HHSC Open Enrollment · Web view2020-01-24 · HHSC reserves the right to amend answers prior to this Solicitation’s closing date. ... (.pdf) on separate portable media devices,

Dr. Courtney N. Phillips, Executive Commissioner

Open Enrollment for

Post-Acute Rehabilitation Services

Enrollment Number: HHS0004222

Enrollment Period Opens: 01/15/2020Enrollment Period Closes: August 31, 2024 at 5:00 PM Central Time

NIGP Class/Item Codes: 948-86 Therapy and Rehabilitation Services

952-15 Case Management952-21 Counseling Services

Addendum 2- 01/30/2020Addendum 1- 01/22/2020

Post-Acute Rehabilitation ServicesEnrollment Number: HHS0004222

TABLE OF CONTENTS

1. GENERAL INFORMATION.......................................................................................................31.1. SCOPE..........................................................................................................................................................31.2. POINT OF CONTACT....................................................................................................................................31.3. SCHEDULE OF EVENTS...............................................................................................................................41.4. TERMS AND CONDITIONS...........................................................................................................................41.5. BACKGROUND..............................................................................................................................................51.6. ELIGIBLE APPLICANTS.................................................................................................................................51.7. STRATEGIC ELEMENTS AND SPECIAL TERMS AND CONDITIONS.............................................................71.8. AMENDMENTS AND ANNOUNCEMENTS REGARDING THIS SOLICITATION................................................81.9. APPLICANT NOTIFICATIONS AND QUESTIONS............................................................................................9

2. STATEMENT OF WORK...........................................................................................................92.1. PROGRAM PURPOSE AND SERVICES..........................................................................................................9

3. APPLICATION AND CONTRACT REQUIREMENTS.........................................................103.1. APPLICANT/PROVIDER REQUIREMENTS....................................................................................................103.2. CONSUMER CHARACTERISTICS.................................................................................................................113.3. MINIMUM QUALIFICATIONS.......................................................................................................................133.4. GOAL AND PERFORMANCE MEASURES....................................................................................................14

4. UTILIZATION AND PAYMENTS...........................................................................................154.1. RATES........................................................................................................................................................154.2. PAYMENT....................................................................................................................................................174.3. INVOICING PROCESS.................................................................................................................................17

5. INFORMATION AND SUBMISSION INSTRUCTIONS.....................................................186. ELIGIBILITY DETERMINATION............................................................................................22

6.1. INITIAL COMPLIANCE SCREENING.............................................................................................................236.2. UNRESPONSIVE APPLICATIONS.................................................................................................................236.3. CORRECTIONS TO APPLICATION...............................................................................................................236.4. REVIEW AND VALIDATION OF APPLICATIONS..........................................................................................246.5. ADDITIONAL INFORMATION.......................................................................................................................246.6. METHOD OF ALLOCATION.........................................................................................................................246.7. DEBRIEFING...............................................................................................................................................246.8. PROTEST PROCEDURES............................................................................................................................25

7. GLOSSARY................................................................................................................................ 25

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1. GENERAL INFORMATION

1.1. Scope

The Health and Human Services Commission (“HHSC”) is seeking to contract with individuals or entities to provide Post-Acute Rehabilitation Services (“PARS”) for people who have a traumatic brain injury (“TBI”), traumatic spinal cord injury (“TSCI”), or both, and more fully described in Section 2. Applicants must be licensed by HHSC or the Texas Department of State Health Services (“DSHS”), as applicable, and operating as one of these facilities prior to contract execution:

1.1.1. An Assisted Living Facility; 1.1.2. A Home and Community Support Services Agency;1.1.3. A nursing facility;1.1.4. A general hospital; or 1.1.5. A specialty hospital.

In conjunction with appropriate licensing, each Applicant must have an accreditation, or obtain it within two years after contract execution, by the Commission on Accreditation of Rehabilitation Facilities (“CARF”) or Joint Commission on Accreditation of Healthcare Organizations (“JCAHO”) in accordance with the specifications contained in this Solicitation.

1.2. Point of Contact

The HHSC Point of Contact for inquiries concerning this Solicitation until completion of the initial application screening is:

Point of Contact: Brettany Boozer, Contract Specialist

Address: Health and Human Services CommissionComprehensive Rehabilitation Services

701 West 51st Street; Mail Code 3084Austin, Texas 78751

Phone: (512) 438-4364Email: [email protected] Hours: 8:00 AM to 5:00 PM CST Monday through Friday

Applicants must direct all requests, communications, and questions relating to this Solicitation to HHSC Point of Contact named above, unless specifically instructed to an alternate contact by HHSC.

An alternate contact will be provided to Applicants by email upon completion of the initial screening conducted by the Contract Specialist.

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mailto:[email protected]


1.3. Schedule of Events

All dates are tentative are subject to change at HHSC's sole discretion. Applications must be received by the HHSC Point of Contact designated in Subsection 1.2, by the enrollment closing period provided in the Schedule of Events below. Late applications will be deemed non-responsive and will not be considered.

Schedule of EventsSolicitation Period Opens September 1, 2019

Solicitation Period Closes August 31, 2024 at 5:00 PM CST

Anticipated Contract Start DateApproximately 30 days after all

screening requirements are met.

1.3.1. Adjustments to Closing Date

HHSC may, at its sole discretion and without additional notice, adjust the closing date for this entire Solicitation, a specific Region, or a specific service delivery area within a Region to meet the needs of HHSC. If an adjustment is made to the closing date specified in the Schedule of Events above, an amendment to this Solicitation will be posted.

1.3.2. Re-Opening the Solicitation

HHSC may without additional notice close or re-open the enrollment period for this entire Solicitation, a specific Region, or for a specific service delivery area within a region to meet the needs of HHSC. If it becomes necessary to close or re-open this Solicitation outside of the dates specified in the Schedule of Events above, an amendment to this Solicitation will be posted.

1.4. Terms and Conditions

The terms and conditions outlined throughout this Solicitation govern this Solicitation and any resulting Contract. Any Contract awarded under this Solicitation will include, but is not limited to, the following attachments: (1) HHSC Uniform Contract Terms and Conditions – Vendor; (2) HHSC Additional Provisions; and (3) Contract Affirmations. All Contract elements and requriements are more fully described in Section 1.7.2.

1.5. Background

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1.5.1. Overview of HHSC

Since 1991, HHSC has overseen and coordinated the planning and delivery of health and human service programs throughout Texas. HHSC is established in accordance with Texas Government Code Chapter 531 and is responsible for the oversight of all Texas Health and Human Service agencies (“HHS Agencies”).

As a result of the consolidation pursuant to the 78th Texas Legislature, Regular Session (2003), House Bill 2292, some of the contracting and procurement activities for the HHS Agencies have been assigned to the Procurement and Contracting Services (“PCS”) Division of HHSC. As such, PCS will administer the initial stages of the procurement process, including enrollment announcement and publication.

1.5.2. Project Overview

HHSC will work in collaboration with Providers to provide an array of training and support services to consumers who have a TBI and/or TSCI to function more independently in the home and community.

1.6. Eligible Applicants

To be eligible to apply for a Contract and receive an award through this Solicitation, Applicants must be qualified in all respects set forth in this Solicitation and shall:

1.6.1. Submit a completed Application (Package 2) with all required supporting documentation and forms.

1.6.2. Be an entity free to participate in state contracts and not be debarred by the Texas Comptroller of Public Accounts: http://comptroller.texas.gov/procurement/prog/vendor_performance/debarred/;

1.6.3. Be free to participate in federal contracts with the System of Award Management (“SAM”). Applicant is ineligible to apply for funds under this Solicitation if currently debarred, suspended, or otherwise excluded or ineligible for participation in Federal or State assistance programs. Search the federal excluded list at the following website: https://www.sam.gov/portal/public/SAM;

1.6.4. Be authorized as a public or private entity to do business in Texas with the Secretary of State: https://direct.sos.state.tx.us/acct/acct-login.asp;

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https://direct.sos.state.tx.us/acct/acct-login.asp

https://direct.sos.state.tx.us/acct/acct-login.asp

https://www.sam.gov/portal/public/SAM

http://comptroller.texas.gov/procurement/prog/vendor_performance/debarred/




1.6.5. Be free of exclusions with the U.S. Department of Health and Human Services, Office of Inspector General: https://exclusions.oig.hhs.gov/;

1.6.6. Be free from negative reports in the Vendor Performance Tracking System on the Centralized Master Bidders List (“CMBL”):https://mycpa.cpa.state.tx.us/tpasscmblsearch/index.jsp; and

1.6.7. Hold one of the following current and valid licenses or acceptance letters issued by HHSC or DSHS:

1.6.7.1. An Assisted Living Facility license issued by HHSC Regulatory Services Division in one of the following subsets: (1) Type A Assisted Living Facility; or (2) Type B Assisted Living Facility; or

1.6.7.2. A Home and Community Support Services Agency (“HCSSA”) license issued by HHSC Regulatory Services Division; or

1.6.7.3. A nursing facility license issued by HHSC Regulatory Services Division; or

1.6.7.4. A Hospital license issued by DSHS; or1.6.7.5. A chemical dependency treatment center license

issued by DSHS; or1.6.7.6. An acceptance letter from HHSC Regulatory Services

Division or from DSHS stating that an application for the license or license subset identified in subsections 1.6.7.1 through 1.6.7.6. under which the Applicant is applying for a contract is complete and has been accepted by HHSC or DSHS, as applicable, prior to submission of an Application under this Solicitation; or

1.6.7.7. Registration with the Executive Council of Physical Therapy and Occupational Therapy (https://www.ptot.texas.gov/page/home).

1.6.8. The license or acceptance letter, as applicable, must be valid. For the license or letter to be valid, it must be current and not have been withdrawn or denied. The license or acceptance letter, as applicable, must remain valid during this Solicitation’s Application review process and throughout the entire term of any resulting contract, including all periods of renewal, if any.

1.7. Strategic Elements and Special Terms and Conditions

1.7.1. Contract Type and Term

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https://www.ptot.texas.gov/page/home

https://www.ptot.texas.gov/page/home

https://mycpa.cpa.state.tx.us/tpasscmblsearch/index.jsp

https://mycpa.cpa.state.tx.us/tpasscmblsearch/index.jsp

https://exclusions.oig.hhs.gov/

https://exclusions.oig.hhs.gov/


HHSC will award one or more Contracts for Post-Acute Rehabilitation Services as described in Section 2. The initial resulting Contract term will be for one or two years, unless renewed, extended, or terminated pursuant to the terms and conditions of the Contract. HHSC reserves the option to amend the term of the resulting Contract for a period or periods of time no greater than a cumulative total of five years, which five-year period includes the original contract term.

At the sole option of HHSC, any resulting Contract may also be extended beyond all exercised renewal periods as necessary to complete the mission of this Solicitation, ensure continuity of service, or as otherwise determined by HHSC to serve the best interest of the state.

1.7.2. Contract Elements

The term “Contract” means any contract awarded as a result of this Solicitation and all attachments, amendments, or addenda to the Contract. All Applicants shall carefully review the draft Contract and all contract attachments, which is attached and incopraoted into this Solication as Package 8. Applicant must expressly state in its Application all terms and conditions of the draft Contract (including any contract attachments) that Applicant would request to be changed before Applicant will sign the Contract. However, Applicant must be willing to accept the draft Contract without change or modification or, if Applicant will require changes, Respondent must provide all draft language it proposes for each change requested. In addition to proposed edits, Applicant must provide a reasonable and articulable explanation of why the Applicant requests each change. Redlining draft Contract or its attachments or providing a statement with the intent or an implication that the Contract will require further discussion is insufficient.

Any term, condition, or other part of Applicant’s Application that has been rejected by HHSC, that is not accepted in writing by HHSC, or that conflicts with applicable law, the Contract, this Solicitation, exhibits to this Solicitation, attachments to the Contract, or applicable terms and conditions will not constitute part of the Contract.

1.7.3. Insurance

Unless otherwise specified in this Contract, Applicant will acquire and maintain, prior to contract execution and for the duration of this Contract, insurance coverage necessary to ensure proper fulfillment of this Contract and potential liabilities thereunder with financially sound and reputable insurers licensed by the Texas Department of Insurance. All required insurance coverage must be issued from a company or

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companies that have both: (1) a Financial Strength Rating of “A” or better from A.M. Best Company, Inc.; and (2) a Financial Size Category Class of “VII” or better from A.M. Best Company, Inc. Upon request by HHSC, Provider will provide evidence of insurance as required under this Contract, including a schedule of coverage or underwriter’s schedules establishing to the satisfaction of HHSC the nature and extent of coverage granted by each such policy. In the event that any policy is determined by HHSC to be deficient to comply with the terms of this Contract, Provider will secure such additional policies or coverage as HHSC may request or that are required by law or regulation. If coverage expires during the term of this Contract, Provider must produce renewal certificates for each type of coverage.

These and all other insurance requirements under the Contract apply to both Provider and its subcontractors, if any. Provider is responsible for ensuring its subcontractors’ compliance with all requirements. All insurance policies must:

(1) be written on a primary and non-contributory basis with any other insurance coverages the Applicant currently has in place; and

(2) include a waiver of subrogation. Applicant must ensure that all insurance policies and certificates of insurance for required coverage are written to include all services and locations related to Applicant’s performance under the Contract.

All certificates of insurance for required coverage other than workers compensation and professional liability must name the state of Texas and its officers, directors, and employees as additional insureds.

1.8. Amendments and Announcements Regarding this Solicitation

HHSC will post all official communication regarding this Solicitation on the HHS Solicitation Opportunities web page that can currently be accessed at: https://apps.hhs.texas.gov/pcs/openenrollment.cfm .

HHSC reserves the right to revise this Solicitation at any time. It is the responsibility of each Applicant to comply with any changes, amendments, or clarifications posted to the HHS Solicitation Opportunities web page. Applicant must check the HHS Solicitation Opportunities web page frequently for changes and notices of matters affecting this Solicitation.An Applicant’s failure to check the HHS Solicitation Opportunities web page will in no way release the Applicant from the requirements of any revisions, addenda, or additional information.

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https://apps.hhs.texas.gov/pcs/openenrollment.cfm


All questions and comments regarding this Solicitation should be sent to the HHSC Point of Contact designated in Subsection 1.2. Questions must reference the appropriate Solicitation page and section numbers. HHSC will post answers to questions to the HHS Solicitation Opportunities web page as deemed appropriate at the sole discretion of HHSC. HHSC reserves the right to amend answers prior to this Solicitation’s closing date.

Applicants should notify HHSC Point of Contact, designated in Subsection 1.2 of this Solicitation, in writing of any ambiguity, conflict, discrepancy, exclusionary specification, omission, or error in this Solicitation prior to submitting an Application. If an Applicant fails to timely notify HHSC of such issues, Applicant submits its Application at its own risk and, if awarded a contract, Applicant: (1) shall have waived any claim of error or ambiguity in this Solicitation or resulting contract, (2) shall not contest HHSC’s interpretation of such provision(s), and (3) shall not be entitled to additional compensation, relief, or time by reason of, or later correction of, the ambiguity, conflict, discrepancy, exclusionary specification, omission, or error.

1.9. Applicant Notifications and Questions

Any notification or questions by the Applicant regarding this Solicitation must be submitted in writing to the HHSC Point of Contact designated in Subsection 1.2 of this Solicitation, unless otherwise specified. At all times, Applicant will maintain and monitor at least one active email address for the receipt of Application-related communications from HHSC. It is the Applicant’s responsibility to monitor this email address for Application-related information.

2. STATEMENT OF WORK

2.1. Program Purpose and Services

The purpose of HHSC’s Comprehensive Rehabilitation Services (“CRS”) program is to help eligible consumers who have a TBI and/or TSCI improve their ability to function independently in the home and the community. The program focuses to improve self-care, communication, and mobility.

CRS is authorized to offer PARS for Residential and Non-Residential and Outpatient Therapy Services. To be eligible to receive these services the consumer must have either a TBI or a TSCI. The services are provided through an interdisciplinary team approach.

For residential services, the consumer must have a TBI or have a TBI with a TSCI, and for a non-residential setting, the consumer may have a TBI or TSCI. Services that are provided are based on an assessment of the individual’s deficits with the goal of achieving independence in the home

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and community and/or establish new patterns of cognitive activity or compensatory mechanisms.

Outpatient therapy services are to be utilized as a continuum of services and does not include residential or non-residnetial base services. Outpatient therapy services include, but are not limited to, occupational therapy, physical therapy, speech therapy, mental health counseling, and substance abuse services. Outpatient therapy services are provided on a one-on-one basis by licensed therapists to participants who have a traumatic brain injury, a traumatic spinal cord injury, or both. A physician must prescribe outpatient therapy services (as applicable), and the prescribed services are provided without admittance to a hospital.

The services are defined in the CRS Standards for Provider’s Manual that is available online and can currently be accessed at: https://hhs.texas.gov/laws-regulations/handbooks/comprehensive-rehabilitation-services-crs-standards-providers, and, unless otherwise specified, should be considered all inclusive.

For a detailed description of contractually required services under CRS PARS, see Package 8, Draft PARS Contract.

3. APPLICATION AND CONTRACT REQUIREMENTS

3.1. Applicant/Provider Requirements

Providers must:

Meet the requirements of, and provide all of the services in, an executed Post-Acute Rehabilitation Contract resulting from this Solicitation; and provide all services in accordance with the CRS Standards for Providers Mauanual which all Providerss must agree and adhere. Review the standards that are applicable to the service(s) you are interested in providing in the CRS Standards Provider Manual that is currently available online and can be accessed at: https://hhs.texas.gov/laws-regulations/handbooks/comprehensive-rehabilitation-services-crs-standards-providers.

3.2. Consumer Characteristics

Provider must be prepared to serve individuals with characteristics, including but not limited to:

3.2.1. Cognitive deficits

3.2.1.1. Attention3.2.1.2. Concentration

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https://hhs.texas.gov/laws-regulations/handbooks/comprehensive-rehabilitation-services-crs-standards-providers






3.2.1.3. Distractibility3.2.1.4. Memory3.2.1.5. Speed of Processing3.2.1.6. Confusion3.2.1.7. Perseveration3.2.1.8. Impulsiveness3.2.1.9. Language Processing3.2.1.10. Executive functions

3.2.2. Speech and Language deficits

3.2.2.1. Not understanding the spoken word (receptive aphasia)

3.2.2.2. Difficulty speaking and being understood (expressive aphasia)

3.2.2.3. Slurred speech3.2.2.4. Speaking very fast or very slow3.2.2.5. Problems reading3.2.2.6. Problems writing

3.2.3. Sensory deficits

Difficulties with interpretation of touch, temperature, movement, limb position and fine discrimination.

3.2.4. Perceptual deficits

Difficulty with the integration or patterning of sensory impressions into psychologically meaningful data.

3.2.5. Vision deficits

3.2.5.1. Partial or total loss of vision3.2.5.2. Weakness of eye muscles and double vision (diplopia)3.2.5.3. Blurred vision3.2.5.4. Problems judging distance3.2.5.5. Involuntary eye movements (nystagmus)3.2.5.6. Intolerance of light (photophobia)

3.2.6. Hearing deficits

3.2.6.1. Decrease or loss of hearing3.2.6.2. Ringing in the ears (tinnitus)3.2.6.3. Increased sensitivity to sounds

3.2.7. Smell deficits

Loss or diminished sense of smell (anosmia)Page 11 of 25


3.2.8. Taste deficits

Loss or diminished sense of taste

3.2.9. Seizures

The convulsions associated with epilepsy that can be several types and can involve disruption in consciousness, sensory perception, or motor movements.

3.2.10. Physical Changes

3.2.10.1.Physical paralysis/spasticity3.2.10.2.Chronic pain3.2.10.3.Control of bowel and bladder3.2.10.4.Sleep disorders3.2.10.5.Loss of stamina3.2.10.6.Appetite changes3.2.10.7.Regulation of body temperature3.2.10.8.Menstrual difficulties

3.2.11. Social-Emotional deficits

3.2.11.1.Dependent behaviors3.2.11.2.Emotional ability3.2.11.3.Lack of motivation3.2.11.4.Irritability3.2.11.5.Aggression3.2.11.6.Depression3.2.11.7.Disinhibition3.2.11.8.Denial / lack of awareness

3.3. Minimum Qualifications

3.3.1. Minimum Organizational Qualifications

3.3.1.1. All Applicants must:

(1) Have at least three years experience providing the rehabilitation services for which the Applicant is applying through this Solicitation (e.g., traumatic brain injury, traumatic spinal cord injury, or both); and

(2) Adhere to the Standards for Providers (see, Section 2.1 of this Solicitation).

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3.3.1.2. Each Provider must:

(1) Have an accreditation, or obtain it no later than two years after contract execution, by CARF or (JCAHO in accordance with the specifications contained in this Solicitation;

(2) Have and maintain a current and valid Certificate of Occupancy for the location at which services are to be provided; and

(3) Hold one of the following current and valid licenses or acceptance letter issued by HHSC or DSHS, or:

a. An Assisted Living Facility (“ALF”) license issued by HHSC Regulatory Services Division in one of the following subsets: (1) Type A Assisted Living Facility; or (2) Type B Assisted Living Facility; or

b. A Home and Community Support Services Agency (“HCSSA”) license issued by HHSC Regulatory Services Division; or

c. Nursing facility license issued by HHSC Regulatory Services Division; or

d. A Hospital or Specialty Hospital license by DSHS; ore. A chemical dependency treatment center license

issued by DSHS; orf. An acceptance letter from HHSC Regulatory

Services Division or from DSHS stating that an application for the license or license subset identified in Sections 3.3.1.2.(3)(a-e) under which the Applicant is applying for a contract is complete and has been accepted by HHSC or DSHS, as applicable, prior to submission of an Application under this Solicitation.

g. Non-residential post-acute facilities can be either facility or community based. All non-residential post-acute rehabilitation facilities that do business with CRS and are not licensed by HHSC as an ALF or as a nursing facility, or by DSHS as a hospital or chemical dependency center, must be:

(i) Registered with the Executive Council of Physical Therapy and Occupational Therapy (http://www.ptot.texas.gov/page/home); or

(ii) Licensed by HHSC as a home and community services agency (https://hhs.texas.gov/doing-business-hhs/provider-porta ls/long-term-care- providers/home-community-support-services-

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http://www.ptot.texas.gov/page/home


agencies- hcssa /how-become-a-licensed-hcssa- provider).

3.3.2. Minimum Personnel Qualifications

Provider’s staff, including Provider’s department directors, or equivalent positions, providing services that by law require a professional license or certification to provide services, must hold a current, valid, and applicable Texas license and/or certification in good standing to do so. Department directors or equivalent positions, are responsible for ensuring that the Provider’s staff providing services, that by law require a professional license or certification to provide services, must hold a current, valid, and applicable Texas license and/or certification in good standing and must provide copies to HHSC of said licenses and/or certifications at HHSC’s request and upon annual contract reviews.

3.4. Goal and Performance Measures

Provider performance evaluation is based on assessment of the output and outcome measures outlined below and in compliance with the terms and conditions of the Contract, as indicated by HHSC contract management and contract monitoring performed by HHSC staff. Providers of post-acute rehabilitation residential and non-residential services for traumatic brain injury must administer the MPAI-4 to all CRS consumers. For non-residential services for TSCI, providers must administer the FIM to all CRS consumers. MPAI must be completed and signed by a licensed professional.

3.4.1. Goal

The goal of the PARS program and any Contract awarded under this Solicitation is to ensure that consumers who have a TBI or TSCI, or both, receive individualized rehabilitation services to aid in attaining independence in the home and community.

3.4.2. Performance Measures

The Provider must be in compliance with all contractual obligations, including but not limited, to delineated outcome and customer satisfaction measures. In addition to the Provider’s compliance with all of its obligations and duties under the Contract resulting from this Solicitation, HHSC will evaluate the performance of the Provider on the basis of the following performance measures:

Performance MeasuresGoal of the Contract: To provide individualized rehabilitation services to eligible consumers, which aid in achieving independence

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in the home and community.Outcome #1: Consumer is discharged to a home and community setting.Outcome Performance Period: Provider performance for this outcome is determined on a case by case basis, as a consumer discharges from the facility.Outcome Indicator: Percent of consumers in the discharged to home and community settings compared to admissions.Outcome Target: 100%Purpose: To ensure consumers are provided rehabilitation services that aid in achieving independence in the home and community.Data Source: Data collection system as defined by CRS program managementMethodology: The facility must report discharge location to HHSC counselor upon discharge from the facility.

4. UTILIZATION AND PAYMENTS

4.1. Rates

An indicator of the level of need for services under PARS is basedon historical utilization data. However, no level of service is guaranteed by this Solicitation or constitutes any promise or guarantee of service utilization on the part of HHSC. The methodology to determine a per diem state-wide rate includes a base component, which covers room and board, administration, personal assistance, and facility and operations costs; a core service component, which covers core therapy services; and billed services for non-residential services. Billing guidelines for PARS must be preauthorized, billed monthly, have data supporting the service, and adhere to CRS policies.

4.1.1. Residential Rates

Regarding residential rates, the base rate will cover room and board, administration, paraprofessional services, medical (physician and nursing services), dietary/nutritional services, case management, and facility and operations costs. The evaluation per diem is based on providing an average of one evaluation each month. The tier rate for core service rate is calculated by reviewing the reimbursement for core services and determining hourly proxy rate for those core services. The hourly rate is applied to the tiered rate structure at the prescribed hourly increment for each tier. Core services include physical therapy, occupational therapy, speech therapy, neuropsychological services, neuropsychiatric services, aquatic therapy, art therapy, behavioral management, chemical dependency, cognitive rehabilitation therapy,

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family therapy, massage therapy, mental restoration, music therapy, and recreational therapy. Ancillary services will continue to be paid as fee-for-service and based on current HHSC rates.

4.1.2. Non-Residential Rates

Regarding non-residential rates, a statewide base rate will cover the coordination of services by the Interdisciplinary Team, appropriate administration, facility and operations costs. A standard facility or community base fee covers dietary and nutritional services, medical services, nursing services, and administrative/operational costs. HHSC will also pay on a fee-for-service basis for core and ancillary services that have been pre-approved by the Comprehensive Rehabilitation Services Counselor, documented in the consumer’s program plan and received by the consumer. Detailed service delivery data will be collected to evaluate the per diem state-wide rate based on data.

4.1.3. Outpatient Therapy Rates

Regarding outpatient therapy rates, HHSC will pay on a fee-for-service basis for core and ancillary services that have been pre-approved by the Comprehensive Rehabilitation Services Counselor, documented in the consumer’s detailed therapy notes and received by the consumer. Detailed service delivery data will be collected to evaluate the per diem state-wide rate based on data. Core services will be paid at the same rate as non-residenital core services but does not include the base rate. Ancillary services will be paid utilizing MAPS codes that are determined by HHSC Rate Analysis Department

4.1.4. Adopted Rates

Adopted rates for the Comprehensive Services Program are published and currently available online at https://rad.hhs.texas.gov/long-term-services-supports/comprehensive-rehabilitation-services-program-crs.

4.2. Payment

4.2.1. Method of Payment

Any Contract resulting from this Solicitation will be paid on a combination of fee-for-service and per diem reimbursement methods funded by state, or state and federal, money based on services provided. Total funding for these services is projected at $12,000,000.00 annually.

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https://rad.hhs.texas.gov/long-term-services-supports/comprehensive-rehabilitation-services-program-crs

https://rad.hhs.texas.gov/long-term-services-supports/comprehensive-rehabilitation-services-program-crs


4.2.1.1. HHSC is the payor of last resort; therefore, all comparable benefits must be exhausted prior to payment of services. HHSC will pay for services in accordance with HHSC rates for Non-Residential services and via the Tiered rate structure for Residential services.

4.2.1.2. If the Provider is providing services for a CRS consumer, then the Provider must follow the CRS Standards Provider Manual that is currently available online and can be accessed at: https://hhs.texas.gov/lawsregulations/handbooks/comprehensive-rehabilitation-services-crs-standards-providers

4.2.1.3. Provider will not be paid for services provided:

(1) If a comparable benefit is available to fund services;

(2) Without a Service Authorization from HHSC; (3) Outside the date range authorized in the Service

Authorization; or (4) Without a denial of benefits and explanation of

benefits, as applicable.

4.3. Invoicing Process

4.3.1. The Provider will submit to HHSC a total bill each month in the format prescribed by HHSC, and will accept as payment in full the Contracted unit rate. Refer to the CRS Provider Standard Manual. Providers that provide both Residential, Non-Residential, and outpatient therapy services for consumers who have a Traumatic Brain Injury are required to upload supporting billing detailed service records information by the 10 th of each month for all services provided in the previous month into a repository data base.

4.3.2. Failure to submit invoices on time may be considered a contract compliance issue and be used in evaluating whether to renew or terminate the Contract.

4.4. Utilization Review

The use of utilization and review activities ensures program fiscal integrity, addresses the state mandate requiring program funds be spent only as allowed under state laws and regulations, and ensure that services are based on medical necessity and efficacy of services provided. Consumer records are chosen for review through a random sample or if billing issues are noted by CRS field staff. Review of consumer records with services and billing occur from the point of entry into the CRS program until after the consumer ends/concludes treatment and may include prospective, concurrent, and

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https://hhs.texas.gov/laws-regulations/handbooks/comprehensive-rehabilitation-services-crs-standards-providers.

https://hhs.texas.gov/laws-regulations/handbooks/comprehensive-rehabilitation-services-crs-standards-providers.

https://hhs.texas.gov/lawsregulations/handbooks/comprehensive-rehabilitation-services-crs-standards-providers




retrospective review activities. Additionally, providers are required to participate in cost reporting and cost surveys performed by the HHSC Rate Analysis Department.

5. INFORMATION AND SUBMISSION INSTRUCTIONS

5.1. Solicitation Cancellation/Partial Award/Non-Award

At its sole discretion, HHSC may cancel this Solicitation, make partial award, or no awards.

5.2. Right to Reject Applications or Portions of Applications

At its sole discretion, HHSC may reject any and all Applications or portions thereof.

5.3. Joint Applications

HHSC will not consider joint or collaborative Applications that require it to contract with more than one Applicant.

5.4. Withdrawal of Applications

Applicants have the right to withdraw their Applications from consideration at any time prior to Contract award, by submitting a written request for withdrawal to the HHSC Point of Contact, as designated in Subsection 1.2.

5.5. Costs Incurred

Issuance of this Solicitation in no way constitutes a commitment by HHSC to award a Contract or to pay any costs incurred by an Applicant in the preparation of an Application in response to this Solicitation. HHSC is not liable for any costs incurred by an Applicant prior to issuance of, or entering into a formal agreement, Contract, or purchase order. Costs of developing Applications, preparing for or participating in oral presentations and site visits, or any other similar expenses incurred by an Applicant are entirely the responsibility of the Applicant, and will not be reimbursed in any manner by the state of Texas.

5.6. Application Submission Instructions

Applicants or interested parties are responsible to periodically check the HHS Enrollment Opportunities website for updates to this Solicitation prior to submitting an application. An Applicant's failure to periodically check HHS Enrollment Opportunities will in no way release the Applicant from “addenda or additional information” resulting in additional costs to meet the requirements of this Solicitation.

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Applications should be submitted either by email, regular mail, or delivery service. DO NOT submit an Application by more than one submittal option as referenced above.

5.7. Electronic Submission

Applicant may submit its application packet by email to the Point of Contact designated in Section 1.2.

5.8. Regular Mail Submission

Applicant must submit two electronic copies of all required documents as scanned versions (.pdf) on separate portable media devices, such as flash drives, to the address designated within Subsection 1.2

5.8.1. Regular Mail Submission

These devices and their content must be compatible with Microsoft Office. Applicants must ensure there are no encryptions on these devices that would prevent HHSC from opening the documents. The electronic Application submission must be organized as directed in Subsection 5.9 of this Solicitation. If Applicant is having difficulty providing an electronic Application submission, contact the HHSC Point of Contact identified in Subsection 1.2 for hard copy submittal accommodations.


It is the Applicant’s responsibility to appropriately mark and deliver the Application and related materials in response to this Solicitation by the Application due date.


Submission of an Application does not execute a Contract.

5.9. Organization of Application and Required Documents

Applicant must organize its scanned and signed Application packets in the order and format referenced below. Each flash drive, compact disc, e-mail, or paper submission of the Application packet must include the documents listed below. The documents must be in the appropriate order, numbered, and labeled accordingly, as follows:

Required Forms/Application Package 1: Respondent Affirmation and Solicitation Acceptance Package 2: Application and Contractor Information

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Package 3: Work Experience Package 4: Application for Texas Identification Number Package 5: Certification Regarding Debarment, Suspension, Ineligibility

and Voluntary Exclusion for Covered Contracts Package 6: Direct Deposit Authorization Package 7: Respondent Information and Disclosures Package 8: Draft CRS PARS Contract (required if requesting revisions)

Supporting Documentation Assumed Name Certificate,if applicable; LLC Articles of Formation (If

applicable); Certificate of Incorporation, if applicable; or Copy of Partnership Agreement and Signatory Assignment (If applicable).

Proof of Insurance, if Applicant already has required insurance, that meets insurance requirements in Subsection 1.7.3.

A copy of the Applicant’s current and valid: – License issued by HHSC as a:

ALF; HCSSA; Nursing facility; or

– License issued by DSHS as a: A Hospital; A chemical dependency treatment center; or

For non-residential post-acute rehabilitation facilities not licensed by HHSC as an ALF or nursing facility, or by DSHS as a hospital or chemical dependency center must submit a copy of the Applicant’s current and valid:– Registration with the Executive Council of Physical Therapy and

Occupational Therapy (http://www.ptot.texas.gov/page/home); or License issued by HHSC as a home and community services agency (https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/home-community-support-services-agencies-hcssa/how-become-a-licensed-hcssa-provider);

– A copy of the Applicant’s CARF Accreditation, as applicable;– A copy of the Applicant’s JCAHO Accreditation, as applicable;– A copy of valid, current Certificate of Occupancy;– Copies of applicable professional licenses of the director, or

equivalent position, of each department for services provided that has licensed and/or certified staff (see, Subsection 2.7.1.2 of this Solicitation) that will be providing direct services/therapies to consumers. If the director, or equivalent position, does not have an applicable professional license, submit written documentation attesting to that fact;

– All CMS 2567, HHSC 3724 deficiency reports, and Statements of Deficiencies for up to and including the two calendar years preceding the date of Application submittal; or if Applicant has no CMS 2567, HHSC 3724 deficiency reports, or Statements of Deficiencies for up to and including the two calendar years

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http://www.ptot.texas.gov/page/home


preceding the date of Application submittal, a statement from Applicant attesting to that fact;

– Narrative of Work experience, available in Form 2 of this Enrollment’s main mage, describing the organization's three years of experience working with people who have a traumatic brain injury, traumatic spinal cord injury, or both including dates of service, positions held and place of employment; and

– Investigation reports for the two calendar years preceding the date of Application submittal; or if Applicant has no investigation reports for the two calendar years preceding the date of Application submittal, a statement from Applicant attesting to that fact.

5.10.Alternate Delivery of Applications

If Applicant cannot submit their application and required documents by email, the documents may be delivered by mail, courier, or delivery service.

DO NOT submit an Application by both email and regular mail or delivery service.

5.10.1. Submit all copies of the Application to HHSC at the address provided below. All required documents must be received by HHSC by the due date and time listed in the Schedule of Events in Subsection 1.3. of this Solicitation.

Delivery OptionPhysical Address for delivery

(Operating Hours – 8:00 A.M. to 5:00 P.M. CST)Health and Human Services Commission

Attn: Brettany Boozer, Comprehensive Rehabilitation Services701 West 51st Street; Mail Code 3084

Austin, Texas 78751

5.10.2. HHSC will date and time-stamp all submissions when received. The clock in the HHSC office is the official timepiece for determining compliance with the deadlines in this Solicitation. HHSC reserves the right to reject late submissions. It is the Applicant’s responsibility to appropriately mark and deliver the Application to HHSC by the specified time and date.

5.10.3. All Applications become the property of HHSC after submission.

5.11.Requirements for Mailed or Delivered Applications

Submit one original set of all required documents and an electronic media device (flash drive or compact disc) containing the required documents. Documents and electronic media device must be placed in a sealed package

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and correctly identified with the Procurment Number of this Solicitation and in the order listed in Section 5.9. It is the Applicant’s responsibility to appropriately mark and deliver the application and related materials in response to this Enrollment.

5.11.1. Each flash drive or compact disc must be in a sealed envelope and labeled as follows:

Full Legal Name of the Organization; Organization’s point of contact; Organization’s point of contact’s job title; Organization’s point of contact’s telephone number and

Email address; HHSC procurement number of this Solicitation; and Date of submission.

6. ELIGIBILITY DETERMINATION

6.1. Initial Compliance Screening

HHSC will perform an initial screening of all Applications received. Unsigned Applications and Applications that do not include all required forms and sections are subject to rejection without further screening and application consideration.

HHSC will review Applications and assess for systemic programmatic issues, such as the severity of past deficiencies and pattern of repeated deficiencies. Decisions regarding selection of Applicants could take up to 60 days. If a Applicant’s Application for enrollment is approved by HHSC, the Applicant must initiate licensure and certification action, if applicable, with the HHSC Regulatory Services Division within 30 days of HHSC notification to the Applicant. After licensed by the HHSC Regulatory Services Division, HHSC will contact the Applicant to execute a Contract.

If no Applications are received, or if no provider Applicant meets the requirements to receive a Contract, HHSC will close this Solicitation.

6.2. Unresponsive Applications

Unless Applicant has taken action to withdraw the Application for this Solicitation, an Application will be considered unresponsive and will not be considered further when any of the following conditions occurs:

6.2.1. The Applicant fails to meet major Solicitation specifications, including:

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6.2.1.1. The Applicant fails to submit the required Application, supporting documentation, or forms.

6.2.1.2. The Applicant is not eligible under Subsection 1.6 of this Solicitation.

6.2.1.3. The Applicant does not accept the payment rate established in this Solicitation.

6.2.2. The Application is not signed.6.2.3. The Applicant’s Application is not clearly legible. Typewritten is

preferred.6.2.4. The Application is not received by the closing of the Solicitation

period provided in Subsection 1.3 of this Solicitation.

6.3. Corrections to Application

Applicants have the right to amend their Application at any time prior to the completion of HHSC’s initial screening and prior to sending the Application to HHSC for further screening (see, Subsection 6.2., Unresponsive Applications). To make corrections, Applicant must submit a written amendment to the HHSC Point of Contact, as designated in Subsection 1.2.

6.4. Review and Validation of Applications

The Applicant must provide full, accurate, and complete information as required by this Solicitation.

6.5. Additional Information

By submitting an Application, the Applicant grants HHSC the right to obtain detailed information, including but not limited to the following, from any lawful source regarding the Applicant’s, its directors’, its officers’, and its employees’:

6.5.1. Past business history, practices, and conduct;6.5.2. Prior regulatory compliance with federal and state statutes and

rules;6.5.3. Ability to supply the goods and services; and6.5.4. Ability to comply with Contract requirements.

By submitting an Application, an Applicant generally releases from liability and waives all claims against any party providing HHSC information about either the Applicant or about the accuracy or veracity of information provided in the Application. HHSC may take such information into consideration in screening or validating information in Applications or supporting documentation.

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6.6. Method of Allocation

Method of allocation is based on a per diem state-wide rate that includes a base rate and a core rate for services the Provider will provide consumers (residential or non-residential services) and the established CRS rates. The residential rate and non-residential rate will differ, as described in Section 4.Because services provided are contingent upon the CRS consumer, any successful Applicant will be awarded a Contract to provide services; however, there is no guarantee that any successful Applicant will receive any consumers for residential or non-residential services as a result of any awarded Contract.

6.7. Debriefing

Any Applicant who is not awarded a Contract may request a debriefing by submitting a written request to the HHSC Point of Contact as designated in Subsection 1.2. of this Solicitation. The debriefing provides information to the Applicant on the strengths and weaknesses of its Application.

6.8. Protest Procedures

The protest procedure for an Applicant who is not awarded a Contract to protest an award or tentative award made by any HHS agency, is allowed for competitive procurements. This Solicitationis non-competitive and cannot be protested as provided in Texas Administrative Code Title 1, Part 15, Chapter 391, Subchapter D, §391.403.

7. GLOSSARY

TERM DEFINITIONApplicant Any individual or entity that submits an Application

for enrollment pursuant to this Solicitation.Application An Application submitted by an Applicant in

response to this Solicitation.Consumer Person receiving services who has a traumatic brain

injury, traumatic spinal cord injury, or both.Expectation Applicant’s perception of satisfaction as indicated

by responses made to the items on the Applicant Satisfaction Survey Questionnaire.

Fiscal Year (state of Texas)

The period beginning September 1 and ending August 31 of each year.

Invoice A Provider’s bill or written request for payment under the contract for services performed.

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http://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=1&pt=15&ch=391&rl=403

http://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=1&pt=15&ch=391&rl=403


TERM DEFINITIONLicensed Professional

A person who has completed a prescribed program of study in a health field and who has obtained a license indicating his or her competence to practice in that field in Texas. Examples of licensed professionals include a physician, registered nurse, occupational therapist, physical therapist, licensed professional counselor, or social worker.

Post-Acute Brain Injury Services (PABI)

Services provided as recommended by an interdisciplinary team to address deficits in functional and cognitive skills based on individualized assessed needs. Services may include behavior management, the development of coping skills, and compensatory strategies. These services may be provided on a residential or non-residential basis.

Post-Acute Rehabilitation Services

Post-Acute Brain Injury services and Post-Acute Spinal Cord Injury services.

Post-Acute Spinal Cord Injury Services

Services provided as recommended by an interdisciplinary team to address deficits in functional skills based on individualized assessed needs. These services are provided in the home and in the community (non-residential settings).

Procurement The acquisition of goods or services.Provider The Applicant who is awarded Contract as a result of

this Solicitation and become a Contractor. Solicitation An Solicitation or other document requesting

submittal of an application to provide goods or services in accordance with the advertised specifications.

Specifications A description of what the purchaser requires and what an applicant must offer. The written statement or description and enumeration of particulars of goods to be purchased or services to be performed.

State The state of Texas.State Agency Agency of the state of Texas as defined in Texas

Government Code 2056.001.

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