of abuse, exploitation or neglect of persons with disabilities be immediately reported to the appropriate investigatory agency (see the table below) or, if taking place in a location other than a residential setting, 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 provider must develop policies and procedures regarding the recognition and appropriate reporting of such allegations or incidents. These procedures must also require notification to the appropriate HHSC program manager and the liaison within one workday if an HHSC consumer is involved in an allegation of abuse, exploitation or neglect. Procedures must also ensure cooperation with investigations conducted by HHSC.

The appropriate investigating agency's toll-free number and the HHSC liaison's office number must be posted in a location that is readily accessible to consumers and the staff.

If the alleged abuse, exploitation or neglect occurs in residential situations such as: then report the incident to the HHSC Ombudsman Office and to the:
a Texas Health and Human Services Commission (HHSC) licensed assisted living facility, nursing home, adult day care facility, intermediate care facility for individuals with an intellectual disability or related conditions, or adult foster care Texas Health and Human Services Commission
Complaints Management and Investigations
P.O. Box 149030, Mail Code E-340
Austin, Texas 78714-9030
Tel: 800-458-9858
a Texas Department of State Health Services licensed substance abuse facility or program Texas Department of State Health Services Substance
Abuse Compliance Group Investigations
1100 West 49th Street
Austin, Texas 78756
Mail Code 2823
Tel: 800-832-9623
a Texas Department of State Health Services licensed hospital Texas Department of State Health Services
Facility Licensing Group
1100 West 49th Street
Austin, Texas 78756
Complaint Hotline 888-973-0022

a Texas Department of Family and Protective Services licensed child care operation, including:

  • a residential child care operation
  • a state licensed facility or community center that provides services for mental health, intellectual disabilities, or related conditions
  • the person's own home
  • an adult foster home (that has three or fewer consumers and is not licensed by HHSC)
  • an unlicensed room and board facility

Texas Department of Family and Protective
Services Statewide Intake Division
P.O. Box 149030
Austin, Texas 78714-9030
Tel: 800-252-5400

www.txabusehotline.org

 

 

1.18 Confidentially Consumer and Employee Information

All staff members of the contractor must maintain confidentiality of consumer and employee information. The contractor must have policy and procedures that address access to confidential records. The contractor must provide physical safeguards for confidential records and ensure that confidential records are available only to authorized staff members. Consumer case records must be stored in a secured location where there is maximum protection against fire, water damage, theft and other hazards.

 

1.18.1 Data Encryption

HHSC policy and federal law mandates all emails containing consumer or agency confidential information must be sent under encryption. Contractors must send HHSC consumer confidential information in a secure manner when emailing information to HHSC employees or to any other individual.

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 consumer 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.

 

1.19 Records

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 to HHSC consumers.

Examples include, but are not limited to:

  • invoices;
  • service authorizations;
  • consumer service reports;
  • company financials;
  • insurance certificates;
  • staff information sheets; and
  • any documentation required under the:
    • entity's contract; and
    • HHSC Standard Procurement Terms and Conditions and/or Independent Living Base/Operational Grant Standards for Service Providers.

 

1.19.1 Record Storage

All original records must be maintained in a paper format. No records can be stored in an electronic manner, such as cloud services or other services that host on the internet or that store, manage or process data. If records are maintained on company or personal server(s) or computer(s), these records must be protected in a secure manner.

 

1.19.2 Record Retention

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 and/or personal computers are required to maintain a level of security that ensures records are maintained in a safe and confidential manner, as defined in the Information Security and Privacy Initial Inquiry (SPI) found at: https://hhs.texas.gov/laws-regulations/forms/miscellaneous/hhs-information-security-privacy-initial-inquiry-spi.

 

1.20 Substance Abuse

Any observations or other evidence of use of alcohol or drugs by an HHSC consumer with a disability of substance abuse must be reported immediately to the HHSC liaison. The provider must maintain documentation that the liaison was informed of any observations or other evidence of use of alcohol or drugs by a consumer.

 

1.21 Consumer Orientation

Any consumer referred to a provider by HHSC must receive orientation and materials, such as handouts or manuals, which address at least the following:

  • information on services;
  • appropriate rules and regulations;
  • consumer responsibilities;
  • safety information;
  • HHSC service number;
  • Client Assistance Program, and
  • additional services for veterans.

 

1.22 HHSC Office of the Ombudsman

Each facility-based provider must post the HHSC Office of the Ombudsman toll-free telephone number, 877-787-8999, specifying that the number is for HHSC applicant and consumer use, or Relay Texas, 7-1-1 or 800-735-2989, for people with a hearing or speech disability.

 

1.23 Client Assistance Program

The Client Assistance Program (CAP) is federally funded and mandated under the Act to provide information, assistance 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 consumer of his or her rights;
  • providing information about services and benefits of the program;
  • advocating for consumers in their relationship with the program;
  • assisting the consumer in understanding and using the appeals process;
  • assisting the consumer and systemic advocacy in relation to the program, which may include policy issues and changes; and
  • resolving issues at the lowest level possible.

CAP is implemented by Disability Rights Texas (DRTx), a legal services organization whose mission 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 individuals with disabilities who are prospective or current consumers about:

  • the availability of CAP;
  • the purposes of the services provided under CAP; and
  • how to contact CAP.

Service providers should notify consumers of CAP upon application, during the development of the independent living plan, and at any time services are reduced, suspended or terminated.

A consumer or the consumer’s 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.

A complaint may be filed 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.

 

1.24 Veterans Services

Each provider must include the following statement created by HHSC, based on Texas Senate Bill 1677, in the consumer orientation 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. For more information, visit www.tvc.texas.gov, the Texas Veterans Portal, or call TexVets at 800-252-8387.

 

1.25 Termination from Program

Providers should address behaviors a consumer exhibits prior to termination from a program. If behaviors are harmful to the consumer or others, appropriate actions should be made so safety is maintained for all parties. Every effort should be made to inform the HHSC liaison before termination of a consumer's services. When the liaison cannot be informed before termination, the liaison must be informed within one workday after termination. The provider must maintain documentation that the liaison was informed of termination.

Reasons for termination include:

  • behaviors dangerous to self or others;
  • serious infraction of the provider's rules;
  • frequent unexcused absenteeism;
  • frequent unexcused tardiness; or
  • lack of cooperation on assigned tasks.

 

1.26 Noncompliance and Performance Deficiencies

HHSC may temporarily suspend a contract provider from providing services for reasons such as:

  • suspected fraud;
  • suspected consumer abuse; and
  • failure to perform services according to the specifications and terms of the contract.

The contractor is required to return to compliance before providing further services.

HHSC may take further adverse actions in conjunction with, or instead of, requesting a corrective action plan. In serious noncompliance situations, HHSC may terminate a contract or debar a provider from future HHSC service contracts without allowing the provider to take corrective action.

 

1.27 Require Contractor Policy and Procedures

To protect consumers and consumer interests, the contractor must develop and adhere to the following policies and procedures concerning:

  • access to confidential records;
  • fraud, waste and abuse;
  • availability and purpose of the Client Assistance Program;
  • allegations or incidents of abuse, exploitation or neglect of persons with disabilities;
  • posting of the HHSC toll-free telephone number, 800-628-5115, specifying it is for HHSC applicant and consumer use; and
  • reporting of observations or evidence of consumer use of alcohol or drugs.

The contractor must develop a written implementation plan within their organization to educate staff and consumers served by the contractor.

 

1.28 Provider's Evaluation of Service Provision

Each provider must have an ongoing self-evaluation system designed to assess the consumer's satisfaction and effectiveness of services provided to HHSC consumers. The system should measure outcomes against pre-established goals. HHSC may ask for proof and the results of the evaluations. Because of the variety of services provided, the method of evaluation is left to the discretion of the provider but must, at a minimum, include the following sections.

 

1.28.1 Goals and Service Objectives

Entity goals are desired results of the program, and what the provider plans to accomplish. The service objectives are the entity's measurable objectives that define the entity's plans to accomplish stated goals.

 

1.28.2 Outcomes and Results

Outcomes refer to the extent to which each service objective is achieved, including the criteria against which actual performance is measured. Measures are stated in general terms and explain how results are to be achieved. Outcomes and results are included in a report format.

 

1.28.3 Consumer Satisfaction

Consumer satisfaction measures input from consumers 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
1 Strongly disagree
2 Disagree
3 Neither agree or disagree
4 Agree
5 Strongly agree

 

All consumers, both successful and unsuccessful, must be given the opportunity to respond.

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

 

1.28.4 Quarterly and Annual Reports of Evaluation Data

Entities must tally collected data quarterly (September – November, December – February, March – May, June – August) and summarize a final report. When data indicates 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.

 

1.29 Monitoring

The contractor agrees to permit on-site monitoring visits and desk reviews, as deemed necessary by HHSC to review all financial or other records and management control systems relevant to the provision of goods and services under this contract.

 

1.29.1 Ongoing Monitoring

HHSC staff members, including the program manager, compliance staff and contract manager, continuously monitor services provided to HHSC consumers. Monitoring may include ongoing dialogue, onsite visits and reviews of case files.

 

1.29.2 Compliance Monitoring

All contractors are subject to periodic programmatic and financial compliance monitoring by HHSC staff members. Risk assessment tools are used at the state and regional level each fiscal year to identify HHSC contractors who will be monitored on site or as a desk review during a 12-month period. As HHSC determines the need, contractors not identified on the risk assessment may also be monitored.

 

1.29.3 Unscheduled Compliance Monitoring

HHSC staff members may conduct a special unscheduled compliance monitoring review upon request, if HHSC management determines such a review is necessary.

 

1.29.4 Monitoring Team

A monitoring team is comprised 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 providing instructions on how to prepare for the review.

 

1.29.5 Monitoring Review

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;
  • explains briefly 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 contractor'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 consumer interviews or observations.

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.

 

1.29.6 Report of the Monitoring Results

For routine monitoring reviews, the lead monitor sends the contractor 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 contractor to either:
    • offer a corrective action plan; or
    • provide further documentation to help resolve the findings.

 

1.29.7 Corrective Action Plan

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

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

HHSC reviews the corrective action plan and may accept the corrective action plan or recommend changes.

If the contractor 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.

 

1.29.8 Monitoring Closeout

If there are no findings, or when the monitoring team accepts the corrective action plan, HHSC sends the contractor a letter to close the monitoring review.

 

1.29.9 Contract Noncompliance and Performance Deficiencies

HHSC may temporarily suspend a contractor from providing services for reasons such as:

  • suspected fraud;
  • suspected consumer abuse;
  • failure to meet contract specifications; or
  • failure to perform according to 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 contractor as part of a corrective action plan. Some situations may require HHSC to impose more serious adverse action, such as contract termination and debarment, without allowing the contractor to take corrective action.