Chapter 1, Basic Standards for Centers for Independent Living (CILs)

Revision 23-1; Effective Nov. 20, 2023 

1.1 Overview

Revision 23-1; Effective Nov. 20, 2023  

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 Standards focus is 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 IL BOGS, 45 CFR parts 75 and 1329, Texas Administrative Code (TAC) Title 26 Chapter 357 and with all applicable clauses in the contract.

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

Revision 23-1; Effective Nov. 20, 2023  

ILBOGS helps to ensure that people receive quality services to help them achieve a successful outcome to their independent living goals. See 1.22 

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

Revision 23-1; Effective Nov. 20, 2023  

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise, per the Administration for Community Living’s Annual Program Performance 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. Examples are, sexual abuse, including any involuntary or nonconsensual sexual conduct that constitutes 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 person 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. This means, any piece of equipment, product, or software or hardware system used to increase, maintain, or improve functional capabilities of people with disabilities and any assistive technology service that helps a person 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 people under 14 years with significant disabilities.

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

Confidential Information – Any communication or record. It can be oral, written, or electronically stored or transmitted, or any other form of communication or record. It can be 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 includes any or all the following: 

• protected health information in any form, including without limitation, electronic protected health information or unsecured protected health information;
• sensitive personal information, defined by federal tax information, personally identifiable information, Social Security data, 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.

Conflict of Interest – A situation that creates a risk that personal interest or relationship will influence professional judgment or actions. These actions could create conflicts with discharge of duties required by this contract and the public interest. 

Consumer Service Record (CSR) – Maintained for an eligible person receiving IL services and meeting the requirements of 45 CFR Section 1329. In cases where IL services are provided to the parent or guardian of a person, the CSR is established for the person. The services provided are reflected in that CSR. Active CSRs are those corresponding to people 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 Entity (DSE ) – Units identified under Section 101(a)(2)(B) of the Act. In Texas, HHSC is the DSE.

Enrollment Contracts – The result of the process where 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. 

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 a person with a disability for monetary or personal benefit, profit or gain without the informed consent of the person with a disability.

Family Services – Services provided to the family members of a person 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 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 for securing housing or shelter, adaptive housing services, including appropriate accommodations to, and modifications of, any space used to serve or occupied by people 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.

Independent Living Plan (ILP) – A written plan where the person and service provider have collaboratively identified the services needed to achieve the person’s goal of living independently.

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 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 people get around in their homes and communities.

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

Noncompetitive Procurement Process – A process where competitive procurement process solicitation methods are not required. They typically involve a direct application or enrollment process.

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

Person - A person who has requested, applied for or is receiving services identified in these standards. Previously referred to as “Consumer” or “Individual” 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 satisfaction survey, or consumer was the wording originally used in the Act.

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 Director – The person responsible for HHSC Independent Living Program operations, including oversight and supervision of the review schedule and any changes to be made public, 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.

Prostheses, Orthotics and Other Appliances – Providing or helping a person get 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 people with disabilities served by HHSC. Use the term provider may be used interchangeably with the terms service provider or contractor.

Provider Mailbox-A centralized mailbox that the HHSC ILS program sends messages to and receives messages from service providers. The provider mailbox address is IL_Provider_Inquiries@hhsc.state.tx.us.

Recreational Services – Providing or identifying opportunities for people 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 people 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 way 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 person 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 that represents entities, either agencies or individuals, approved to provide services to people with disabilities served by HHSC. Sometimes interchanged with the terms provider or contractor.

Significant Disability –  a severe physical, mental, cognitive or sensory impairment which substantially limits the  ability to function independently in the family or community or whose ability to obtain, maintain or advance in employment is substantially limited. 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. See Independent Contractor Defined on the IRS webpage for more information. 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 14 and 24 years old, 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 Professional Standards

Revision 23-1; Effective Nov. 20, 2023  

Service providers must not discriminate because of age, race, color, creed, religion, sex, national origin, disability or veteran's status in the procurement of products or services.

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

Service providers must ensure consumer products and services are provided per the individual plans jointly developed with each person.

Service providers must use appropriate procurement methods per the federal and state laws and regulations.
Service providers must maintain procurement procedures designed to ensure provider performance meets the terms, conditions and specifications of each purchase.

Service providers must offer each person 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 service provider 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.

1.5 Contracting with HHSC 

Revision 23-1; Effective Nov. 20, 2023  

HHSC may choose not to contract with an entity because of a 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:

• HHS Office of Inspector General Exclusion Program website;
• System for Award Management website;
• Texas Comptroller of Public Accounts Debarred Vendor List; or
• HHSC Debarment and Suspension Log.

The contractor, contractor's employees, representatives, agents, and any sub-contractors 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 a sub-contract relationship. If the contractor uses a sub-contractor for any or all the work required, the following conditions will apply:

• HHSC must provide permission in writing for the use of a sub-contractor;
• Form 3455, Provider Staff Information, must indicate the person is an approved sub-contractor by attaching the written approval granted by HHSC; 
• 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 is the sole contact for HHSC; and
• the contractor lists a designated point of contact for all HHSC inquiries.

Each service provider's contract(s) includes terms and conditions. Many HHSC contracts will offer the opportunity for renewals. Awarded contracts will describe the services and counties where 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).

1.5.1 Data Use Agreement (DUA)

Revision 23-1; Effective Nov. 20, 2023  

All contracts include a requirement that the contractor and any sub-contractors who access, create, or maintain confidential information must execute a Data Use Agreement (DUA). Find a copy of the DUA here.  

1.5.2 Service Provider Orientation

Revision 23-1; Effective Nov. 20, 2023  

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 is 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.

1.6 Renewals

Revision 23-1; Effective Nov. 20, 2023  

HHSC decides if renewing a contract is in the best interest of people receiving services 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.

Service providers may not begin providing services or request funds until a contract has been signed by both parties and a notice to proceed has been issued by HHSC.

1.7 Amendments

Revision 23-1; Effective Nov. 20, 2023  

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 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 outlines the scope, definitions, staff qualifications, deliverables or fees, as applicable, to which the contractor must adhere. The authorized representative of each party included in the amendment must sign the amendment.

1.8 Adherence to Standards

Revision 23-1; Effective Nov. 20, 2023  

Contractors must comply with all ILS standards. 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.

1.9 Contractors Standards of Conduct

Revision 23-1; Effective Nov. 20, 2023  

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.

1.9.1 Professionalism

Revision 23-1; Effective Nov. 20, 2023  

Contractors are expected to always perform contractual services in a professional manner to include:

• interaction with HHSC consumers and staff in a professional, courteous, respectful and timely manner;
• appropriate dress which is generally business casual attire, when providing services;
• maintaining the confidentiality of all consumer information in full compliance with state and federal regulations per the sound professional practices;
• obtaining a confidentiality release for any person attending the meeting with the consumer who is not the person’s 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 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 person’s family member;
  • relationships with people 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.

1.9.2 Conflict of Interest

Revision 23-1; Effective Nov. 20, 2023  

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  on file.

1.10 Insurance Coverage

Revision 23-1; Effective Nov. 20, 2023  

1.10.1 General or Business Liability

Revision 23-1; Effective Nov. 20, 2023  

The contractor must have general or business liability insurance coverage that protects people, 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. For HHSC to recoup its losses in the event of a liability claim, each service provider must maintain liability coverage of at least the total amount of all its contracts with HHSC. 

1.10.2 Professional Liability

Revision 23-1; Effective Nov. 20, 2023  

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 people 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. 

1.10.3 Motor Vehicle Insurance

Revision 23-1; Effective Nov. 20, 2023  

Contractors are not required to transport consumers. Contractors electing to transport people 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 people in vehicles. These records must provide evidence of a valid driver license, personal injury protection (PIP) and auto liability insurance coverage.

1.10.4 Workers' Compensation

Revision 23-1; Effective Nov. 20, 2023  

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

1.11 Safe and Secure Environments

Revision 23-1; Effective Nov. 20, 2023  

Contractors must support a safe and secure environment for their employees, HHSC consumers and visitors. The contractor must record all incidents per 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 a person served by the Independent Living Services program, a contractor's staff, including sub-contractors and the public. Examples of incidents include, but are not limited to:

• violence, including domestic violence situations where 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;
• suspected consumer substance abuse or other behaviors which could substantially impede a person’s ability to complete independent living goals;
• threats by personal contact, letter, phone or email; and
• abuse, neglect or exportation of a person with a disability.

Report all incidents within one business day to the HHSC provider mailbox, IL_provider_inquiries@hhsc.state.tx.us. 

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

1.12 Physical Locations

Revision 23-1; Effective Nov. 20, 2023  

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

1.12.1 Occupation Permit or Building Permit

Revision 23-1; Effective Nov. 20, 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.

1.12.2 Fire Safety

Revision 23-1; Effective Nov. 20, 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, in writing at 333 Guadalupe, Austin, Texas 78701, or by phone at 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.

1.12.3 General Building Safety

Revision 23-1; Effective Nov. 20, 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.

1.12.4 Accessibility

Revision 23-1; Effective Nov. 20, 2023  

Each facility and the entity headquarters must maintain a paper copy of the completed ADA Checklist for Existing Facilities. 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 person’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 are provided to HHSC consumers that will be using the area(s) found not accessible.

1.12.5 Safety Plan

Revision 23-1; Effective Nov. 20, 2023  

Each provider must have a safety plan for each physical location that ensures the safety and health of staff, 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 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 because 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.

1.13 Allegations or Incidents of Abuse, Exploitation or Neglect of People with Disabilities

Revision 23-1; Effective Nov. 20, 2023  

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.

1.14 Confidentially Consumer and Employee Information

Revision 23-1; Effective Nov. 20, 2023  

All staff members of the contractor must maintain confidentiality of personal 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. Case records must be stored in a secured location where there is maximum protection against fire, water damage, theft and other hazards.

1.14.1 Data Encryption

Revision 23-1; Effective Nov. 20, 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 in a secure manner 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 asks HHSC staff to send an encrypted email related to the person or to the contractor's email address. This email can be used to send encrypted information back to HHSC if the directions are followed accurately.

1.15 Records

Revision 23-1; Effective Nov. 20, 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 to HHSC consumers.

Examples include, but are not limited to:

• invoices;
• service authorizations;
• 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.

1.15.1 Record Storage

Revision 23-1; Effective Nov. 20, 2023  

All original records must be maintained in:

•    original format
•    a secure location
•    climate-controlled conditions 

If records are maintained on company or personal server(s) or computer(s), these records must be protected in a secure manner.

1.15.2 Record Retention

Revision 23-1; Effective Nov. 20, 2023  

All records must be maintained in their original 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 personal computers must 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).

1.16 Consumer Orientation

Revision 23-1; Effective Nov. 20, 2023  

Any person referred to a provider must receive orientation and materials, such as handouts or manuals, addressing the following:

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

1.17 HHSC Office of the Ombudsman

Revision 23-1; Effective Nov. 20, 2023  

Each facility-based provider must post the HHSC Office of the Ombudsman toll-free phone 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.

1.18 Client Assistance Program

Revision 23-1; Effective Nov. 20, 2023  

The Client Assistance Program (CAP) is federally funded and mandated under the Act to provide information, help and advocacy for people with disabilities 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;
• assisting the person in understanding and using the appeals process;
• helping the person and systemic advocacy for 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 people 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 CAP;
• the purposes of the services provided under CAP; and
• how to contact CAP.

Service providers should notify a person of CAP upon application, during the development of the independent living plan, and at any time 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.

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.

1.19 Veterans Services

Revision 23-1; Effective Nov. 20, 2023 

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.

1.20 Noncompliance and Performance Deficiencies

Revision 23-1; Effective Nov. 20, 2023  

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

• suspected fraud;
• suspected 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.

1.21 Provider Policy and Procedures

Revision 23-1; Effective Nov. 20, 2023  

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

• 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 phone number, 800-628-5115, specifying it is for HHSC applicant and consumer use; and
• reporting of observations or evidence of a person's use of alcohol or drugs.

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

1.22 Provider's Evaluation of Service Provision

Revision 23-1; Effective Nov. 20, 2023  

Each provider must have an ongoing self-evaluation system designed to assess the person’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. Due to 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.

1.22.1 Goals and Service Objectives

Revision 23-1; Effective Nov. 20, 2023  

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.

1.22.2 Outcomes and Results

Revision 23-1; Effective Nov. 20, 2023  

Outcomes mean how the provider achieves each service objective, including the criteria that they measure the actual performance. Measures are stated in general terms, and they explain how to achieve results. Include outcomes and results in a report format.

1.22.3 Consumer Satisfaction

Revision 23-1; Effective Nov. 20, 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

Give all people the chance to respond to the survey at least annually and at closure.

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

1.22.4 Quarterly and Annual Reports of Evaluation Data

Revision 23-1; Effective Nov. 20, 2023  

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.

1.23 Monitoring

Revision 23-1; Effective Nov. 20, 2023  

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

1.23.1 Ongoing Monitoring

Revision 23-1; Effective Nov. 20, 2023  

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.

1.23.2 Compliance Monitoring

Revision 23-1; Effective Nov. 20, 2023  

All contractors are subject to periodic program schedule 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.

1.23.3 Unscheduled Compliance Monitoring

Revision 23-1; Effective Nov. 20, 2023  

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

1.23.4 Monitoring Team

Revision 23-1; Effective Nov. 20, 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 and provides information about the scope of the review and instructions on how to prepare for the review.

1.23.5 Monitoring Review

Revision 23-1; Effective Nov. 20, 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 to be accessible for, 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 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.

1.23.6 Report of the Monitoring Results

Revision 23-1; Effective Nov. 20, 2023  

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 more documentation to help resolve the findings.

1.23.7 Corrective Action Plan

Revision 23-1; Effective Nov. 20, 2023  

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, including contract termination.

1.23.8 Monitoring Closeout

Revision 23-1; Effective Nov. 20, 2023  

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.

1.23.9 Contract Noncompliance and Performance Deficiencies

Revision 23-1; Effective Nov. 20, 2023  

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

• suspected fraud;
• suspected 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 along 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 impose more serious adverse action, such as contract termination and debarment, without allowing the contractor to take corrective action.