TEXAS HEALTH AND HUMAN SERVICES COMMISSION
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Home and Community Based Services - Adult Mental Health
Recovery Management Service Entities
Procurement Number: HHS0000074
|Addendum #6 |
|Revised on August 4, 2020 |
|Item |Purpose of Change |Previous |Revision |
|1. |Update Enrollment |August 31, 2020 |August 31, 2021 |
| |Period Close Date | | |
| |on pg. 1 | | |
|Addendum #5 |
|Revised on March 9, 2020 |
|Item |Purpose of Change |Previous |Revision |
|1. |How to Obtain |The last two paragraphs in Article I, Letter A, |The last two paragraphs in Article I, Letter A, Introduction, |
| |Technical |Introduction, Currently State: |Revised to State: |
| |Assistance with | | |
| |this OE |Respondents may seek technical assistance in completing |SYSTEM AGENCY recommends Respondents seek technical assistance|
| | |this OE and HCBS-AMH program implementation support via |in completing this OE and HCBS-AMH program implementation |
| | |Texas Institute for Excellence in Mental Health. For more|support via The University of Texas Health Science Center- San|
| | |details on the specific assistance available, email |Antonio (UTHSCSA). For more details on the specific |
| | |txinstitute4mh@austin.utexas.edu. |assistance available, email Dr. Matt Brown at |
| | | |brownma@uthscsa.edu. |
| | |The enrollment period begins December 18, 2014, and will | |
| | |remain open through August 31, 2020. Respondents deemed |Dr. Matt Brown is a subject matter expert on the HCBS-AMH OE |
| | |qualified to provide services shall be awarded a |document and process, and can provide comprehensive, no-cost |
| | |Contingency Contract which shall be effective on the day |technical assistance to OE Respondents. Dr. Matt Brown and |
| | |of execution through 8/31/2022. SYSTEM AGENCY may, at its|UTHSCSA are prepared to assist Respondents with completing all|
| | |sole discretion, extend the closing date of this OE. As |aspects of the OE. |
| | |stated in Sec. II, SYSTEM AGENCY may also, at its sole | |
| | |discretion, withdraw this OE before the stated date the |Respondents that are unsuccessful in three attempts to submit |
| | |enrollment period ends. |a complete and acceptable application will be restricted from |
| | | |reapplying for 365 days from the date of the last rejected |
| | | |application. |
| | | | |
| | | |The enrollment period begins December 18, 2014, and will |
| | | |remain open through August 31, 2020. Respondents deemed |
| | | |qualified to provide services shall be awarded a Contingency |
| | | |Contract which shall be effective on the day of execution |
| | | |through 8/31/2022. SYSTEM AGENCY may, at its sole discretion,|
| | | |extend the closing date of this OE. As stated in Sec. II, |
| | | |SYSTEM AGENCY may also, at its sole discretion, withdraw this |
| | | |OE before the stated date the enrollment period ends. |
|2. |Update OE Point of |Article VI, Letter A, OE Point of Contact Currently |Article VI, Letter A, OE Point of Contact is now: |
| |Contact |States: | |
| | | |For purposes of submitting questions concerning this OE, the |
| | |For purposes of submitting questions concerning this OE, |only contact is the Mental Health Contract Management Unit |
| | |the only contact is Tracie Deloach unless otherwise |unless otherwise delegated by the OE Point of Contact. All |
| | |delegated by the OE Point of Contact. All communications |communications concerning this OE must be submitted by email |
| | |concerning this OE must be submitted by email to: |to: |
| | | | |
| | |OE Point of Contact Email: |OE Point of Contact Email: MHContracts@hhsc.state.tx.us |
| | |Tracie.DeLoach01@hhsc.state.tx.us |Ref: OE# HHS0000074 |
| | |Ref: OE# HHS0000074 | |
|Addendum #4 |
|Revised on May 31, 2019 |
|Item |Purpose of Change |Previous |Revision |
|1. |Update Enrollment |August 31, 2019 |August 31, 2020 |
| |Period Close Date on| | |
| |pg. 1 | | |
|2. |Update Open |Article VI, Letter A, OE Point of Contact was: |Article VI, Letter A, OE Point of Contact is now: |
| |Enrollment Point of | | |
| |Contact |Christopher Dickinson |Tracie Deloach |
| | |Christopher.Dickinson@hhsc.state.tx.us |Tracie.DeLoach01@hhsc.state.tx.us |
|3. |URL Updates | |
| |throughout Open | |oral-health-services-providers/home-community-based-services-adu|
| |Enrollment | |lt-mental-health |
|4. |Update Enrollment |The enrollment period begins December 18, 2014, and will |The enrollment period begins December 18, 2014, and will remain |
| |Period Close Date |remain open through August 31, 2019. Respondents deemed |open through August 31, 2020. Respondents deemed qualified to |
| |and initial award |qualified to provide services shall be awarded a |provide services shall be awarded a Contingency Contract which |
| |period in Section |Contingency Contract which shall be effective on the day of|shall be effective on the day of execution through 8/31/2022. |
| |I. A. |execution through 8/31/2019. SYSTEM AGENCY may, at its |SYSTEM AGENCY may, at its sole discretion, extend the closing |
| | |sole discretion, extend the closing date of this OE. As |date of this OE. As stated in Sec. II, SYSTEM AGENCY may also, |
| | |stated in Sec. II, SYSTEM AGENCY may also, at its sole |at its sole discretion, withdraw this OE before the stated date |
| | |discretion, withdraw this OE before the stated date the |the enrollment period ends. |
| | |enrollment period ends | |
|5. |Update Enrollment |Contingency contracts awarded under this OE will be | |
| |Period Close Date |effective on the date of execution through August 31, 2019.| |
| |and initial award |SYSTEM AGENCY may, at its sole discretion, renew a | |
| |period in Section |contingency contract after the initial term. The contracts| |
| |III. C. |may be renewed up to three additional one- year period | |
| | |contract terms. Renewal is contingent upon the | |
| | |availability of funds and the satisfactory performance of | |
| | |the contractor during the prior contract period. | |
|6. |Update Appendix D |Region 16 was: |Region 16 is now: |
| | | | |
| | |Dallas |Dallas, Ellis, Navarro, Kaufman, Rockwall, Hunt |
|7. |Update Appendix D |Region 25 was: |Region 25 is now: |
| | | | |
| | |Ellis, Navarro, Kaufman, Rockwall, Hunt, Hopkins, Lamar, |Hopkins, Lamar, Delta, Franklin, Titus, Camp, Morris |
| | |Delta, Franklin, Titus, Camp, Morris | |
|Addendum #3 |
|March 28, 2019 |
|Item |Purpose of Change |Previous |Revision |
|1. |Update Open |Article VI, Letter A, OE Point of Contact was: |Article VI, Letter A, OE Point of Contact is now: |
| |Enrollment Point of | | |
| |Contact |Amy Hess |Christopher Dickinson |
| | |Amy.Hess@hhsc.state.tx.us |Christopher.Dickinson@hhsc.state.tx.us |
|Addendum #2 |
|January 13, 2017 |
|Item |Purpose of Change |Previous |Revision |
|1. |Update cover page to|Enrollment Cover Page read in part as follows: |Enrollment Cover Page now reads in part as follows: |
| |reflect revised |Open Enrollment |Open Enrollment |
| |enrollment title and|For |For |
| |agency name | | |
| | |Home and Community Based Services—Adult Mental Health |Home and Community Based Services—Adult Mental Health |
| | |Recovery Management Service Entities |Recovery Management Entity |
| | | | |
| | | | |
| | |Department of State Health Services |Health and Human Services Commission |
|2. |To update agency |Department of State Health Services, DSHS or Department |All references to Department of State Health Services, |
| |name | |DSHS or Department are replaced with Health and Human |
| | | |Services Commission (HHSC) or System Agency |
|3. |To revise language |Section I. A., Introduction read in part as follows: |Section I. A. Introductions is revised in part to read as |
| |in the Introduction | |follows: |
| | |The Department of State Health Services (DSHS or Department) | |
| | |Mental Health announces this notice of Open Enrollment (OE) |The Health and Human Services Commission (“SYSTEM AGENCY”)|
| | |requesting applications to enter into a contract with DSHS. The |Home and Community Based Services-Adult Mental Health |
| | |contingency contract will fund Contractor to provide recovery |(HCBS-AMH) Services Program announces this notice of Open |
| | |management services for seriously and persistently mentally ill |Enrollment (OE) requesting applications to enter into a |
| | |adults enrolled in the Home and Community Based Services – Adult |contract with SYSTEM AGENCY. Respondents are hereby |
| | |Mental Health program (HCBS-AMH). Contractors will bill DSHS for|notified that the HCBS-AMH Services Program and all |
| | |all clinical services provided including the development, |functions associated with the HCBS-AMH Services Program |
| | |coordination and monitoring of services in line with a |have been transferred by the Department of State Health |
| | |person-centered recovery model. |Services to SYSTEM AGENCY with all rights, |
| | | |responsibilities and obligations thereto, as provided in |
| | | |Texas Government Code, Section 531.0201. |
| | | | |
| | | |The contingency contract will require the contractor to |
| | | |provide HCBS-AMH Recovery Management services to adults |
| | | |with a diagnosis of serious mental illness and have a |
| | | |history of at least one of the following additional |
| | | |criteria: |
| | | | |
| | | |Long-term psychiatric hospitalization(s); |
| | | |Frequent arrests and psychiatric crisis; |
| | | |Frequent emergency department visits and psychiatric |
| | | |crisis. |
|4. |To revise language |Section I. A. Introductions read in part as follows: |Section I. A. is revised to read in part as follows: |
| |in the introduction | | |
| | |Respondents may seek technical assistance in completing this OE |Respondents may seek technical assistance in completing |
| | |and HCBS-AMH program implementation support thru 8/31/2016 via |this OE application and HCBS-AMH program implementation |
| | |Texas Institute for Excellence in Mental Health (TIEMH). For |support via Texas Institute for Excellence in Mental |
| | |more details on the specific assistance available, email |Health. For more details on the specific assistance |
| | |txinstitute4mh@austin.utexas.edu. |available, email txinstitute4mh@austin.utexas.edu. |
|5. |Add language to | |Section I. A. Introductions, adds the below language to |
| |introduction | |the end of the section: |
| | | | |
| | | |The enrollment period begins December 18, 2014, and will |
| | | |remain open through August 31, 2018. Respondents deemed |
| | | |qualified to provide services shall be awarded a |
| | | |Contingency Contract which shall be effective on the day |
| | | |of execution through 8/31/2018. SYSTEM AGENCY may, at its|
| | | |sole discretion, extend the closing date of this OE. As |
| | | |stated in Sec. II, SYSTEM AGENCY may also, at its sole |
| | | |discretion, withdraw this OE before the stated date the |
| | | |enrollment period ends. |
|6. |To add Definitions |Section I. B. Definitions, is revised in part to add definitions.|Section I. B. Definitions, is revised in part to add the |
| | | |following definitions: |
| | | | |
| | | |Budget – A financial schedule documented in the contract |
| | | |that describes how funds will be used and/or describes the|
| | | |basis for reimbursement for the provision of contracted |
| | | |services. Types of budget may include categorical (line |
| | | |item), fee for service, or lump sum payable upon receipt |
| | | |of a product or deliverable. |
| | | | |
| | | |Budget Period – The duration of the budget (stated in the |
| | | |number of months the contract will reflect from begin date|
| | | |to end date of the term of the contract). Each renewal |
| | | |will have its own budget period. |
| | | | |
| | | |Respondent – A person or entity that submits a response to|
| | | |a solicitation. For purposes of this document, |
| | | |“respondent” is intended to include such phrases as |
| | | |“offeror”, “applicant”, “bidder”, “responder”, or other |
| | | |similar terminology employed by SYSTEM AGENCY to describe |
| | | |the person or entity that responds to a solicitation. |
| | | | |
|7. |To revise |Section I. B. Definitions, is revised in part to revise the below|Section I. B. Definitions, is revised in part to revise |
| |definitions |definitions: |the following definitions: |
| | | | |
| | |Contingency Contract – Also called a “contract” in this OE, a |Contingency Contract – Also called a “contract” in this |
| | |written agreement referring to promises or agreements for which |OE, a written agreement referring to promises or |
| | |the law establishes enforceable duties and remedies between a |agreements for which the law establishes enforceable |
| | |minimum of two parties. A DSHS contract is assembled using a |duties and remedies between a minimum of two parties and |
| | |core contract (base), one of more program attachments, and other |which is contingent on one or more factors. A SYSTEM |
| | |required exhibits (general provisions, etc.). |AGENCY contract is assembled using a core contract (base),|
| | | |one of more program attachments, and other required |
| | |Contract Term – The period of time during which the contract or |exhibits (general provisions, etc.). |
| | |program attachment will be effective from begin date to end, or | |
| | |renewal date |Contract Term – The period of time during which the |
| | | |contract or program attachment will be effective from |
| | |Effective Date – The date the contract term begins. |execution date to end, or renewal date. |
| | | | |
| | |Procurement and Contracting Services – The division within SYSTEM|Effective Date – The date the contract term is effective. |
| | |AGENCY that provides direction and support of purchasing, | |
| | |contracting and HUB services. PCS oversees, coordinates, and |Procurement and Contracting Services – The division within|
| | |assists the Program with procurement needs, issues open |SYSTEM AGENCY that provides direction and support of |
| | |enrollments and competitive procurements. PCS maintains the |purchasing, contracting and HUB services. PCS oversees, |
| | |official contract file from procurement to contract closeout |coordinates, and assists the Program with procurement |
| | | |needs, issues open enrollments and competitive |
| | | |procurements. PCS maintains the official contract file |
| | | |from procurement to contract closeout |
|8. |Revise language |Section II. Limitation reads as follows: |Section II. Limitations is revised to read as follows: |
| |under Limitations | | |
| | |Issuance of this OE in no way constitutes a commitment by DSHS or|Issuance of this OE in no way constitutes a commitment by |
| | |the State of Texas to execute a contract or to pay any costs |SYSTEM AGENCY or the State of Texas to execute a contract |
| | |incurred by any respondent who may submit an enrollment |or to pay any costs incurred by any Respondent who may |
| | |application. |submit an enrollment application. |
| | | | |
| | |The resulting contingency contract will be subject to the |The resulting contingency contract will be subject to the |
| | |availability of state and federal funds. Contingency contracts |availability of state and federal funds and the need for |
| | |awarded under this OE and any anticipated contract renewals are |HCBS-AMH services. Contingency contracts awarded under |
| | |contingent upon the continued availability of funding. DSHS |this OE and any anticipated contract renewals are |
| | |reserves the right to alter, amend or withdraw this OE at any |contingent upon the continued availability of funding. |
| | |time prior to the execution of a contingency contract. If a |SYSTEM AGENCY reserves the right to alter, amend or |
| | |contingency contract has been fully executed and this OE is |withdraw this OE at any time prior to the execution of a |
| | |altered, amended, or withdrawn, DSHS and contractor’s obligations|contingency contract. If a contingency contract has been |
| | |and rights will be determined in accordance with the provisions |fully executed and this OE is altered, amended, or |
| | |of the contract. |withdrawn, SYSTEM AGENCY and contractor’s obligations and |
| | | |rights will be determined in accordance with the |
| | | |provisions of the contract. |
|9. |Revise Eligibility |Section IV. A. Eligibility Requirements and Affirmations read as |Section IV. A. Eligibility Requirements and Affirmations |
| |Requirements and |follows: |is revised to read as follow: |
| |Affirmations | | |
| | |Eligible respondents include organizations, business, LLC or |Eligible respondents include organizations, business, LLC |
| | |individuals with the capacity to meet requirements to provide |or individuals with the capacity to meet requirements to |
| | |HCBS-AMH Recovery Management Services. Eligible respondent must |provide HCBS-AMH Recovery Management Services. Eligible |
| | |comply with the criteria listed below. |respondent must comply with the criteria listed below. |
| | | |For further information refer to the HCBS-AMH Provider |
| | |Respondent must be a Medicaid provider prior to the provision of |Manual at . |
| | |HCBS-AMH services. | |
| | |Respondent must be established as an appropriate legal entity as |Minimum Requirements for All Direct Service Providers of |
| | |described in the paragraph above, under state statutes and must |HCBS-AMH Recovery Management: |
| | |have the authority and be in good standing to do business in | |
| | |Texas and to conduct the activities described in the OE. |1. Have at least 2 years of experience working with people|
| | |Respondent must have a Texas address. A post office box may be |with severe mental illness; |
| | |used when the enrollment application is submitted, but the |2. Have a master’s degree in human services or a related |
| | |respondent must conduct business at a physical location in the |field. |
| | |service area prior to the date that the contract is awarded. |3. Prior to receiving referrals for the provision of |
| | |Respondent must be in good standing with the U.S. Internal |HCBS-AMH services, Respondent must be authorized as an |
| | |Revenue Service. |active Medicaid Provider. |
| | |Respondent affirms they are not currently debarred, suspended, or|4. Respondent must be established as an appropriate legal |
| | |otherwise excluded or ineligible for participation in Federal or |entity as described in the paragraph above, under state |
| | |State assistance programs. |statutes and must have the authority and be in good |
| | |Respondent’s staff members, including the executive director, |standing to do business in Texas and to conduct the |
| | |must not serve as voting members on their employer’s governing |activities described in the OE. |
| | |board. |5. Respondent must have a Texas address. A post office |
| | |In compliance with Comptroller of Public Accounts and Texas |box may be used when the enrollment application is |
| | |Procurement and Support Services rules, a name search will be |submitted, but the respondent must conduct business at a |
| | |conducted using the websites listed in this section prior to the |physical location in the service region or within 30 miles|
| | |development of a contract. |of an adjacent service region prior to the date that the |
| | |A respondent is not considered eligible to contract with DSHS if |contract is awarded. This physical location must be zoned |
| | |a name match is found on any of the following lists: |to conduct business, be compliant with property |
| | |The System for Award Management (SAM) is an official U.S. |agreements, and be obtained prior to the site review as |
| | |Government system that consolidated the capabilities of CCR/Fed |well as prior to date the contract is awarded. If |
| | |Reg, ORCA and EPLS. Search the federal excluded list at the |respondent’s business address is their home respondent |
| | |following website: ; and |shall attach proof that the building is approved to be |
| | |Texas Comptroller of Public Accounts (CPA) Debarment List located|zoned for business or if leased that the building owner |
| | |at |approves the space to be used for business purposes. |
| | |. Respondent must be in good standing with the U.S. |
| | |/debarred/ |Internal Revenue Service. |
| | |Respondent must have established organizational policies and |7. Respondent affirms they are not currently debarred, |
| | |procedures that comply with HCBS-AMH standards. Topics include, |suspended, or otherwise excluded or ineligible for |
| | |but are not limited to (See HCBS-AMH Provider Manual at located |participation in Federal or State assistance programs. |
| | |at for guidance |8. Respondent’s staff members, including the executive |
| | |regarding minimum standards): |director, must not serve as voting members on their |
| | |Confidentiality and retention of client records and progress |employer’s governing board. |
| | |notes; |9. Respondent shall have a HIPPA compliant encrypted |
| | |Provision of services / coordination of care (including routine |e-mail extension that is exclusively associated with the |
| | |and emergency appointment availability, and assurance that all |respondent’s organization and have capacity to assign |
| | |HCBS-AMH Recovery Management services and HCBS-AMH provider |employees an e-mail address with the exclusive e-mail |
| | |services will be available to individuals in each service area. |extension. |
| | |This includes notification of DSHS when HCBS-AMH Recovery |10. Respondent shall provide SYSTEM AGENCY, upon request, |
| | |Management services or other HCBS-AMH provider services are |with the personnel files of any or all HCBS-AMH staff |
| | |unavailable for any period of time); |(including administration, owners and board members) prior|
| | |Quality management plan; |to the commencement of HCBS-AMH services and at the |
| | |Utilization management; |request of SYSTEM AGENCY. Personnel files shall include: |
| | |Determination of respondent’s capacity to serve individuals; |a. Credentialing (including verification of licensure, |
| | |Notification to DSHS of respondent’s capacity to serve |qualifications, training requirements, certification |
| | |individuals; |records for employees; and |
| | |Housing and placement policies and procedures (monitoring and |b. Criminal History Background and all Abuse Registry |
| | |tracking placement, expansion of community housing relationship |checks. |
| | |plan, and other procedures identified on Form E ); |11. Respondent and all administrative staff shall complete|
| | |Compliance with 1915(i) federal regulations, including settings |HCBS-AMH Pre-application modules located at the following |
| | |requirements for Provider owned and operating settings; |website: |
| | |Managing Conflicts of Interests |
| | |Personnel recordkeeping / management; |ommunity-based-services-adult-mental-health-2/ prior to |
| | |Critical incident reporting; |completion of the OE application. Respondents shall submit|
| | |Personnel and client safety (behavior management, restraint, |Pre-application certificates with the OE application to |
| | |suicide precaution/ prevention ); |verify completion of all HCBS-AMH Pre-application modules.|
| | |Personnel credentialing and training (including verification of | |
| | |licensure, qualifications, training requirements, and |12. In compliance with Comptroller of Public Accounts and |
| | |certification records for employees ); |Texas Procurement and Support Services rules, a name |
| | |Medication safety; |search will be conducted using the websites listed in this|
| | |Payment of employees ; |section prior to the development of a contract. |
| | |Process to submit reports and billing invoices to DSHS (including|13. A respondent is not considered eligible to contract |
| | |verification of the individual’s Medicaid for a billing period); |with SYSTEM AGENCY if a name match is found on any of the |
| | |Medicaid fair hearing; |following lists: |
| | |Consumer rights and grievances |a. The System for Award Management (SAM) is an official |
| | |Reporting of abuse, neglect, and exploitation |U.S. Government system that consolidated the capabilities |
| | |Critical Incidents |of CCR/Fed Reg, ORCA and EPLS. If the Respondent is |
| | |Transfer of individual’s to another HCBS-AMH Provider; and |listed under the Active Excluded subsection of the SAM, |
| | |Discharge of individuals from the HCBS-AMH program. |they are excluded. Search the federal excluded list at the|
| | |Respondent affirms they are not related by blood or marriage to |following website: ; |
| | |an individual enrolled in HCBS-AMH services. |and |
| | |Respondent affirms they are not empowered to make financial or |b. Texas Comptroller of Public Accounts Debarment List |
| | |health-related decisions on behalf of an individual enrolled in |located at |
| | |the HCBS-AMH program. |
| | |Respondent affirms they have not violated federal law in |ormance/debarred/ |
| | |connection with any contract awarded by the federal government |14. Respondent must have established organizational |
| | |for relief, recovery or reconstruction efforts as a result of |policies and procedures that comply with HCBS-AMH |
| | |Hurricanes Katrina or Rita or any other disaster occurring after |standards. Topics include, but are not limited to (See |
| | |September 25, 2005, the respondent is ineligible to receive a |HCBS-AMH Provider Manual at located at |
| | |Provider Agreement. | for guidance |
| | |A respondent affirms they have not had a contract or Provider |regarding minimum standards): |
| | |Agreement suspended or terminated, or has surrendered its |a. Confidentiality and retention of client records and |
| | |license, or has had its license suspended or revoked by any |progress notes; |
| | |local, state or federal department or agency or non-profit |b. Provision of services / coordination of care (including|
| | |respondent. |routine and emergency appointment availability, access to |
| | |All respondents must disclose to DSHS all pending or threatened |Recovery Manager or alternate contact person 24 hours a |
| | |litigation. |day, 7 days a week, 365 days a year, and assurance that |
| | |Respondent affirms they will identify to DSHS whether any person |all HCBS-AMH Recovery Management services and HCBS-AMH |
| | |who has an ownership, controlling interest in the organization, |provider services will be available to individuals in each|
| | |employee, or volunteer of the organization has pending criminal |service area. This includes notification of SYSTEM AGENCY |
| | |charges, been placed on community supervision (probation or |when/if HCBS-AMH Recovery Management services or other |
| | |parole), received deferred adjudication or convicted of a |HCBS-AMH provider services are unavailable for any period|
| | |criminal offense. |of time); |
| | |Respondent affirm they will comply with Human Resources Code, |c. Quality management plan; to include diagnosis of issues|
| | |Section 48.252, requiring a provider to |and resolution |
| | |Cooperate completely with an investigation of alleged abuse, |d. Utilization management; |
| | |neglect, or exploitation conducted by the Department of Family |e. Determination of respondent’s capacity to serve |
| | |and Protective Services. |individuals(See section 2110 of the HCBS-AMH Provider |
| | |Provide complete access to the Department of Family and |manual) |
| | |Protective Services during an investigation to: |f. Housing and placement policies and procedures |
| | |All sites owned, operated, or controlled by the provider; and |(monitoring and tracking placement, expansion of community|
| | |Clients and client records. |housing relationship plan, and other procedures identified|
| | |Local Mental Health Authorities shall affirm they will comply |on Form E ); |
| | |with the Texas Administrative Code, Chapter 414, Subchapter L. |g. Compliance with 1915(i) federal regulations, including |
| | |This includes, but is not limited to: |settings requirements for Provider owned and operating |
| | |Amending their contracts to ensure contractor’s compliance with |settings; |
| | |this subchapter. |h. Managing Conflicts of Interests if applying to be both |
| | |Implementing policies and procedures addressing disciplinary and |Recovery Manager and Provider Agency (include |
| | |other action in conformed cases of abuse, neglect, and |organizational chart that clearly defines administrative |
| | |exploitation involving employees and agents, in accordance with |separation between Recovery Manager and Provider |
| | |Section 414.557. |functions; audit process for managing conflicts of |
| | |Ensuring that a Client Abuse and Neglect Reporting form (AN-1-A) |interest; employee trainings and attestation statement; |
| | |is completed within 14 calendar days of the receipt of the |reporting conflicts of interest to SYSTEM AGENCY such as |
| | |investigative report from the Department of Family and Protective|change in administrative structure, billing practice, |
| | |Services or a decision made after review of appeal using the |responsible party for invoice submission). |
| | |CANRS Definitions and the CANRS Classification, when the |i. Personnel recordkeeping / management; |
| | |perpetrator or alleged perpetrator is an employee or agent of the|j. Critical incident reporting; |
| | |Local Mental Health Authority, community center, or contractor, |k. Personnel and client safety (behavior management |
| | |or if the perpetrator is unknown. |procedures restraint procedures: Including but not limited|
| | |Ensuring, within one working day after completion of the AN-1-A |to: TAC Title 25, Part 1, Chapter 415, Subchapter F), |
| | |form that: |suicide precaution/ prevention procedures); |
| | |The information contained in the completed AN-1-A form is entered|l. Medication safety; |
| | |into the Client Abuse Neglect Reporting System (CANRS); or if |m. Payment of employees ; |
| | |access to CANRS is unavailable, a copy of the completed AN-1-A |n. Process to submit reports and billing invoices to |
| | |form is forwarded for data entry to the Office of Consumer |SYSTEM AGENCY (including verification of the individual’s|
| | |Services and Rights Protection-Ombudsman, P.O. Box 12668, Austin,|Medicaid for a billing period); |
| | |TX 78711-2668. |o. Medicaid fair hearing; |
| | |If Respondent is applying for both the Recovery Management OE and|p. Consumer rights and grievances |
| | |the HCBS-AMH Provider OE, Respondent affirms that recovery |q. Reporting of abuse, neglect, and exploitation |
| | |management decisions will not be subject to influence or revision|r. Critical Incidents |
| | |by those providing or administering other HCBS-AMH services. |s. Transfer of individual’s to another HCBS-AMH Provider; |
| | | |and |
| | |20. Respondent must have general liability insurance. |t. Discharge of individuals from the HCBS-AMH program. |
| | | |15. Respondent affirms they are not related by blood or |
| | |Minimum Requirements for All Direct Service Providers of HCBS-AMH|marriage to an individual enrolled in HCBS-AMH services. |
| | |Recovery Management |16. Respondent affirms they are not empowered to make |
| | |Have at least 2 years of experience working with people with |financial or health-related decisions on behalf of an |
| | |severe mental illness; |individual enrolled in the HCBS-AMH program. |
| | |Have a master’s degree in human services or a related field; |17. Respondent affirms they have not violated federal law |
| | | |in connection with any contract awarded by the federal |
| | | |government for relief, recovery or reconstruction efforts |
| | | |as a result of Hurricanes Katrina or Rita or any other |
| | | |disaster occurring after September 25, 2005, the |
| | | |respondent is ineligible to receive a Provider Agreement. |
| | | |18. A respondent affirms they have not had a contract or |
| | | |Provider Agreement suspended or terminated, or has |
| | | |surrendered its license, or has had its license suspended |
| | | |or revoked by any local, state or federal department or |
| | | |agency or non-profit respondent. |
| | | |19. All respondents must disclose to SYSTEM AGENCY all |
| | | |pending or threatened litigation. |
| | | |20. Respondent affirms they will identify to SYSTEM |
| | | |AGENCY whether any person who has an ownership, |
| | | |controlling interest in the organization, employee, or |
| | | |volunteer of the organization has pending criminal |
| | | |charges, been placed on community supervision (probation |
| | | |or parole), received deferred adjudication or convicted of|
| | | |a criminal offense. |
| | | |21. Respondent affirm they will comply with Human |
| | | |Resources Code, Section 48.252, requiring a provider to |
| | | |a. Cooperate completely with an investigation of alleged |
| | | |abuse, neglect, or exploitation conducted by the |
| | | |Department of Family and Protective Services. |
| | | |b. Provide complete access to the Department of Family and|
| | | |Protective Services during an investigation to: |
| | | |i. All sites owned, operated, or controlled by the |
| | | |provider; and |
| | | |ii. Clients and client records. |
| | | |22. Local Mental Health Authorities shall affirm they will|
| | | |comply with the Texas Administrative Code, Chapter 414, |
| | | |Subchapter L. This includes, but is not limited to: |
| | | |a. Amending their contracts to ensure contractor’s |
| | | |compliance with this subchapter. |
| | | |b. Implementing policies and procedures addressing |
| | | |disciplinary and other action in conformed cases of abuse,|
| | | |neglect, and exploitation involving employees and agents, |
| | | |in accordance with Section 414.557. |
| | | |c. Ensuring that a Client Abuse and Neglect Reporting form|
| | | |(AN-1-A) is completed within 14 calendar days of the |
| | | |receipt of the investigative report from the Department of|
| | | |Family and Protective Services or a decision made after |
| | | |review of appeal using the CANRS Definitions and the CANRS|
| | | |Classification, when the perpetrator or alleged |
| | | |perpetrator is an employee or agent of the Local Mental |
| | | |Health Authority, community center, or contractor, or if |
| | | |the perpetrator is unknown. |
| | | |d. Ensuring, within one working day after completion of |
| | | |the AN-1-A form that: |
| | | |i. The information contained in the completed AN-1-A form |
| | | |is entered into the Client Abuse Neglect Reporting System |
| | | |(CANRS); or if access to CANRS is unavailable, a copy of |
| | | |the completed AN-1-A form is forwarded for data entry to |
| | | |the Office of Consumer Services and Rights |
| | | |Protection-Ombudsman, P.O. Box 12668, Austin, TX |
| | | |78711-2668. |
| | | |23. If Respondent is applying for both the Recovery |
| | | |Management OE and the HCBS-AMH Provider OE, Respondent |
| | | |affirms that recovery management decisions will not be |
| | | |subject to influence or revision by those providing or |
| | | |administering other HCBS-AMH services. |
| | | |24. Respondent must have general liability insurance (Form|
| | | |J). |
| | | |25. All documents submitted must be numbered in numerical |
| | | |sequence in the lower right corner. Any additions to the |
| | | |original submission may be added, but the application must|
| | | |be renumbered to ensure the final packet is sequentially |
| | | |numbered and the entire packet resubmitted. |
| | | |26. If a contingency contract has been fully executed and |
| | | |the Respondent requests to contract to serve additional |
| | | |service region(s) or additional target population(s), |
| | | |Respondent will complete the following: |
| | | |a. Updated Form-A-Face Page |
| | | |b. Updated Form-C-Contact Person Information |
| | | |c. Updated Form G-Organizational Chart |
| | | |d. Updated Form-J-Proof of General Liability Insurance |
| | | |e. Updated Form-K-Organizational Brochure or Biographical |
| | | |Information |
| | | |f. Updated electronic Policy and Procedure Manual from the|
| | | |Respondent to reflect the additional proposed service |
| | | |region(s), target population(s), or programmatic changes |
| | | |due to expansion. |
| | | |g. Provide addresses to physical locations within the |
| | | |requested expansion service region(s). |
| | | |i. On site reviews of Respondent offices and residential |
| | | |settings in requested service region(s) designated for |
| | | |individuals enrolled in HCBS-AMH will be conducted at the |
| | | |discretion of SYSTEM AGENCY. Onsite reviews for additional|
| | | |service regions are subject to the terms identified in |
| | | |Section VI.C.4. |
|10. |To revise required |Section IV. B. Required Activities read as follows: |Section IV. B. Required Activities is revised to read as |
| |activities |Respondent must provide HCBS-AMH recovery management services and|follows: |
| | |associated activities to individuals enrolled in the HCBS-AMH |Respondent must provide HCBS-AMH recovery management |
| | |program directly. Documentation of HCBS-AMH Recovery Management |services and associated activities to individuals enrolled|
| | |services must be provided to DSHS upon request. HCBS-AMH |in the HCBS-AMH program directly. Documentation of |
| | |Recovery Management services provided by the HCBS-AMH Recovery |HCBS-AMH Recovery Management services must be provided to |
| | |Manager include but are not limited to the following: |SYSTEM AGENCY upon request. HCBS-AMH Recovery Management |
| | | |services provided by the HCBS-AMH Recovery Manager include|
| | |1. Educate and inform the individual enrolled in the HCBS-AMH |but are not limited to the following: |
| | |program about services, the individual recovery planning process,| |
| | |recovery resources, rights, and responsibilities; |1. Educate and inform the individual enrolled in the |
| | |2. Obtain and review supporting documentation (assessment data, |HCBS-AMH program about services, the individual recovery |
| | |medical, psychiatric, criminal records) and make recommendations |planning process, recovery resources, rights, and |
| | |to be used as a guide in the independent recovery process; |responsibilities; |
| | |3. Coordinate and develop the IRP using a person-centered |2. Obtain and review supporting documentation (assessment |
| | |planning approach which supports the individual enrolled in the |data, medical, psychiatric, criminal records) and make |
| | |HCBS-AMH program in directing and making informed choices |recommendations to be used as a guide in the independent |
| | |according to the individual’s needs and preferences; |recovery process; |
| | |4. When applicable, provide pre-transition services (recovery |3. Coordinate and develop the IRP using a person-centered |
| | |management inside the in-patient psychiatric facility) to |planning approach which supports the individual enrolled |
| | |maximize the individual enrolled in the HCBS-AMH program’s |in the HCBS-AMH program in directing and making informed |
| | |readiness to transition effectively into the community; |choices according to the individual’s needs and |
| | |5. Collect and provide supporting documentation to be considered |preferences; |
| | |by DSHS in the independent evaluation and reevaluations; |4. When applicable, provide pre-transition services |
| | |6. Document interactions with individuals and service providers |(recovery management inside the in-patient psychiatric |
| | |and ensure individual’s documents are kept in secure location to |facility) to maximize the individual enrolled in the |
| | |maintain confidentiality; |HCBS-AMH program’s readiness to transition effectively |
| | |7. Identify and facilitate services providers and brokers to |into the community; |
| | |obtain and integrate services and advocate to resolve issues that|5. When applicable, provide recovery management services |
| | |impede access to needed services; |inside SYSTEM AGENCY approved facility, which may include |
| | |8. Develop/pursue resources to support the individual enrolled in|a correctional or crisis facility; |
| | |the HCBS-AMH program’s recovery goals including non-HCBS |6. Collect and provide supporting documentation to be |
| | |Medicaid, Medicare, and/or private insurance or other community |considered by SYSTEM AGENCY in the independent evaluation |
| | |resources; |and reevaluations; |
| | |9. Assist the individual enrolled in the HCBS-AMH program in |7. Document interactions with individuals and service |
| | |identifying and developing natural supports (family, friends, and|providers and ensure individual’s documents are kept in |
| | |other community members) and resources to promote the |secure location to maintain confidentiality; |
| | |individual’s recovery; |8. Identify and facilitate services providers and brokers |
| | |10. Inform individual enrolled in the HCBS-AMH program of their |to obtain and integrate services and advocate to resolve |
| | |consumer rights in area of housing, entitlements, and other |issues that impede access to needed services; |
| | |services provided; |9. Develop/pursue resources to support the individual |
| | |11. Assist individual enrolled in the HCBS-AMH program with fair |enrolled in the HCBS-AMH program’s recovery goals |
| | |hearing requests when needed and upon request; |including non-HCBS Medicaid, Medicare, and/or private |
| | |12. Assist individual enrolled in the HCBS-AMH program with |insurance or other community resources; |
| | |applying for and maintaining income source; |10. Assist the individual enrolled in the HCBS-AMH program|
| | |13. Connect individual enrolled in the HCBS-AMH program with |in identifying and developing natural supports (family, |
| | |necessary resources to address legal, immigration and entitlement|friends, and other community members) and resources to |
| | |needs; |promote the individual’s recovery; |
| | |14. Actively coordinates with other individuals and/or service |11. Inform individual enrolled in the HCBS-AMH program of |
| | |providers essential to physical and/or behavioral services for |their consumer rights in area of housing, entitlements, |
| | |the individual enrolled in HCBS-AMH program (including their MCO)|and other services provided; |
| | |to ensure that other services are integrated and support their |12. Assist individual enrolled in the HCBS-AMH program |
| | |recovery goals, health, and welfare; |with fair hearing requests when needed and upon request; |
| | |15. Monitor health, welfare, and safety through regular contacts |13. Assist individual enrolled in the HCBS-AMH program |
| | |(visits with the individual enrolled in the HCBS-AMH program, |with applying for and maintaining income source; |
| | |their paid and unpaid supports, and natural supports) at a |14. Connect individual enrolled in the HCBS-AMH program |
| | |minimum frequency required by DSHS; |with necessary resources to address legal, immigration and|
| | |16. Respond to and assesses emergency situations and incidents |entitlement needs; |
| | |and provides appropriate crisis and referrals to respite services|15. Actively coordinates with other individuals and/or |
| | |to ensure that appropriate actions are taken to protect the |service providers essential to physical and/or behavioral |
| | |health, welfare, and safety of all individuals involved in these |services for the individual enrolled in HCBS-AMH program |
| | |incidences; |(including their MCO) to ensure that other services are |
| | |17. Review service provider documentation and monitors the |integrated and support their recovery goals, health, and |
| | |individual enrolled in the HCBS-AMH’s progress; |welfare; |
| | |18. Initiate and facilitate recovery plan team discussions or |16. Monitor health, welfare, and safety through regular |
| | |meetings when services are not achieving desired outcomes. |contacts (visits with the individual enrolled in the |
| | |Outcomes include housing status, employment status, involvement |HCBS-AMH program, their paid and unpaid supports, and |
| | |in the criminal justice system, response to treatment and other |natural supports) at a minimum frequency required by |
| | |services, and satisfaction with services; |SYSTEM AGENCY; |
| | |19. Through the recovery plan monitoring process, solicits input |17. Respond to and assesses emergency situations and |
| | |from the individual enrolled in the HCBS-AMH program and/or their|incidents and provides appropriate crisis and referrals to|
| | |family, as appropriate, related to satisfaction with services; |respite services to ensure that appropriate actions are |
| | |20. Provide linkage to training and counseling for individual |taken to protect the health, welfare, and safety of all |
| | |enrolled in the HCBS-AMH program family support or unpaid |individuals involved in these incidences; |
| | |caregivers; |18. Review service provider documentation and monitors the|
| | |21. Coordinate transportation and communication services to |individual enrolled in the HCBS-AMH’s progress; |
| | |ensure ease of accessibility to services for the individual |19. Initiate and facilitate recovery plan team discussions|
| | |enrolled in the HCBS-AMH program. |or meetings when services are not achieving desired |
| | |22. Provide referrals and monitoring of pre-vocational, supported|outcomes. Outcomes include housing status, employment |
| | |employment, and supported education; |status, involvement in the criminal justice system, |
| | |23. Coordinate peer support services and linkage to peer support |response to treatment and other services, and satisfaction|
| | |programs, trainings and other resources to help the individual |with services; |
| | |enrolled in the HCBS-AMH program become fully integrated in |20. Through the recovery plan monitoring process, solicits|
| | |his/her community of choice; |input from the individual enrolled in the HCBS-AMH program|
| | |24. Assist the individual enrolled in the HCBS-AMH program in |and/or their family, as appropriate, related to |
| | |navigating through transfer of services and discharge planning; |satisfaction with services; |
| | |25. In the case of provider of last resort, have policy which |21. Provide linkage to training and counseling for |
| | |keeps the HCBS-AMH Recovery Management role administratively |individual enrolled in the HCBS-AMH program family support|
| | |separate from HCBS-AMH provider; |or unpaid caregivers; |
| | |26. Arrange for modifications in services and service delivery, |22. Coordinate transportation and communication services |
| | |as necessary; |to ensure ease of accessibility to services for the |
| | |27. Advocate for continuity of services, system flexibility and |individual enrolled in the HCBS-AMH program. |
| | |integration, proper utilization of facilities and resources, |23. Provide referrals and monitoring of pre-vocational, |
| | |accessibility, and beneficiary rights; |supported employment, and supported education; |
| | |28. Participate in any DSHS-identified activities related to |24. Coordinate peer support services and linkage to peer |
| | |quality oversight and provide reporting as required by DSHS; |support programs, trainings and other resources to help |
| | |29. Maintain appropriate documentation of all HCBS-AMH Recovery |the individual enrolled in the HCBS-AMH program become |
| | |Management services in the format prescribed by DSHS. |fully integrated in his/her community of choice; |
| | |Information shall be collected, maintained, and reported by |25. Assist the individual enrolled in the HCBS-AMH program|
| | |Respondent in accordance with the following specifications: |in navigating through transfer of services and discharge |
| | |a. All reports shall be submitted to DSHS within the time frame |planning; |
| | |and formats, and including subject matter, specified in the |26. In the case of provider of last resort, have policy |
| | |contract and by DSHS Project Director. Respondent shall work |which keeps the HCBS-AMH Recovery Management role |
| | |closely with DSHS staff to track the time between report requests|administratively separate from HCBS-AMH provider; |
| | |and production. |27. Arrange for modifications in services and service |
| | |b. Respond within five working days to requests for ad hoc |delivery, as necessary; |
| | |reports by DSHS. |28. Advocate for continuity of services, system |
| | |c. Report critical incidents as defined by DSHS in writing within|flexibility and integration, proper utilization of |
| | |72 hours of incident or notification of the incident and in |facilities and resources, accessibility, and beneficiary |
| | |accordance with DSHS policy; |rights; |
| | |30. Maintain appropriate documentation of the administration of |29. Participate in any SYSTEM AGENCY-identified activities|
| | |all HCBS-AMH Recovery Management services and expenditures as |related to quality oversight and provide reporting as |
| | |instructed by DSHS. Respondent shall comply with the roles and |required by SYSTEM AGENCY; |
| | |responsibilities of the recovery management respondent HCBS-AMH |30. Maintain appropriate documentation of all HCBS-AMH |
| | |Provider Manual, available online at |Recovery Management services in the format prescribed by |
| | |; |SYSTEM AGENCY. Information shall be collected, |
| | |31. Abide by applicable federal and state laws, regulations, and |maintained, and reported by Respondent in accordance with |
| | |rules relating to activities listed above; |the following specifications: |
| | |32. Have a HIPPA compliant encrypted e-mail extension that is |a. All reports shall be submitted to SYSTEM AGENCY within |
| | |exclusively associated with the respondent or the respondent’s |the time frame and formats, and including subject matter, |
| | |organization and have capacity to assign employees an e-mail |specified in the contract and by SYSTEM AGENCY Project |
| | |address with the exclusive e-mail extension for training purposes|Director. Respondent shall work closely with SYSTEM AGENCY|
| | |and submitting reporting data; and |staff to track the time between report requests and |
| | |33. Participate in any DSHS-identified activities related to |production. |
| | |quality oversight and provide reporting as required by DSHS. |b. Respond within five working days to requests for ad hoc|
| | |34. Respondent shall conduct Criminal History Background and |reports by SYSTEM AGENCY. |
| | |Abuse Registry checks for all individuals involved in the |c. Report critical incidents as defined by SYSTEM AGENCY |
| | |administration and provision of HCBS-AMH Recovery Management |in writing within 72 hours of incident or notification of |
| | |services. |the incident and in accordance with SYSTEM AGENCY policy; |
| | |35. Respondent shall provide DSHS, upon request, with the |31. Maintain appropriate documentation of the |
| | |personnel files of any or all identified HCBS-AMH Recovery |administration of all HCBS-AMH Recovery Management |
| | |Manager and alternate Recovery Manager prior to the commencement |services and expenditures as instructed by SYSTEM AGENCY. |
| | |of HCBS-AMH services. Personnel files shall include: |Respondent shall comply with the roles and |
| | |i. Credentialing (including verification of licensure, |responsibilities of the recovery management respondent |
| | |qualifications, training requirements, and certification records |HCBS-AMH Provider Manual, available online at |
| | |for employees; |; |
| | |ii. Criminal History Background and Abuse Registry checks; |32. Abide by applicable federal and state laws, |
| | |iii. Resume; and |regulations, and rules relating to activities listed |
| | |iv. W-4 Forms of identified Recovery Managers |above; |
| | |36. Respondent shall receive approval from DSHS on their |33. Have a HIPPA compliant encrypted e-mail extension that|
| | |determined capacity to serve prior to the provision of HCBS-AMH |is exclusively associated with the respondent or the |
| | |services. |respondent’s organization and have capacity to assign |
| | | |employees an e-mail address with the exclusive e-mail |
| | | |extension for training purposes and submitting reporting |
| | | |data; and |
| | | |34. Participate in any SYSTEM AGENCY-identified activities|
| | | |related to quality oversight and provide reporting as |
| | | |required by SYSTEM AGENCY. |
| | | |35. Respondent shall conduct Criminal History Background |
| | | |and Abuse Registry checks for all individuals involved in |
| | | |the administration and provision of HCBS-AMH Recovery |
| | | |Management services. |
| | | |36. Respondent shall provide SYSTEM AGENCY, upon request, |
| | | |with the personnel files of any or all identified HCBS-AMH|
| | | |Recovery Manager and alternate Recovery Manager prior to |
| | | |the commencement of HCBS-AMH services. Personnel files |
| | | |shall include: |
| | | |a. Credentialing (including verification of licensure, |
| | | |qualifications, training requirements, and certification |
| | | |records for employees; |
| | | |b. Criminal History Background and all Abuse Registry |
| | | |checks; |
| | | |c. Resume; and |
| | | |d. W-4 Forms of identified Recovery Managers |
| | | |37. Respondent shall receive approval from SYSTEM AGENCY |
| | | |on their determined capacity to serve prior to the |
| | | |provision of HCBS-AMH services. (See HCBS-AMH Provider |
| | | |Manual Section 2110 for complete information) |
| | | |38. Respondent shall affirm they have a history of |
| | | |compliance with the laws relating to the respondent’s |
| | | |business operations and the affected services and whether |
| | | |the respondent is currently in compliance. |
|11. |Revise website |Section V. C. Program Requirements read in part as follows: |Section V. C. Program Requirements is revised in part as |
| |address for Civil | |follows: |
| |Rights Office |Contractors are required to conduct Project activities in | |
| | |accordance with federal and state laws prohibiting |Contractors are required to conduct Project activities in |
| | |discrimination. Guidance for adhering to non-discrimination |accordance with federal and state laws prohibiting |
| | |requirements can be found on the Health and Human Services |discrimination. Guidance for adhering to |
| | |Commission (HHSC) Civil Rights Office website at: |non-discrimination requirements can be found on the SYSTEM|
| | |. |AGENCY Civil Rights Office website at: |
| | | |
| | | |ffice |
|12. |To add Form K. to |Section VI. C. Evaluation Process read in part as follows: |Section VI. C. Evaluation Process is revised in part as |
| |the screening | |follows: |
| |criteria |Enrollment applications will be evaluated according to the | |
| | |criteria below. All enrollment applications remain with DSHS and|Enrollment applications will be evaluated according to the|
| | |will not be returned to the respondent. |criteria below. All enrollment applications remain with |
| | | |SYSTEM AGENCY and will not be returned to the respondent. |
| | |Enrollment applications are evaluated for eligibility and | |
| | |completeness. The eligibility criteria requirements include the |Enrollment applications are evaluated for eligibility and |
| | |following: |completeness. The eligibility criteria requirements |
| | | |include the following: |
| | |1. The respondent must meet the eligibility criteria, and | |
| | |affirmations, in Section IV. Eligible Respondent. |1. The respondent must meet the eligibility criteria, and |
| | |2. Other screening criteria as follows: |affirmations, in Section IV. Eligible Respondent. |
| | |a. FORM A: Face Page. Face Page bears an original signature of |2. Other screening criteria as follows: |
| | |the authorized official of the respondent organization; |a. FORM A: Face Page. Face Page bears an original |
| | |b. FORM B: Open Enrollment Application Checklist; |signature of the authorized official of the respondent |
| | |c. FORM C: Contact Person Information Form; |organization; |
| | |d. FORM D: Board Member Information; |b. FORM B: Open Enrollment Application Checklist; |
| | |e. FORM E: Housing and Entitlement Determination; |c. FORM C: Contact Person Information Form; |
| | |f. FORM F: Organizational Overview, Philosophy, or Mission |d. FORM D: Board Member Information; |
| | |Statement; |e. FORM E: Housing and Entitlement Attestation; |
| | |g. FORM G: Organizational Chart/Structure; |f. FORM F: Organizational Overview, Philosophy, or Mission|
| | |h. FORM H: Policies and Procedures; and |Statement; |
| | |i. FORM I: Job Description for HCBS-AMH Recovery Management |g. FORM G: Organizational Chart/Structure; |
| | |position |h. FORM H: Policies and Procedures; and |
| | |j. FORM J: Proof of General Liability Insurance |i. FORM I: Job Description for HCBS-AMH Recovery |
| | | |Management position |
| | | |j. FORM J: Proof of General Liability Insurance |
| | | |k. FORM K: Organization Brochure or Biographical |
| | | |Information |
|13. |To add language | |Section VI. C. Evaluation Process is revised to add the |
| |regarding site | |following: |
| |visits | | |
| | | |On site reviews of Respondent offices and residential |
| | | |setting in requested service region(s) designated for |
| | | |individuals enrolled in HCBS-AMH will be conducted at the |
| | | |discretion of SYSTEM AGENCY. Respondents will provide |
| | | |addresses to physical locations within the requested |
| | | |service region(s). |
|14. |Add language to |Section VI. D. Rejection of Enrollment Applications read as |Section VI. D. Rejection of Enrollment Applications is |
| |Rejection of |follows: |revised as follows: |
| |Enrollment | | |
| |Applications |1. DSHS reserves the right to reject any or all enrollment |1. SYSTEM AGENCY reserves the right to reject any or all |
| | |applications and is not liable for any costs incurred by the |enrollment applications and is not liable for any costs |
| | |respondent in the development or submission of the enrollment |incurred by the respondent in the development or |
| | |application. |submission of the enrollment application. |
| | |2. Any attempt by an employee, officer, or agent of the |2. Any attempt by an employee, officer, or agent of the |
| | |respondent to influence the outcome of DSHS’s review through |respondent to influence the outcome of SYSTEM AGENCY’s |
| | |contact with any Commissioner or staff member of DSHS or other |review through contact with any Commissioner or staff |
| | |Texas Health and Human Services agency will result in rejection |member of SYSTEM AGENCY or other Texas Health and Human |
| | |of the enrollment application. |Services agency will result in rejection of the enrollment|
| | |3. Any material misrepresentation in an enrollment application |application. |
| | |submitted to DSHS will result in rejection of the enrollment |3. Any material misrepresentation in an enrollment |
| | |application. |application submitted to SYSTEM AGENCY will result in |
| | |4. Enrollment applications may be rejected for failure to meet |rejection of the enrollment application. |
| | |respondent eligibility criteria or inability to perform required |4. Enrollment applications may be rejected for failure to |
| | |activities. |meet respondent eligibility criteria or inability to |
| | |5. If a Respondent wishes to re-apply for the Open Enrollment |perform required activities. |
| | |after receiving a rejection letter: |5. If a Respondent wishes to re-apply for the Open |
| | |a. Respondent is not permitted to re-apply for 6 months from the |Enrollment after receiving a rejection letter: |
| | |date of the rejection letter; and |a. Respondent is not permitted to re-apply for 6 months |
| | |b. Respondent must correct the item(s) identified in the |from the date of the rejection letter; |
| | |rejection letter |b. Respondent must correct the item(s) identified in the |
| | | |rejection letter prior to re-applying: and |
| | | |c. Respondent must complete a new OE RM Application. |
|15. |To add Form K to the|Section VII. Application Instructions and Criteria for Acceptance|Section VII. Application Instructions and Criteria for |
| |required documents |read in part as follows: |Acceptance is revised to read as follows: |
| | | | |
| | |The following application documents are required: |The following application documents are required: |
| | |FORM A: Face Page; |FORM A: Face Page; |
| | |FORM B: Open Enrollment Application Checklist; |FORM B: Open Enrollment Application Checklist; |
| | |FORM C: Contact Person Information Form; |FORM C: Contact Person Information Form; |
| | |FORM D: Board Member Information; |FORM D: Board Member Information; |
| | |FORM E: Housing and Entitlement Determination; |FORM E: Housing and Entitlement Determination; |
| | |FORM F: Organizational Overview, Philosophy, or Mission |FORM F: Organizational Overview, Philosophy, or Mission |
| | |Statement; |Statement; |
| | |FORM G: Organizational Chart/Structure; |FORM G: Organizational Chart/Structure; |
| | |FORM H: Policies and Procedures; and |FORM H: Policies and Procedures; |
| | |FORM I: Job Description for HCBS-AMH Recovery Management |FORM I: Job Description for HCBS-AMH Recovery Management |
| | |position |position; |
| | |FORM J: Proof of General Liability Insurance |FORM J: Proof of General Liability Insurance; and |
| | | |FORM K: Organization Brochure or Biographical Information |
| | | | |
|Addendum #1 |
|Revised on January 8, 2016 |
|Item |Purpose of Change |Previous |Revision |
| |To add language about |Language added to Section I. A. Introduction |Language was added as follows: |
| |technical assistance in | | |
| |completing the OE. | |“Respondents may seek technical assistance in completing this|
| | | |OE and HCBS-AMH program implementation support thru 8/31/2016|
| | | |via Texas Institute for Excellence in Mental Health (TIEMH). |
| | | |For more details on the specific assistance available, email |
| | | |txinstitute4mh@austin.utexas.edu. |
| |To add language |Language added to Section III. A., Use of funds. |Section III. A., now includes the following: |
| |regarding the use of | | |
| |funds and funding | |DSHS, at its sole discretion, may adjust the funding amount |
| |methodology. | |of a Program Attachment based on performance measures, |
| | | |outcome measures, waitlist, and/or other criteria determined |
| | | |by DSHS, and contingent on availability of funds allocated |
| | | |for the adjustments DSHS may implement an alternative |
| | | |reimbursement methodology using the rates set forth herein |
| | | |(or using the rates that exist at the time a contract is |
| | | |executed). This alternative methodology may include the use |
| | | |of a case rate based on expected lengths of stay. |
|3. |To add funding |Section III. B. Term of Contract, contained language that |Section III. B. is now Funding Obligation and reads as |
| |obligation language |read, in part, as follows" |follows: |
| | |Contingency contracts awarded under this OE will begin on |This Contract is contingent upon the availability of funding.|
| | |the date of execution through August 31, 2018. DSHS may, |If funds become unavailable through lack of appropriations, |
| | |at its sole discretion renew a contingency contract after |budget cuts, transfer of funds between programs or health and|
| | |the initial term |human services agencies, amendment of the Appropriations Act,|
| | | |Health and Human Services agency consolidation, or any other |
| | | |disruptions of current appropriated funding for this |
| | | |Contract, DSHS may restrict, reduce or terminate funding |
| | | |under this Contract. Notice of any restriction or reduction |
| | | |shall include instructions and detailed information on how |
| | | |DSHS shall fund the services and/or goods to be procured with|
| | | |the restricted or reduced funds |
| |To change Section III. |Section III. B. Term of Contract is now located in Section |Section III. C. Term of Contract |
| |B. Term of Contract to |III. C |Contingency contracts awarded under this OE will begin on the|
| |Section III. C. | |date of execution through August 31, 2018. DSHS may, at its |
| | | |sole discretion renew a contingency contract after the |
| | | |initial term….. |
| |To add eligibility |Section IV.A, Eligibility Requirements and Affirmations, |Language was revised to add the following: |
| |requirements and |contained language that read, in part, as follows: | |
| |affirmations | |Eligible respondents include organizations, business, LLC or |
| | |Eligible respondents include organizations, business, LLC |individuals with the capacity to meet requirements to provide|
| | |or individuals with the capacity to meet requirements to |HCBS-AMH Recovery Management Services. Eligible respondent |
| | |provide HCBS-AMH Recovery Management Services. Eligible |must comply with the criteria listed below. |
| | |respondent must comply with the criteria listed below. | |
| | | |1. Respondent must be a Medicaid provider prior to the |
| | |1. Respondent must be established as an appropriate legal |provision of HCBS-AMH services. |
| | |entity as described in the paragraph above, under state |2. Respondent must be established as an appropriate legal |
| | |statutes and must have the authority and be in good |entity as described in the paragraph above, under state |
| | |standing to do business in Texas and to conduct the |statutes and must have the authority and be in good standing |
| | |activities described in the OE. |to do business in Texas and to conduct the activities |
| | |2. Respondent must have a Texas address. A post office box|described in the OE. |
| | |may be used when the enrollment application is submitted, |3. Respondent must have a Texas address. A post office box |
| | |but the respondent must conduct business at a physical |may be used when the enrollment application is submitted, but|
| | |location in the service area prior to the date that the |the respondent must conduct business at a physical location |
| | |contract is awarded. |in the service area prior to the date that the contract is |
| | |3. Respondent must be in good standing with the U.S. |awarded. |
| | |Internal Revenue Service. |4. Respondent must be in good standing with the U.S. Internal|
| | |4. Respondent affirms they are not currently debarred, |Revenue Service. |
| | |suspended, or otherwise excluded or ineligible for | |
| | |participation in Federal or State assistance programs……. | |
| |To revise language in |Section IV.A, Eligibility Requirements and Affirmations, |Language was revised to add the following: |
| |eligibility requirements|contained language that read, in part, as follows: | |
| |and affirmations | |9. Respondent must have established organizational policies |
| | |9. Respondent must have established organizational policies|and procedures that comply with HCBS-AMH standards. Topics |
| | |and procedures that comply with HCBS-AMH standards. Topics|include, but are not limited to (See HCBS-AMH Provider Manual|
| | |include, but are not limited to (See HCBS-AMH Provider |at located at for|
| | |Manual for guidance regarding minimum standards): |guidance regarding minimum standards): |
| | |a. Confidentiality and retention of client records and |a. Confidentiality and retention of client records and |
| | |progress notes; |progress notes; |
| | |b. Provision of services / coordination of care (including |b. Provision of services / coordination of care (including |
| | |routine and emergency appointment availability, and |routine and emergency appointment availability, and assurance|
| | |assurance that all HCBS-AMH Recovery Management services |that all HCBS-AMH Recovery Management services and HCBS-AMH |
| | |and HCBS-AMH provider services will be available to |provider services will be available to individuals in each |
| | |individuals in each service area. This includes |service area. This includes notification of DSHS when |
| | |notification of DSHS when HCBS-AMH Recovery Management |HCBS-AMH Recovery Management services or other HCBS-AMH |
| | |services or other HCBS-AMH provider services are |provider services are unavailable for any period of time); |
| | |unavailable for any period of time); |c. Quality management plan; |
| | |c. Quality management plan; |d. Utilization management; |
| | |d. Utilization management; |e. Determination of respondent’s capacity to serve |
| | |e. Determination of respondent’s capacity to serve |individuals; |
| | |individuals; |f. Notification to DSHS of respondent’s capacity to serve |
| | |f. Notification of DSHS of respondent’s capacity to serve |individuals; |
| | |individuals; |g. Housing and placement policies and procedures (monitoring |
| | |g. Housing and placement policies and procedures |and tracking placement, expansion of community housing |
| | |(monitoring and tracking placement, expansion of community |relationship plan, and other procedures identified on Form E |
| | |housing relationship plan, and other procedures identified |); |
| | |on Form E ); |h. Compliance with 1915(i) federal regulations, including |
| | |h. Compliance with 1915(i) federal regulations, including |settings requirements for Provider owned and operating |
| | |settings requirements for Provider owned and operating |settings; |
| | |settings; |i. Managing Conflicts of Interests |
| | |i. Personnel recordkeeping / management; |j. Personnel recordkeeping / management; |
| | |j. Critical incident reporting; |k. Critical incident reporting; |
| | |k. Personnel and client safety (behavior management, |l. Personnel and client safety (behavior management, |
| | |seclusion and restraint); |restraint, suicide precaution/ prevention ); |
| | |l. Personnel credentialing and training (including |m. Personnel credentialing and training (including |
| | |verification of licensure, qualifications, training |verification of licensure, qualifications, training |
| | |requirements, and certification records for employees ); |requirements, and certification records for employees ); |
| | |m. Medication safety; |n. Medication safety; |
| | |n. Payment of employees ; |o. Payment of employees ; |
| | |o. Process to submit invoices to DSHS (including |p. Process to submit reports and billing invoices to DSHS |
| | |verification of the individual’s Medicaid for a billing |(including verification of the individual’s Medicaid for a |
| | |period); |billing period); |
| | |p. Medicaid fair hearing; |q. Medicaid fair hearing; |
| | |q. Consumer rights and grievances |r. Consumer rights and grievances |
| | |r. Reporting of abuse, neglect, and exploitation |s. Reporting of abuse, neglect, and exploitation |
| | |s. Critical Incidents |t. Critical Incidents |
| | |t. Transfer of individual’s to another HCBS-AMH Provider; |u. Transfer of individual’s to another HCBS-AMH Provider; and|
| | |and |v. Discharge of individuals from the HCBS-AMH program. |
| | |u. Discharge of individuals from the HCBS-AMH program. | |
| |To add language to |Section IV.B of the open enrollment, Required Activities, |Required activities were added as follows: |
| |required activities |adds activity number 35 and 36. | |
| | | |35. Respondent shall provide DSHS, upon request, with the |
| | | |personnel files of any or all identified HCBS-AMH Recovery |
| | | |Manager and alternate Recovery Manager prior to the |
| | | |commencement of HCBS-AMH services. Personnel files shall |
| | | |include: |
| | | |i. Credentialing (including verification of licensure, |
| | | |qualifications, training requirements, and certification |
| | | |records for employees; |
| | | |ii. Criminal History Background and Abuse Registry checks; |
| | | |iii. Resume; and |
| | | |iv. W-4 Forms of identified Recovery Managers |
| | | |36. Respondent shall receive approval from DSHS on their |
| | | |determined capacity to serve prior to the provision of |
| | | |HCBS-AMH services. |
| |To revise language in |Section VI .B, Evaluation Process, contained language that |Language was revised as follows: |
| |Evaluation Process |read, in part, as follows: | |
| | |2. Other screening criteria as follows: |2. Other screening criteria as follows: |
| | |a. FORM A: Face Page. Face Page bears an original |a. FORM A: Face Page. Face Page bears an original signature |
| | |signature of the authorized official of the respondent |of the authorized official of the respondent organization; |
| | |organization; |b. FORM B: Open Enrollment Application Checklist; |
| | |b. FORM B: Open Enrollment Application Checklist; |c. FORM C: Contact Person Information Form; |
| | |c. FORM C: Contact Person Information Form; |d. FORM D: Board Member Information; |
| | |d. FORM D: Board Member Information; |e. FORM E: Housing and Entitlement Determination; |
| | |e. FORM E: Housing and Entitlement Determination; |f. FORM F: Organizational Overview, Philosophy, or Mission |
| | |f. FORM F: Organizational Overview, Philosophy, or Mission|Statement; |
| | |Statement; |g. FORM G: Organizational Chart/Structure; |
| | |g. FORM G: Organizational Chart/Structure; |h. FORM H: Policies and Procedures; and |
| | |h. FORM H: Policies and Procedures; and |i. FORM I: Job Description for HCBS-AMH Recovery Management |
| | |i. FORM I: Job Description and Resume for HCBS-AMH Recovery|position |
| | |Management position with required staff qualifications |j. FORM J: Proof of General Liability Insurance |
| | |j. FORM J: Proof of General Liability Insurance | |
| |To revise language in |Section VI .B, Evaluation Process, contained language that |Language was revised as follows: |
| |Evaluation Process |read, in part, as follows: | |
| | | |4. The respondent may be subject to an Onsite Review which |
| | |4. The respondent may be subject to an Onsite Review which |may include the following information, when applicable. |
| | |may include the following information, when applicable. |Additional information may be requested at the discretion of |
| | |Additional information may be requested at the discretion |DSHS. |
| | |of DSHS. |a) Information submitted as a part of the OE application; |
| | |a) Information submitted as a part of the OE application; |b) Policies and Procedures Manuals/Operational |
| | |b) Policies and Procedures Manuals/Operational |Handbooks/Guidelines to include the following policies and |
| | |Handbooks/Guidelines to include the following policies and |procedures: |
| | |procedures: |i. Confidentiality and retention of client records and |
| | |i. Confidentiality and retention of client records and |progress notes; |
| | |progress notes; |ii. Provision of HCBS-AMH Recovery Management services / |
| | |ii. Provision of HCBS-AMH Recovery Management services / |coordination of care (including routine and emergency |
| | |coordination of care (including routine and emergency |appointment availability, and assurance that all HCBS-AMH |
| | |appointment availability, and assurance that all HCBS-AMH |Recovery Management services will be available to individuals|
| | |Recovery Management services will be available to |in each service area. This includes notification of DSHS when|
| | |individuals in each service area. This includes |HCBS-AMH recovery management service is unavailable for any |
| | |notification of DSHS when HCBS-AMH recovery management |period of time); |
| | |service is unavailable for any period of time); |iii. HCBS-AMH quality management plan; |
| | |iii. HCBS-AMH quality management plan; |iv. Utilization management; |
| | |iv. Utilization management; |v. Determination of respondent’s capacity to serve |
| | |v. Determination of respondent’s capacity to serve |individuals; |
| | |individuals; |vi. Housing and Entitlement Determination (knowledge of |
| | |vi. Housing and Entitlement Determination (knowledge of |advocacy in areas of housing and entitlements, identified on |
| | |advocacy in areas of housing and entitlements, identified |Form E); |
| | |on Form E); |vii. Personnel recordkeeping / management; |
| | |vii. Personnel recordkeeping / management; |viii. Critical incident reporting; |
| | |viii. Critical incident reporting; |ix. Managing Conflicts of Interest; |
| | |ix. Personnel, client safety, and crisis planning (behavior|x. Personnel, client safety, and crisis planning (behavior |
| | |management, seclusion and restraint); |management, and restraint, suicide precaution/prevention); |
| | |x. Individual and personnel credentialing and training |xi. Individual and personnel credentialing and training |
| | |(including verification of licensure, qualifications, |(including verification of licensure, qualifications, |
| | |training requirements, and certification records for |training requirements, and certification records for |
| | |employees); |employees); |
| | |xi. Medication safety |xii. Medication safety |
| | |xii. Payment of employees |xiii. Payment of employees |
| | |xiii. Process to submit invoices to DSHS (including |xiv. Process to submit reports and billing invoices to DSHS |
| | |verification of the individual’s Medicaid for a billing |(including verification of the individual’s Medicaid for a |
| | |period); |billing period); |
| | |xiv. Medicaid fair hearing; |xv. Medicaid fair hearing; |
| | |xv. Consumer rights and grievances; |xvi. Consumer rights and grievances; |
| | |xvi. Reporting abuse, neglect, and exploitation; |xvii. Reporting abuse, neglect, and exploitation; |
| | |xvii. Critical incidents; |xviii. Critical incidents; |
| | |xviii. Transfer of individual’s to another HCBS-AMH Entity;|xix. Transfer of individual’s to another HCBS-AMH Entity; |
| | | |xx. Discharge of individuals from HCBS-AMH; |
| | |xix. Discharge of individuals from HCBS-AMH; |xxi. Respondent’s licensing, credentialing, and personnel |
| | |xx. Respondent’s licensing, credentialing, and personnel |files ; |
| | |files ; |xxii. Organizational or facility environment; |
| | |xxi. Organizational or facility environment; |xxiii. Client record keeping practices, by reviewing an |
| | |xxii. Client record keeping practices, by reviewing an |existing client record; and |
| | |existing client record; and |xxiv. Qualifications (education, experience, licensure, |
| | |xxiii. Qualifications (education, experience, licensure, |certification, training requirements, and registration) of |
| | |certification, training requirements, and registration) of |all individuals to provide services as described in the |
| | |all individuals to provide services as described in the |HCBS-AMH Provider Manual, available online at |
| | |HCBS-AMH Provider Manual, available online at |. This includes |
| | |. This includes |professional standards and regulations, including malpractice|
| | |professional standards and regulations, including |or liability insurance for professional staff. |
| | |malpractice or liability insurance for professional staff. |xxv. Proof of General Liability Insurance |
| | |xxiv. Proof of General Liability Insurance |xxvi. Person-Centered Recovery Planning; |
| | |xxv. Person-Centered Recovery Planning; |xxvii. Provision of clinical supervision best practices; and |
| | |xxvi. Provision of clinical supervision best practices; and|xxviii. Knowledge of issues affecting people with severe |
| | |xxvii. Knowledge of issues affecting people with severe |mental illness and community-based interventions/resources |
| | |mental illness and community-based interventions/resources |for this population. |
| | |for this population. | |
| |To add language on |Section VI.D of the open enrollment, Rejection of |Language was added as follows: |
| |re-applying for the open|Enrollment Applications, adds item number 5. | |
| |enrollment. | |5. If a Respondent wishes to re-apply for the Open Enrollment|
| | | |after receiving a rejection letter: |
| | | |a. Respondent is not permitted to re-apply for 6 months from |
| | | |the date of the rejection letter; and |
| | | |b. Respondent must correct the item(s) identified in the |
| | | |rejection letter |
| |To revise application |Section VII. Application Instructions and Criteria for |Language was revised as follows: |
| |instructions and |Acceptance, contained language that read, in part, as | |
| |criteria for acceptance |follows: |The following application documents are required: |
| | | |FORM A: Face Page; |
| | |The following application documents are required: |FORM B: Open Enrollment Application Checklist; |
| | |FORM A: Face Page; |FORM C: Contact Person Information Form; |
| | |FORM B: Open Enrollment Application Checklist; |FORM D: Board Member Information; |
| | |FORM C: Contact Person Information Form; |FORM E: Housing and Entitlement Determination; |
| | |FORM D: Board Member Information; |FORM F: Organizational Overview, Philosophy, or Mission |
| | |FORM E: Housing and Entitlement Determination; |Statement; |
| | |FORM F: Organizational Overview, Philosophy, or Mission |FORM G: Organizational Chart/Structure; |
| | |Statement; |FORM H: Policies and Procedures; and |
| | |FORM G: Organizational Chart/Structure; |FORM I: Job Description for HCBS-AMH Recovery Management |
| | |FORM H: Policies and Procedures; and |position |
| | |FORM I: Job Description and Resume for HCBS-AMH Recovery |FORM J: Proof of General Liability Insurance |
| | |Management position with required staff qualifications | |
| | |FORM J: Proof of General Liability Insurance | |
-----------------------
Cecile Young
Executive Commissioner
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