Exhibit E, Statement of Work SOW.pdf

HHS0016750 – Specialized Residential Health Services Exhibit E

STATEMENT OF WORK

CONTENTS

2.1 Description of Services

2.1.1 Generic Patient Profile

2.2 Contractor Requirements

2.2.1 Residential Setting Requirements

2.2.2 Residential Services

2.2.3 Health Services

2.2.4 Administrative Services

2.2.5 Reimbursement Methodology

2.3 Conviction Disclosure and Removal

2.3.1 Disclosure

2.3.2 Removal

2.3.3 Criminal History Checks and Registry Clearances

2.4 Abuse, Neglect, and Exploitation Investigating Reporting Requirements

2.4.1 Reporting Abuse, Neglect, or Exploitation to HHSC

2.4.2 Ensuring the Safety and Protection of the Individual Served

2.4.3 Investigations

2.4.4 Notifying Appropriate Licensing Authorities

2.4.5 Reporting Deaths of the Individual Served by HHSC

2.5 Payment and Invoicing

2.6 Monitoring by HHS

2.1 Description of Services

This Statement of Work (SOW) includes the Services, requirements, deliverables, and performance standards to be performed by the Contractor under the Contract. For additional specification and clarification, please refer to the Addenda, attachments, exhibits, and other documents expressly designated by HHSC as part of the Contract.

Contractor must provide all Services and abide by all terms and conditions of the Contract as it relates to Services provided for the Individual. All Services under this Contract must be reasonably necessary to provide for the direct medical needs of the Individual. HHSC reserves the right to determine, in its sole discretion, that Services or any aspect of Services, are not reasonably necessary to provide for the direct medical needs of the Individual. In such instances, Contractor will not be entitled to reimbursement or other compensation for such Unallowable Services.

Contractor, if applicable, shall coordinate the transition of Services with any current Contractor as much as practicable. Services are expected to begin upon Contract Effective Date and shall be fully provided to the Individual by Contractor within five (5) calendar days.

2.1.1 Generic Patient Profile

This is a generic patient profile of the Individual to assist with identifying potential scope, frequency, and duration of Services:

a. The Individual is an elderly, medically complex person with moderate to severe intellectual disability who may frequently exhibit behaviors injurious to self and others. The Individual may not be able to:

1. Stand, sit, or ambulate independently;

2. Independently perform activities of daily living such as toileting, personal and oral hygiene, food preparation, etc.;

3. Identify or express wants and needs, clearly, such as communicate thirst, hunger, pain, or injury;

4. Independently maintain essential bodily functions such as blood sugar regulation, bladder or bowel voiding, or perform bolus movements; or

5. Take food, drink, or medication orally.

b. The Individual may require:

1. Moderate to full support performing activities of daily living;

2. Management and administration of all medications including life sustaining medications;

3. Medical devices to support life sustaining bodily functions;

4. Continuous monitoring of health status;

5. Therapies related to intellectual and behavioral needs;

6. Enteral feeding support; or

7. Behavioral interventions.

2.2 Contractor Requirements

Contractor must provide the following Services for the Individual:

2.2.1 Residential Setting Requirements

a. Residence

1. Contractor is responsible for assuming the current lease on the individual’s residence unless:

A. The existing lease is terminated by the lessor in favor of a new lease agreement;

B. The existing lessee or lessor refuse the transfer; or C. HHSC determines that any conditions placed upon the transfer of the lease or included as a condition in the transfer or new lease are unreasonable such as lease payments that substantially exceed the market rate for the location.

2. In the event the current lessee or lessor refuses or upon HHSC determination of unreasonableness, Contractor is responsible for finding and securing an appropriate new residence that meets the following requirements:

A. Located in a residential neighborhood in Tarrant County or Denton County or in a county approved, in writing, by HHSC.

B. Leased by the Contractor with the Individual indicated as a resident of the residence on the lease.

C. At least a three (3) bedroom, two (2) bathroom home to facilitate the following requirements:

i A private bedroom for the Individual.

ii At least one (1) additional bedroom.

iii A separate, enclosed room for use as an office for staff, which must not interfere with the home-like appearance of the residence.

iv A private full bathroom including a functional toilet, sink, and shower for exclusive use by the Individual (a modification to the bathroom may be necessary to meet the needs of the individual pursuant to Section 2.2.1(3).

v A full bathroom including a functional toilet, sink, and shower for use by Service Providers and visitors.

D. Sufficient outside space within the property lines to allow for outside activities when desired by the Individual including outside space enclosed within a privacy fence that complies with applicable local ordinances and codes.

E. Similar in appearance to other residences in the community that ensures the individual’s rights of privacy, dignity, and respect in a residential setting that provides a home-like setting that does not have the qualities of an institution1, and is in compliance with applicable federal, State, and local regulations.

F. Is preapproved in writing by HHSC.

3. Residential Modifications Residential Modifications are those physical adaptations to a residence, identified by the Interdisciplinary Team (IDT), that are necessary to ensure the Individual's health, welfare and safety or that enables the Individual to function with greater independence in the residence. Any residential modifications must comply with the Americans with Disabilities Act (ADA) requirements. Such adaptations may include the installation of wheelchair ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems that are needed to accommodate the medical equipment and supplies necessary for the Individual’s welfare. Excluded are those adaptations or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the Individual, such as carpeting, roof repair, central air conditioning, etc. Residential Modifications that add to the total square footage of the home or have not been approved by HHSC are excluded.

Contractor must facilitate, and document, the following:

A. Residential Modifications must be approved in writing by HHSC and the property owner prior to the initiation of a Residential Modification by the Contractor.

B. Residential Modification Requests must be based on a written, legible assessment by an appropriate licensed professional. The Residential Modification Request must include:

i. The in-person assessment of the Individual by an appropriate licensed professional conducted in the Individual's residence not more than one (1) year before the date of Residential Modification Request;

ii. A description of, and a recommendation for, a Residential Modification and any associated installation specifications necessary to make the Residential Modification functional by the licensed professional;

iii. A diagnosis in the assessment that is related to the Individual's need for the minor home modification (for example, cerebral palsy, quadriplegia, or deafness);

1 Guidance §483.10(i) of Appendix PP – Guidance to Surveyors for Long Term Care Facilities in the State Operations Manual provided by the Centers for Medicare and Medicaid Services https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/downloads/appendix-pp-state-operations-manual.pdf shall be used to determine compliance with the requirement to provide and maintain a home-like setting that does not have the qualities of an institution.

iv. A description in the assessment of the condition related to the diagnosis (for example, unable to ambulate without assistance);

v. A description in the assessment of the specific needs of the Individual and how the Residential Modification will meet those needs (for example, the individual needs to enter and exit the home safely and the addition of a wheelchair ramp will allow him to do so);

vi. A written and signed agreement obtained from the property owner that contains a complete description of the minor home modification and any associated installation specifications, as identified in the written assessment, with a drawing or picture of both the existing and proposed floor plans or any physical change to a space or item in or part of the residence. The agreement must contain language that the property owner is providing permission to make the identified residential modification and understands that neither the contractor nor HHSC will provide funds or carry out work to revert the property to its original condition prior to the residential modification.

vii. A drawing or picture of both the existing and proposed floor plans; and

viii. Three (3) bids from three different vendors that are based on applicable requirements in (vi) of this section and itemized before submission to HHSC for vendor selection and final approval.

b. Prior to Assumption of Existing Lease, Lease Renewal, or Move-In

1. Contractor must ensure a residence is appropriate and meets the requirements of the

Contract before a lease agreement is assumed, executed, renewed, extended, or otherwise becomes enforceable.

2. Contractor is responsible for the following prior to the Individual relocating to a new residence; or within three (3) business days of the Contractor assuming an existing lease:

A. An on-site inspection of the residence to ensure that it complies with requirements of the Contract;

B. Any noncompliance with the Residential Requirements of the Contract identified during the on-site inspection must be immediately reported to HHSC and corrected in a reasonable time prior to the Individual living in the residence; and

C. Contractor agrees that HHSC is the sole arbiter of what constitutes reasonable time.

c. Maintenance

1. Contractor must ensure and maintain the residence to provide a safe and healthy environment for the Individual that is clean and free of any debris.

2. Contractor must maintain the entire residential property as non-smoking and ensure staff are not permitted to use any tobacco product during their assigned work hours.

3. Contractor must maintain the home – cleaning, lawn care, routine home maintenance, reporting issues to property owner as needed.

d. Emergency Plan

1. Contractor must create, within seven (7) calendar days of Contract Execution, and maintain an emergency plan that addresses emergencies specific to the residential setting, geographic location, and the Individual living in the residence;

2. Drills for fire emergencies must be conducted six (6) times each calendar year with at least two drills occurring overnight;

3. Contractor must make sure the Individual and Service Provider follow the emergency plan during drills and emergencies; and

4. Contractor must create and maintain documentation of the performance of emergency drills and make available to HHSC upon request.

2.2.2 Residential Services

a. Direct Care Services

1. Contractor shall provide the following In Home Services for the Individual:

A. Residential support.

B. Assist with bathing, dressing, and personal hygiene.

C. Assist with eating.

D. Assist with meal planning and preparation.

E. Assist with housekeeping.

F. Assist with ambulation and mobility.

G. Reinforce behavioral support.

H. Operate a vehicle to transport the individual by.

J. Assist with the administration of the Individual's medication and/or perform tasks delegated by a registered nurse in accordance with rules of the Texas Board of Nursing at 22 Texas Administrative Code (TAC), Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) and Human Resources Code, Sections 161.091 - 161.093, as applicable.

K. Supervise the Individual's safety and security.

2. Hours of Care and Staffing Protocol.

A. Service Providers delivering residential services must be present and awake when the Individual is present in the residence.

B. Service Providers delivering residential services must be available for shifts covering twenty-four (24) hours per day, seven (7) days a week.

C. Contactor may not have a Service Provider delivering residential services work more than 16 consecutive hours.

https://texas-sos.appianportalsgov.com/rules-and-meetings?chapter=225&interface=VIEW_TAC&part=11&title=22 https://texas-sos.appianportalsgov.com/rules-and-meetings?chapter=225&interface=VIEW_TAC&part=11&title=22 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=11&ch=225&rl=14 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=11&ch=225&rl=14 https://texas-sos.appianportalsgov.com/rules-and-meetings?chapter=225&interface=VIEW_TAC&part=11&title=22 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=11&ch=225&rl=14 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=11&ch=225&rl=14 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=11&ch=225&rl=14 https://statutes.capitol.texas.gov/docs/HR/htm/HR.161.htm https://texas-sos.appianportalsgov.com/rules-and-meetings?$locale=en_US&interface=VIEW_TAC_SUMMARY&queryAsDate=02%2F25%2F2025&recordId=166068 https://texas-sos.appianportalsgov.com/rules-and-meetings?$locale=en_US&interface=VIEW_TAC_SUMMARY&queryAsDate=02%2F25%2F2025&recordId=166068 https://statutes.capitol.texas.gov/docs/HR/htm/HR.161.htm https://texas-sos.appianportalsgov.com/rules-and-meetings?$locale=en_US&interface=VIEW_TAC_SUMMARY&queryAsDate=02%2F25%2F2025&recordId=166068

D. If a Service Provider delivering residential services works for 16 consecutive hours, the Service Provider delivering residential services must be off duty for at least eight

(8) hours before working another shift of any length.

E. If a Service Provider delivering residential services works for 16 hours in any 24-hour period, the Service Provider delivering residential services must be off duty for at least eight (8) consecutive hours during the same 24-hour period.

3. Residential service outside the residence.

A. Encourage inclusion in community activities, social interaction, participation in leisure activities, and development of socially valued behaviors.

B. Supervise the Individual’s safety and security when accessing services such as dental, medical, and psychological services in the community.

4. Transportation A. Transportation includes the activity of transporting the Individual from one location to another. Contractor shall provide a vehicle to facilitate transportation of the Individual to ensure access to dental, medical, and psychological services in the community or in support of a transportation plan developed by the IDT and approved by HHSC.

B. The transportation vehicle must be:

i. In good repair;

ii. Equipped with properly operating air conditioning and heating systems;

iii. In compliance with State law; and

iv. Available to meet the transportation needs of the Individual upon Effective

Date of the Contract.

C. Contractor must ensure that any Service Provider who provides transportation:

i. Has a valid Texas driver’s license; and

ii. Transports the Individual in a vehicle compliant with the Contract and State law and in accordance with Title 7 of the Texas Transportation Code.

b. Direct Care Staffing

1. Residential Manager

A. Residential Manager Responsibilities:

i. Create and coordinate the scheduling of the Service Providers delivering residential services to ensure availability and shift changes;

ii. Coordinate the daily activities and transportation for the Individual;

iii. Ensure the Service Providers of residential services and transportation have received specialized training in the management of problem behaviors as required by the Individual’s Behavioral Support Plan (BSP), and remain current on the training requirements;

iv. Oversee and manage the residence and maintenance requests;

v. Manage the Service Providers of residential support and transportation;

vi. Oversee transportation requirements and the Individual’s needs for transportation;

vii. Review and maintain records as required by the Individualized Habilitation Plan (IHP) and BSP;

viii. Review and maintain records that evidence the service delivery of residential services and transportation, which include a description of the tasks and activities provided during the service delivery;

ix. Ensure tasks assigned to Service Providers from the RN, behavioral health specialist, social worker, or other professionals are documented and available for review by HHSC;

x. Identify training needs and ensure Service Provider training is completed timely and documented;

xi. Track expenses and maintain proper supporting documentation for invoices;

xii. Pay bills, i.e., rent, utilities, home maintenance, groceries; and

xiii. Assist with report development, as needed.

B. Residential Manager Required Qualifications.

Must have a bachelor’s degree in psychology or health-related field, and at least two (2) years of experience working with individuals with intellectual and developmental disabilities.

2. Service Provider of Residential and Transportation Services Requirements Staff Responsibilities:

A. In addition to providing the Residential Services activities listed in Section 2.2.2

(a) and (b) above, the Service Provider(s) must also;

i. Document the Individual’s activities, medications, treatments, and significant observations each calendar day;

ii. Complete and maintain required trainings; and

iii. Participate in the Interdisciplinary Team (IDT), as requested.

B. Service Provider Required Qualifications:

i. Must be an Adult;

ii. Must have a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma or have successfully completed a written competency-based assessment, developed, and administered by the Contractor; and

iii. Must provide a written personal reference which evidences the Service Provider’s ability to provide a safe and healthy environment for the Individual from at least three (3) persons who are not relatives (See Degree of Consanguinity or Affinity Appendix III) to the Service Provider.

c. Nursing Services

1. Primary Registered Nurse

A. Qualifications:

i. Registered Nurse (RN) must be licensed in Texas and in good standing with the

Texas Board of Nursing as a RN; and https://www.hhs.texas.gov/handbooks/transition-assistance-services-orientation-handbook/appendix-iii-degree-consanguinity-or-affinity https://www.hhs.texas.gov/handbooks/transition-assistance-services-orientation-handbook/appendix-iii-degree-consanguinity-or-affinity https://www.hhs.texas.gov/handbooks/transition-assistance-services-orientation-handbook/appendix-iii-degree-consanguinity-or-affinity https://www.hhs.texas.gov/handbooks/transition-assistance-services-orientation-handbook/appendix-iii-degree-consanguinity-or-affinity https://www.hhs.texas.gov/handbooks/transition-assistance-services-orientation-handbook/appendix-iii-degree-consanguinity-or-affinity https://www.hhs.texas.gov/handbooks/transition-assistance-services-orientation-handbook/appendix-iii-degree-consanguinity-or-affinity https://www.hhs.texas.gov/handbooks/transition-assistance-services-orientation-handbook/appendix-iii-degree-consanguinity-or-affinity https://www.hhs.texas.gov/handbooks/transition-assistance-services-orientation-handbook/appendix-iii-degree-consanguinity-or-affinity

ii. Must be in compliance with Chapter 301 of the Texas Occupations Code (Nursing Practice Act) ; 22 TAC Chapter 217 (relating to Licensure, Peer Assistance, and Practice); 22 TAC Chapter 224 (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments); 225 TAC Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions).

B. Responsibilities:

i. Must perform health care responsibilities and monitor the Individual’s health conditions;

ii. Conducts the comprehensive nursing assessments to evaluate health and functional needs for the Individual at least annually;

iii. Responsible for overall coordination, compliance, quality of nursing care provided to the individual, and compliance with treatment plans (BSP);

iv. Discusses the assessment as part of the IDT;

v. Assists in the development of the IHP;

vi. Administers medication or delegates medication administration as appropriate;

vii. Monitors the Individual’s health status, use of medications, and treatment progress;

viii. Monitor’s health risks, data, and information, including ensuring that an unlicensed Staff Member is performing only those nursing tasks identified from a nursing assessment;

ix. Assists the Individual to secure routine and emergency medical Services;

x. Makes referrals for appropriate medical Services;

xi. Performs health care procedures ordered or prescribed by a physician or medical practitioner and required by standards of professional practice or law to be performed by an RN or LVN; and

xii. Must be available for up to 40 hours per week during normal business hours.

Additional Nursing Service Providers, as applicable.

2. Registered Nurses A. Qualifications:

i. Registered Nurse (RN) must be licensed in Texas and in good standing with the Texas Board of Nursing as a RN; and

ii. Must be in compliance with Chapter 301 of the Texas Occupations Code (Nursing Practice Act); 22 TAC Chapter 217 (relating to Licensure, Peer Assistance, and Practice); 22 TAC Chapter 224 (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments); 22 TAC Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions).

https://statutes.capitol.texas.gov/Docs/OC/htm/OC.301.htm https://statutes.capitol.texas.gov/Docs/OC/htm/OC.301.htm https://texas-sos.appianportalsgov.com/rules-and-meetings?chapter=217&interface=VIEW_TAC&part=11&title=22 https://texas-sos.appianportalsgov.com/rules-and-meetings?chapter=224&interface=VIEW_TAC&part=11&title=22 https://texas-sos.appianportalsgov.com/rules-and-meetings?chapter=225&interface=VIEW_TAC&part=11&title=22

B. Responsibilities:

i. Responsible for providing nursing services to the individual in compliance with treatment plans and under the direction of the Primary Registered Nurse;

ii. Administers medication;

iii. Monitors the Individual’s health status, use of medications, and treatment during scheduled times;

iv. Monitor’s health risks, data, and information, including ensuring that an unlicensed Service Provider is performing only those nursing tasks identified in the nursing assessment;

v. Assists the Individual to secure routine and emergency medical Services;

vi. Makes recommendations for appropriate medical Services to the Primary

Registered Nurse; and

vii. Performs health care procedures:

a. Ordered or prescribed by a physician or medical practitioner;

b. Required by standards of professional practice or law to be performed by an

RN;

c. Directed by the Primary Registered Nurse; or

d. As necessary to ensure the health and welfare of the Individual.

3. Licensed Vocational Nurses, as applicable A. Qualifications:

i. Must hold an active and unencumbered Texas Licensed Vocational Nurse (LVN) license issued by the Texas Board of Nursing.

ii. Current Basic Life Support (BLS) certification from an accredited provider (e.g., American Heart Association).

iii. Must comply with Texas Nursing Practice Act and all applicable regulations.

iv. Minimum one (1) year of clinical experience as an LVN.

v. Experience in home health, long-term care, hospice, or residential setting.

B. Responsibilities:

i. Provide direct nursing care under the supervision of an RN in compliance with care plans.

ii. Monitor condition of Individual, including oxygen levels, wound care, medication administration, and mobility assistance.

iii. Recognize and report significant changes in patient status to the RN or physician.

iv. Maintain accurate and timely documentation of all nursing interventions and patient observations.

v. Monitor vital signs, administer medications, and perform routine nursing care under RN supervision.

d. Nurse Staffing

1. Primary Registered Nurse Oversight

A. Primary Registered Nurse is responsible for the overall coordination, compliance, and quality of nursing care provided to the individual.

B. Ensures appropriate nurse staffing levels and continuity of care.

C. Supervises additional nursing Service Providers, and delegates nursing tasks.

D. Adjusts Nursing Service Provider staffing plans based on the Individual’s changing medical needs in collaboration with the IDT and upon affirmation by HHSC.

2. 24-Hour Staffing, if medically necessary A. A minimum of one Registered Nurse or Licensed Vocational Nurse must be in the individual’s presence at all times deemed necessary by the IDT and affirmed by HHSC, to respond to documented medical need for which 24-Hour nursing serviceService is determined to be medically necessary.

B. Shifts must be scheduled to ensure adequate overlap for end-of-shift nurse to nurse reporting.

C. An emergency backup plan must be developed to ensure adequate coverage is maintained to ensure continuous nursing Service Provider availability at all times.

3. Staffing Adjustment Nursing coverage levels may be adjusted based on the individual’s medical need as determined by the IDT and affirmed by HHSC.

2.2.3 Health Services

a. Interdisciplinary Team (IDT) Contractor must ensure the Individual is served by an Interdisciplinary Team (IDT).

Responsibilities of the IDT:

1. Establishes an ongoing process for the development of the IHP to address all needs for the Individual;

2. Develops an IHP that identifies supports and Services necessary to achieve the

Individual's goals and objectives, identifies existing supports, including natural supports and other supports available to the Individual, within 30 calendar days of Contract execution, at least annually thereafter, or as medical needs require more frequency;

3. Adheres to the IHP that will address treatment needs that are identified by Service Providers when the Services begin;

4. Determines needed Services;

5. Revises the effective IHP to address any changes to the Individual’s condition or needs;

6. Considers the Individual's style of interaction and communication preferences;

7. At least annually, provides the Individual with a comprehensive behavioral and medical assessment, including a functional assessment. The Individual’s assessments provided to and discussed by the IDT will form the basis for development of an IHP to address habilitative, vocational, behavioral, residential, nursing, and transportation needs;

8. Ensures the Individual has a personalized IHP based on individualized assessments that meet the Individual’s needs and abilities, and enhances the Individual’s strengths;

9. Ensures that Services identified in the IHP are provided in an individualized manner and are based on the results of assessments of the Individual's strengths, the Individual's personal goals, and the Individual's needs;

10. Ensures that progress or lack of progress toward desired goals and objectives is documented in observable, measurable, or outcome-oriented terms and that the IHP is revised as needed;

11. Provides a treatment model that will focus on the development of individualized age-appropriate goals in the areas of social functioning, living skills, and community integration for the Individual;

12. Ensures that the Individual is evaluated annually and as needed, to determine the Individual's strengths, needs, preferences, and appropriateness of the Individual’s IHP;

13. Ensures the IHP is maintained in the residence by Home Manager and copy with Case Manager; and

14. Create summary reports following completion of an assessment pursuant to Contract requirements to include date of assessment conducted, who completed the plan/assessment, date plan/assessment sent to IDT, and date reviewed by IDT. A summary report is required for the Assessments listed below.

A. Comprehensive Nursing Assessment;

B. Psychological Assessment;

C. Social Work Assessments;

D. Annual Physician Visit;

E. Transportation Plan; and F. Individual Health Plan.

The Assessments above must be completed within 30 calendar days of Contract Execution, conducted annually thereafter, or as medical needs require more frequency.

b. The following shall comprise the IDT:

1. Individual

2. Legally Authorized Representative(s)/Legal Guardian(s)

3. Case Manager

4. Social Worker

5. Behavioral Support Professional

6. Primary Registered Nurse

7. Habilitation Specialist

8. Direct Care Staff

9. Residential Manager

c. IDT Member Qualifications

1. Case Manager Qualifications

A. Bachelor’s or advanced degree from an accredited college or university with a major in a social, behavioral, or human service field including, but not limited to, psychology, social work, medicine, nursing, rehabilitation, counseling, sociology, human development, gerontology, educational psychology, education, or criminal justice; or

B. Two (2) years of paid experience providing case management to an individual with intellectual and developmental disabilities.

2. Social Worker Qualifications The Social Worker must be licensed in Texas, in good standing with the licensing board, and provides Services in accordance with Texas Occupations Code, Chapter 505.

3. Behavioral Support Professional Qualifications A. The Behavior Support Professional must either be behavior analyst certified by the

Behavior Analyst Certification Board, Inc., and licensed in accordance with Chapter 506 of the Texas Occupations Code, or

B. A psychologist licensed in accordance with Chapter 501 of the Texas Occupations Code , with experience treating individuals with intellectual and other disabilities.

4. Primary Registered Nurse Qualifications Refer to Section 2.2.3. Nursing Services, a. Primary Registered Nurse, for Qualifications and Responsibilities.

5. Habilitation Specialist Qualifications The Habilitation Specialist must have a degree in the human services field.

6. Direct Care Staff Qualifications Refer to Section 2.2.2. Residential Services, b. Direct Care Staffing, for Qualifications and Responsibilities.

7. Residential Manager Qualifications Refer to Section 2.2.2. Residential Services, b. Direct Care Staffing, for Qualifications and Responsibilities.

d. IDT Member Responsibilities

1. Case Manager Responsibilities

A. Initiates, coordinates, schedules, and facilitates IDT meetings, when needed, or at least annually;

B. Participates in IDT meetings;

C. Develops, reviews, and updates the Individual’s IHP with other IDT members in accordance with 2.2.4.a.5 of this Section;

D. Communicates to the IDT members any revisions to the IHP, and revises the IHP as necessary;

E. Maintains a copy of the Individual’s assessments, IHP, behavioral plan and any pertinent information related to the Individual;

F. Develops reports as required by the Contract;

G. Monitors the delivery of Services provided to the Individual; and https://statutes.capitol.texas.gov/docs/OC/htm/OC.506.htm https://statutes.capitol.texas.gov/Docs/OC/htm/OC.501.htm https://statutes.capitol.texas.gov/Docs/OC/htm/OC.501.htm

H. Review’s documentation monthly to determine whether the Individual is progressing toward the desired goals and objectives identified on the IHP. Goals and objectives must be observable, measurable, and outcome oriented.

2. Social Worker Responsibilities A. Assists with the development of reports; and B. Participates in the IDT meetings.

3. Behavioral Support Professional Responsibilities A. Conduct a psychological and behavioral needs assessment at least annually.

B. Develop and maintain a Behavioral Support Plan (BSP) specific to the Individual served.

C. Monitor and evaluate the effectiveness of the BSP.

D. Assist with the development of reports.

E. Provide training to Direct Care Staff, Home Manager, Staff Members, Individual, family members, or other persons involved in the Individual's care, who may have direct contact with the Individual.

F. Consult and educate the Individual, family member or other persons involved in the Individual's care regarding the implementation of the BSP, the techniques to use in assisting the Individual to control maladaptive or socially unacceptable behaviors exhibited by the Individual.

G. Maintain records of Services or training provided and make records available to HHSC upon request.

4. Registered Nurse Responsibilities Refer to Section 2.2.3. Nursing Services, a. Primary Registered Nurse, for Qualifications and Responsibilities.

5. Habilitation Specialist Responsibilities, if necessary A. Providing assistance to the Individual in acquiring, retaining, and improving self-help, socialization, and daily living skills; and B. Training the Individual on ADLs, IADLs and health-related tasks, such as:

i. Self-care;

ii. Personal hygiene;

iii. Household tasks;

iv. Mobility;

iv. Money management;

v. Community integration, including how to get around in the community;

vii. Use of adaptive equipment

viii. Personal decision making;

ix. Reduction of challenging behaviors to allow Individual to accomplish ADLs, IADLs, and health-related tasks; and

x. Self-administration of medication.

6. Direct Care Staff Responsibilities Refer to Section 2.2.2. Residential Services, b. Direct Care Staffing, for Qualifications and Responsibilities.

7. Residential Manager Responsibilities Refer to Section 2.2.2. Residential Services, b. Direct Care Staffing, for Qualifications and Responsibilities.

e. Individualized Habilitation Plan (IHP) The Contractor ensures the IHP includes specific objectives to address the outcomes identified by the IDT that:

1. Are observable, measurable, and outcome-oriented;

2. Are derived from assessments of the Individual's strengths, personal goals, and needs;

3. Has a target date for completion of each objective;

4. Identifies the frequency and duration of Services needed to complete each objective;

5. Includes a crisis prevention plan listing specific responsibilities and actions to address any medical, or psychiatric emergencies; and

6. Includes the signature and date of the Individual, LAR, and the case manager.

f. Comprehensive Nursing Assessment Assessment Requirements:

1. Conducted by an RN annually or, as medical needs require, more frequently.

2. Assessment includes:

A. Extensive evaluation of the Individual’s health status;

B. Addresses anticipated changes in the conditions of the Individual as well as emergent changes in the Individual's health status;

C. Identifies changes to previous conditions of the Individual;

D. Collects information regarding the Individual's health status;

E. Analyzes information collected about the Individual's health status to make nursing diagnoses and independent decisions regarding nursing Services provided to the F. Individual; and G. Identifies nursing interventions and evaluates the need for different interventions.

3. Comprehensive Nursing Assessment is presented by the RN at all meetings of the IDT.

g. Psychological Assessment Assessment Requirements:

1. Psychological Assessment must be conducted at least annually in addition to monitoring and evaluating the effectiveness on a monthly basis by a licensed psychologist or Board-Certified Behavior Analyst (BCBA).

2. Assess requirements for behavior management and habilitation goals.

3. Behavior Support Plan (BSP), if applicable:

A. Describes how the behavioral data is collected and monitored;

B. Allows for the decrease/increase in the use of the techniques based on the

C. behavioral data;

D. Allows for revision of the plan when desired behavior is not displayed, or the techniques are not effective;

E. Obtain written consent from the Individual or LAR to implement the BSP;

F. Provide written notification to the Individual or LAR of the right to discontinue implementation of the BSP at any time;

G. Review, at least annually in addition to monitoring and evaluating on a continuous basis, the effectiveness of the techniques and determine whether the behavior support plan needs to be continued;

H. Assist the Individual to meet as many of the Individual's needs as possible by using generic community services and resources in the same way and during the same hours as these generic services are used by the community at large; and

I. Ensure that the Individual participates in day activities appropriate to individuals of the same age and consistent with the Individual's or LAR's choice.

h. Coordination of Medical and Dental Services with HHSC

1. All assessments, plans, and supporting documentation related to service delivery or performance under the Contract must be made available to HHSC as requested.

2. Any changes to the Services delivered to the individual under the Contract must be affirmed in writing by HHSC prior to initiation of the revised Services.

3. Requests for HHSC affirmation of any revision must be submitted to the Contract

Manager via email at CAPM_Operations@hhs.texas.gov.

2.2.4 Administrative Services

a. Training

1. Contractor must ensure that staff members involved in the direct care of the Individual receive initial and periodic training on the current needs of the Individual.

2. Contractor must ensure that training records are maintained by the Residential Manager.

3. Contractor must ensure that staff members meet all qualifications prior to initiating service delivery to the Individual.

4. Specific training on the Individual’s behavior, if required, must be provided by a

Board-Certified Behavior Analyst (BCBA) or a psychologist.

b. Management of Services and Contract Requirements

1. Contractor must ensure Services provided in the home by qualified staff members are compliant with the Contract.

2. Contractor must ensure Service Providers are qualified to deliver Services as required by the Contract.

c. Records/Reports Documenting Compliance with Contract

1. Contractor must ensure that all personal information concerning the Individual, such as lists of names, addresses, and records obtained by the Contractor is kept confidential that the use or disclosure of such information and records is limited to purposes directly connected with the provision of Services, and is otherwise neither directly nor indirectly, used or disclosed to anyone other than HHSC unless the consent of the Individual or LAR is obtained beforehand; and

2. Contractor must ensure that all Service Providers document the tasks and activities provided or delivered to the Individual. Documentation of Service delivery must:

A. Identify the specific Service provided (residential, transportation, nursing, etc.);

B. Be written after the Service is provided;

C. Include the name of the individual who provided the Service;

D. Include the day, month, and year the Service was provided;

E. Include a detailed description of activities performed by the Service Provider of the

Individual;

F. Include a brief description of the location of the service delivery, such as the address or name of business;

G. Include the exact time the service event began and the exact time the service event ended, documented by the Service Provider delivering the Service;

H. Include a description of any unusual incidents that occur such as seizures or behavioral outbursts; and I. For registered nursing, include a description of the medical need for the activity performed during the service event.

3. Contractor must adopt and implement workplace policies and procedures that meet the standards set forth in Texas Health and Safety Code, Section 81.014, Long-Term Care Facility Infection Prevention and Control Program and Section 81.041, Reportable Diseases.

4. Contractor must make available or submit any record or report upon HHSC’s request and at no cost to the HHSC. Examples include, but are not limited to, the following:

A. Documentation of training completion;

B. Workplace policies and procedures;

C. Service Provider qualifications;

D. Service delivery documentation;

E. IHP;

F. Assessments; and Any documentation, as determined by HHSC, to validate that the Services being performed are reasonably necessary to provide for the direct medical needs of the Individual.

d. Communication with HHSC Point of Contact:

The Point of Contact will be the Contract Manager identified by HHSC. Contractor will notify HHSC within 24 hours of the Contractor's learning of a change in the Individual’s residence, change in Individual’s health condition, or an emergency situation resulting in https://statutes.capitol.texas.gov/Docs/HS/htm/HS.81.htm https://statutes.capitol.texas.gov/Docs/HS/htm/HS.81.htm https://statutes.capitol.texas.gov/Docs/HS/htm/HS.81.htm the Individual’s hospitalization or institutionalization, and anyemergency situation that may have a deleterious effect or impact to the Individual’s health or safety.

e. Transition of Services Contractor shall provide Services, as described in this SOW, within the following three (3) phases:

1. The Transition Phase

A. Contractor will work with the HHSC System and the current vendor to set up a transition plan in order to assist in the transfer of Services.

B. The Transition Work Plan will be required to be updated biannually and maintained by Contractor and approved by the HHSC.

2. The Operations Phase includes the Services in this SOW.

3. The Turnover Phase

Turnover begins 90 days prior to the end of the Contract Term or as requested by HHSC.

Turnover includes the administrative and operations activities performed by Contractor to transfer Services to a successor Service Provider to ensure that the State or the Individual does not experience any adverse impact during Turnover.

2.2.5 Reimbursement Methodology

a. Reimbursement of Actual Costs

The Contractor shall be entitled to reimbursement for the Actual Costs, as authorized by HHSC, of providing Services that are reasonably necessary to provide for the direct medical needs of the Individual. “Actual Costs” include, but are not limited to, direct expenses for third-party goods, materials, or Services such as nursing care, housing expenses, or other client-related expenditures approved by HHSC.

b. Cost Reimbursement

This payment method is based on an approved budget and submission of a request for reimbursement of expenses Contractor has incurred at the time of the request.

c. Administrative Fee

In addition to reimbursement for Actual Costs, the Vendor may invoice HHSC for an administrative fee equal to ten percent (10%) of the total Actual Costs incurred for providing the authorized Services. This administrative fee shall constitute the Vendor’s allowable profit and is intended to cover administrative, coordination, and management expenses associated with fulfilling the requirements of the Contract. All payments for items such as goods and supplies, leases, subscriptions, or utilities will be considered as passthrough costs and are not subject to the administrative fee.

d. Acknowledgment of Profit

Contractor acknowledges that the ten percent (10%) administrative fee represents profit and constitutes fair and reasonable compensation for administrative and operational Services provided under this Contract.

2.3 Conviction Disclosure and Removal

2.3.1 Disclosure

Contractor shall comply with all disclosure requirements contained in the Contract, including Exhibit C, Additional Provisions, Version 1.0, Section 7 in which any person associated with the Contractor who is in direct contact with the Individual served under the Contract and who has been convicted, who has received a probated sentence, who has been arrested, (for whom there exists an arrest warrant) or for whom there exists a wanted person’s notice related to any crime relevant to that person’s employment or duties must be disclosed to HHSC. For purposes of the Contract, a crime relevant to a person’s employment or duties shall be defined as any sexual offense, drug related offense, homicide, theft, assault, battery, or any other crime involving personal injury or threat to another person.

2.3.2 Removal

If any person associated with the Contractor who is in direct contact with the Individual served under the Contract has been convicted of a crime covered by Section 2.3.1 or Exhibit C, Additional Provisions, Version 1.0, Section 7, Contractor must remove that person from direct contact with the Individual served under the Contract unless otherwise agreed to by HHSC. HHSC reserves the right to request removal of any person with direct contact with the Individual at any time regardless of criminal conviction.

2.3.3 Criminal History Checks and Registry Clearances

Any person associated with the Contractor who would be placed in direct contact with the Individual served under the Contract will be subject to criminal history checks, including fingerprinting and registry clearance searches (collectively, the "checks"). The registry clearance searches include the Employee Misconduct Registry (EMR), Nurse Aide Registry (NAR), and State and Federal checks of the List of Excluded Individuals/Entities (LEIE). These checks must be performed according to the following schedule:

a. All checks must be performed prior to a Service Provider having any contact with the

Individual or performing any Services under the Contract.

b. Fingerprint criminal history record check must be conducted at least annually.

c. EMR, NAR, and both LEIE checks must be conducted at least monthly.

Documentation of the checks must be maintained and made available upon request by HHSC. The documentation must include:

a. Type of check being documented;

b. Name of the person(s) for which the check is run;

c. Date the check was performed;

d. Printed name of person conducting the check; and

e. Signature of person conducting the check.

2.4 Abuse, Neglect, and Exploitation Investigating Reporting Requirements

a. Contractor must ensure that the Individual and LAR are informed of how to report allegations of abuse, neglect, or exploitation to DFPS (the Department of Family and Protective Services) and are provided with the Texas/Abuse/Neglect Hotline toll-free telephone number (1-800-252-5400) in writing.

b. Contractor must ensure that all staff receive training on how to report allegations of abuse, neglect, or exploitation to DFPS before their first day working with the Individual and yearly thereafter.

c. Contractor must have documentation that supports completion of training.

d. Contractor must ensure that all staff are instructed to report to DFPS immediately, but not later than one (1) hour after having knowledge or suspicion, that the Individual has been or is being abused, neglected, or exploited.

e. Contractor must ensure that all staff are provided with the Texas/Abuse/Neglect Hotline toll-free telephone number (1-800-252-5400) in writing.

f. Contractor must report to DFPS any suspicion, knowledge, or allegation that any person has committed abuse, neglect, or exploitation of the Individual served under the Contract, by telephone at (1-800-252-5400). These reports must be made immediately, if possible, but not more than one (1) hour after the incident or knowledge of the incident as required by the TAC, including Title 26, Texas Administrative Code, Chapter 711, and Subchapter C, relating to Abuse, Neglect and Exploitation.

2.4.1 Reporting Abuse, Neglect, or Exploitation to HHSC

Contractor must report by telephone or email notification to the assigned Contract Manager any allegation that a person has committed abuse, neglect, or exploitation of the Individual served under the Contract. Contractor shall further notify the Contract Manager of any disciplinary action taken against any of the Contractor's employees accused of abuse, neglect, or exploitation of the Individual serviced under the Contract. HHSC reserves the right to request removal of any person with direct contact with the Individual at any time regardless of commencement or completion of any disciplinary action.

2.4.2 Ensuring the Safety and Protection of the Individual Served

If any person associated with the Contractor who is in direct contact with the Individual served under the Contract is accused of abuse, neglect, or exploitation, Contractor must remove the person from direct contact with the Individual served under the Contract until an investigation is completed. The person associated with the allegation of abuse, neglect, or exploitation may resume contact with the Individual served under the Contract if the investigation results in the person being cleared of all allegations of abuse, neglect, or exploitation.

If the Contractor suspects the Individual has been or is being abused, neglected, or exploited or is notified of an allegation of abuse, neglect, or exploitation, the Contractor must take necessary actions to secure the safety of the Individual, including:

a. Obtaining immediate and ongoing medical and/or psychological Services for the Individual as necessary;

b. Restricting access by the alleged perpetrator of the abuse, neglect, or exploitation to the

Individual pending investigation of the allegation; and

c. Notifying as soon as possible, but no later than 24 hours after the Contractor reports or is notified of an allegation, the Individual and the Individual's LAR, of the allegation report and the actions…