Vocational Rehabilitation Services Manual D-200: Purchasing Goods and Services

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Introduction

This chapter describes the requirements for purchasing goods and services for the Texas Workforce Commission's (TWC) Vocational Rehabilitation (VR) customers.

For information on unique or additional purchasing requirements (such as approvals, consultations, and specific documentation), see the section relevant to the service (for example, sections on assistive technology or medical services).

This chapter, along with other chapters of the Vocational Rehabilitation Services Manual (VRSM) and the VR Standards for Providers (VR-SFP) manual, establishes statewide operating procedures for VR programs that:

  • define services and service limitations; and
  • support the highest compliance with federal and state law through:
    • best-value purchasing;
    • use of comparable benefits;
    • customer participation in the cost of services;
    • documentation in ReHabWorks (RHW) and/or the customer's paper case file;
    • informed customer choice;
    • professional and ethical obligations;
    • provider and facility qualifications; and
    • the individualized plan for employment (IPE).

All purchasing activities are subject to internal and external review, audit, and investigation at any time. As public servants who are responsible for assisting Texans and serving the Texas taxpayers, VR employees are expected to maintain the highest level of ethical conduct. Violation of these policies may result in disciplinary action up to and including dismissal and, in some cases, referral to state or federal law enforcement agencies. For more information, see the TWC Personnel Manual, 1.9 Ethics/Standards of Conduct.

The VRSM is not intended to create immovable barriers in the VR process. However, there are certain goods and services that cannot be purchased with VR funds or that require a specific level of review and approval before authorizing the purchase. For more information on restricted goods and services, see D-205: Purchasing Thresholds and Restrictions and D-206: Purchasing Restrictions. For more information about required approvals and consultations, refer to the relevant sections of the VRSM and to the Required Approvals and Consultations Table in the appendices of this manual.

When there is a clearly demonstrated vocational need that cannot be approved at the local field office, the VR counselor discusses the circumstances with the VR Supervisor, VR Manager, and/or a regional or state office program specialist. Together, they determine whether there is justification for requesting an exception to published policies and procedures. If the need is justified, then the VR counselor sends a request for an exception to his or her policies and procedures through your chain of management to state office for consideration.

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D-201: Legislative Authorization

The state and federal laws governing the purchase of goods and services for VR customers include the following:

  • Education Department General Administrative Regulations, 34 Code of Federal Regulations (CFR) Parts 76, 77, 79, 81, and 82
  • 34 CFR Part 361
  • 2 CFR Part 190, as adopted in 2 CFR Part 3485
  • 2 CFR part 200, as adopted in 2 CFR Part 3474
  • 34 Texas Administrative Code, Part I, Chapter 20, Statewide Procurement and Support Services
  • Texas Government Code, Chapter 2155

VR does not discriminate on the basis of race, color, sex, national origin, age, disability, or veteran status when purchasing goods and services for customers.

D-201-1: Policy, Procedure, and Guidance Documents

VR counselors, designated technicians, and other VR staff members who purchase goods and services for customers also must follow the policies, procedures, and guidance published in the following TWC manuals:

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D-202: VR Staff Responsibilities

All VR staff members must ensure compliance with purchasing processes.

VR Counselor

Only a VR counselor and his or her supervisor may authorize the use of VR funds to purchase a good or service. Other VR staff members who provide direct services to customers may recommend a purchase as a part of the VR team, but the VR counselor is ultimately responsible for ensuring that the service is reasonable, is appropriate, and is necessary to achieve the employment goal described in the customer's IPE.

Before the service authorization (SA) is generated, the VR counselor makes the purchase in compliance with the published policies, procedures, and guidelines, including completing all required documentation and obtaining all of the reviews or approvals that are required to authorize the purchase in RHW.

Internal Program Resource Staff

The following individuals are available to provide specialized oversight, support, and consultation for purchasing processes and procedures:

  • Designated subject matter experts
  • Dental consultants
  • In-house providers
  • Medical services coordinators
  • Medical consultants
  • Psychological consultants
  • Assistive technology specialists
  • Managers and management teams
  • Unit support technicians
  • Program specialists (unit, regional, and central office)

VR staff members who have purchasing questions that are not addressed in this chapter, elsewhere in the VRSM, or in other policy and procedure manuals, must consult with the appropriate program staff members before completing an SA.

D-202-1: Documentation Requirements

RHW is an electronic case management system. It communicates with TWC's financial system to authorize and track payments for all customer goods and services.

Purchasing documentation is kept in both RHW and in the paper case file.

All documentation that supports the purchase of a good or service must be entered into RHW and filed in the customer's paper case file by VR staff before obligating VR funds.

VR funds are obligated at the time that a SA is generated in RHW.

IPE, IPE Amendment, and Case Notes

The only goods and services that may be purchased before the customer's IPE is completed are the goods and services that are necessary to:

  • complete diagnostics;
  • support the completion of diagnostics;
  • assess eligibility; or
  • develop the IPE.

Purchases made before the IPE is completed must be documented in a service justification case note.

After the customer is determined eligible and an IPE is completed, substantial services (such as training, surgery, and vehicle modifications) may be purchased only if they are included in the customer's current IPE or in an IPE amendment in RHW.

Services that support substantial services (such as maintenance or ancillary services; for example, X-rays and lab work) can be documented in the original IPE, in an IPE amendment, or in a service justification case note.

Documentation of the service justification may also be included as part of another case note in RHW, such as in a Counseling and Guidance case note or a Joint Annual Review (JAR) case note.

When there is no clear association between a purchased service and a service identified in the IPE or IPE amendment, the VR counselor must document the association clearly in an RHW case note.

For more information about completing an IPE, JAR, or IPE amendment, refer to B-400: Individualized Plan for Employment.

For more information on creating service records and SAs in RHW, refer to the ReHabWorks User's Guide, Chapter 16: Case Service Record and Chapter 17: Case Purchase Order.

Paper Case File Documentation

All documents related to the purchasing process are legal records and must be kept in the customer's paper case file.

Purchasing-related documents include:

  • bids;
  • invoices;
  • reports;
  • printed SAs; and
  • related correspondence.

Purchasing documentation must be:

  • date-stamped on the day that it is received by the VR office; and
  • filed in the customer's paper case file.

RHW does not store copies of SAs that are revised; therefore, the following applies:

  • When the initial SA is generated, the VR staff must
    • print a paper copy of the SA,
    • have the VR counselor sign the SA, and
    • file the SA in the customer's paper case file.
  • If an SA is changed while it is still open, the VR staff
    • print a paper copy of the revised SA,
    • have the VR counselor sign the revised SA, and
    • file the revised SA in the customer's paper case file.

All printed SA's remain in the customer's casefile, even if the SA is revised.

To ensure that the provider's file accurately reflects the purchasing activities in RHW, the VR staff sends a copy of the SA to the provider:

  • when the SA is generated; and
  • when an open SA is changed.

If an SA is closed because the service is no longer authorized, VR staff members must notify the provider no later than the same business day that the SA is closed.  Document the notification of the provider in a case note in RHW.

Note: Electronic copies of closed SAs are kept in RHW. Therefore, even if an SA is changed as a result of closing the SA, printed copies of closed SA's are not required in the paper case file.

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D-203: Purchasing Decisions

All goods and services purchased with VR funds must be appropriate and necessary to support a competitive integrated employment outcome.

For additional information about documentation requirements for purchasing, refer to D-202-1: Documentation Requirements.

When authorizing the purchase of a good or service, the VR counselor considers:

  • the cost, accessibility, type, and duration of the services;
  • the customer's informed choice;
  • the customer's satisfaction with the proposed services;
  • the provider's compliance with the Americans with Disabilities Act;
  • the qualifications of the service provider;
  • the setting in which the services are provided; and
  • the provider's history of success with other customers.

Additionally, the following must also be considered for each purchase:

  • Best value
  • Use of comparable benefits
  • Required customer participation in cost of services (also referred to as BLR)
  • Separation of duties
  • Ethics and purchasing

D-203-1: Informed Customer Choice

The customer (and, as appropriate, his or her representatives) must be involved in decision making related to all aspects of the customer's VR services, including selecting the goods, services, and providers during the purchasing process.

The VR counselor must document in a case note the customer's involvement in the selection of goods, services, and providers.

D-203-2: Best Value Purchasing

Because VR uses tax revenue to pay for services, VR must purchase the least expensive services that meet the customer's vocational needs.

To accomplish this, VR staff members apply the best-value purchasing approach. The approach ensures that, when authorizing a purchase, staff members consider not only the initial cost but also the factors that influence the total cost and value to both the customer and TWC.

These factors include, but are not limited to:

  • installation costs;
  • warranties;
  • life-cycle costs;
  • quality and reliability;
  • delivery costs and terms;
  • the timeliness of the delivery;
  • the cost of training associated with a purchase; and
  • the indicators of the provider's probable performance (for example, the provider's past performance, financial resources, ability to perform, experience, responsibility, reputation, and ability to provide reliable maintenance and support).

D-203-3: Use of Comparable Services and Benefits

Comparable services and benefits, including accommodations and auxiliary aids and services, are resources that are provided or paid for, in whole or in part, by other Federal, State, or local public agencies, by health insurance, or by employee benefits. These resources must be available to VR customer at the time needed and they must be commensurate to the services that the customer would otherwise receive from the TWC-VR. (Based on 34 CFR §361.5(c)(8).)

Comparable services and benefits do not include:

  • scholarships or other awards of merit;
  • student loans;
  • personal loans; or
  • customer contributions to the cost of services.

Requirement to Use Comparable Services and Benefits

When a customer is determined eligible for VR services, 34 CFR §361.53 requires that prior providing any VR service, TWC-VR must determine whether comparable services and benefits exist under any other program and whether those services and benefits are available to the customer. When comparable services benefits are available, these resources must be used for planned services before using VR funds.

Exceptions for Use of Comparable Services and Benefits

Comparable services and benefits must be utilized unless doing so would significantly interrupt or delay:

  • the progress of the customer toward achieving the employment outcome identified in the IPE;
  • an immediate job placement; or
  • the provision of VR services to any individual who is determined to be at extreme medical risk, based on medical evidence provided by an appropriate qualified medical professional.

While all available resources should be utilized to ensure compliance with D-203-2 Best Value Purchasing, the requirement to use comparable services and benefits does not apply to the following goods and services:

  • Assessments for determining eligibility and VR needs;
  • Counseling and guidance;
  • Referral and other services to secure needed services from other agencies;
  • Job-related services, including job search and placement assistance, job retention services, follow-up services, and follow-along services; and
  • Rehabilitation technology, including telecommunications, sensory, and other technological aids and devices.

Federal Financial Aid

If the customer needs postsecondary training to reach the IPE goal, the customer must be informed that he or she is required to apply for and use, if granted, support from the Federal Financial Student Aid Program that does not include a payback requirement. When applicable, include this requirement on the IPE. Refer to C-414-6: Financial Aid for additional information.

Services and Benefits for Veterans

The US Department of Veterans Affairs has a range of benefits available to veterans of the military, naval, and air services, and to certain members of their families. Among the benefits available to service-disabled veterans and their families are several types of financial assistance, including monthly cash payments, health care, housing benefits, and educational benefits.

In addition, additional resources for veterans are:

  • Centers for Independent Living;
  • Community Services for the Blind;
  • TWC's Texas Veterans Leadership Program;
  • Texas Veterans Commission; and
  • the Hazelwood Act.

For additional information, refer to A-304: Veterans with Disabilities.

Insurance as a Comparable Benefit

VR is the payor of last resort. Comparable benefits and the customer's required participation in the cost of services must be applied before VR funds are spent.

After the customer's primary and/or secondary benefit coverage has been applied and the customer's ability to pay has been determined, if VR is paying a portion of the total owed to the provider, VR may pay an amount equal to the customer's copayment, coinsurance, or deductible due.

VR payment must not exceed the amount allowed by the customer's insurance or the allowable VR rate or the VR contract rate, whichever is less.

Documenting Use of Comparable Services and Benefits

The exploration of and use and non-use of comparable services and benefits must be thoroughly documented in the customer's case file. This includes documentation in ReHabWorks (RHW):

  • Case notes
  • Service records
  • IPE or IPE amendments
  • Closure Services page.

Copies of documents related to approval or denial of comparable benefits must be filed in the customer's paper case file.

Documenting Comparable Benefits in ReHabWorks

The following comparable benefits selections can be selected to document the use of comparable benefits when service records, IPEs, and Closure Services pages are developed in ReHabWorks:

  • Centers for Independent Living
  • Child Protective Services
  • Educational Institutions (elementary and secondary)
  • Educational Institutions (postsecondary)
  • Educational Service Center
  • Employers
  • Employment Networks (not otherwise specified)
  • Federal Student Aid (such as Pell grants, SEOP (Supplemental Educational Opportunity Grant), work study, etc.)
  • Intellectual and Developmental Disabilities Agencies
  • Lion's Club
  • Medicaid Programs
  • Medicaid Waiver
  • Medical Health Provider (public or private)
  • Medicare
  • Mental Health Provider (public or private)
  • One-Stop Employment and Training Centers
  • Other Sources
  • Other State Agencies
  • Other VR State Agencies
  • Public Housing Authority
  • Scholarship
  • Social Security Administration (Disability Determination Services or District office)
  • State Department of Correction and Juvenile Justice
  • State Employment Service Agency
  • Tuition Waiver (non-blind, non-deaf)
  • Tuition Waiver Blind
  • Tuition Waiver Deaf
  • Veteran's Administration
  • Waiver Programs—MDCP In-Home, CLASS & Family Support Class
  • Welfare Agency (state or local government)
  • Worker's Compensation

D-203-4: Customer Participation in the Cost of Services

A customer's eligibility for VR services does not depend on the customer's income or liquid assets; however, if the customer's net income or liquid assets exceed the basic living requirements (BLR), the customer must participate in the cost of services.

The monthly net income and liquid assets levels that are used to calculate the customer's required contribution to the cost of services are available on the Basic Living Requirements (BLR) page.

Exception

A customer whose net income or liquid assets exceed the BLR is not required to help pay for services, if:

  • the customer is eligible for Social Security disability benefits—that is, Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI); or
  • the VR Manager grants an exception because the customer's participation would prevent the customer from receiving a necessary service.

The VR counselor must inform the customer that failure to provide complete and accurate financial information:

  • violates federal and Texas law; and
  • may result in a denial or delay of services that are not exempt from customer contribution requirements.

Determining the Customer's Requirement and Ability to Participate

To determine whether a customer must participate in the cost of services and his or her financial ability to do so, the VR counselor uses the following four-step procedure.

  1. Determine whether the customer is required to participate in the cost of services

    When determining whether the customer is required to participate in the cost of services, VR staff:

    • considers the monthly net income and liquid assets of the customer;
    • considers the monthly net income and liquid assets of the customer's spouse (if applicable); and
    • considers the monthly net income and liquid assets of the parent (or foster parent, legal guardian, or conservator), if the customer's parent claims the customer as a dependent for purposes of federal income taxes; and
    • compares the total monthly net income and liquid assets BLR levels.

    NOTE: When completing the Monthly Financial Information screen in RHW, the customer's net income must be entered in the Economic Resources section to get an accurate BLR calculation. 

  2. Obtain documented proof of the all income and expenses.

    When an individual applies for services, the VR counselor requests documented proof of all:

    • income (excluding any payment in-kind, such as food stamps or housing subsidies);
    • liquid assets (cash plus assets that are easily converted to cash);
    • expenses; and/or
    • any allowable additions to the BLR.

    A customer who is eligible for Social Security disability benefits (SSI or SSDI) provides only proof of Social Security eligibility. The law exempts recipients of Social Security disability benefits from the requirement to participate in the cost of VR services regardless of income, so no additional proof of income or expenses is required.

  3. Calculate the customer's contribution.

    When the customer's liquid assets exceed the BLR level after including any allowable BLR additions, the customer must contribute an amount equal to the excess toward the cost of goods and services.

    For each month in which VR pays for goods and/or services, the customer must contribute the difference between the customer's monthly net income and the BLR level after including any allowable BLR additions.

    The customer's contribution must not exceed the cost of the good and/or service.

  4. Review, periodically, the customer's proof of income and expenses.

    At least annually, the VR counselor:

    • reviews the customer's income, liquid assets, and expenses; and
    • documents the review results in a RHW case note.

If the customer's income, liquid assets, or expenses change significantly during the life of the case, the VR staff

  • reassesses whether the customer must participate in the cost of services;
  • documents proof of the changes (and, if documentation is not available, notes the reason in a case note);
  • updates the financial information in RHW; and
  • documents the reason for the change in the comment section of the financial information page at the time of the update (this will create a case note in RHW when the changes to the page are saved).

If the customer's IPE is developed before proof of income and expenses is received, the VR counselor does not include services that require the customer's participation in the cost (see list of service exempt from customer participate below).

When proof of income and expenses are received, the VR counselor amends the IPE as needed.

Types of Income, Liquid Assets, and Required Proof

The table below lists the types of income and corresponding proof required of the customer, spouse, and parent (if the customer is claimed as a dependent).

Income

Proof Required

Net wages and net income from other enterprises

Requires:

  • a check stub;
  • a bank statement; or
  • an earnings statement.

Social Security disability benefits (SSI or SSDI) received by the customer for their disability

No proof is required for the actual income amount of the customer's SSI or SSDI checks; however, proof of eligibility for SSI or SSDI benefits must be in the customer's casefile.

All other Social Security benefits (for example, survivor or retirement benefits received by the customer or the customer's spouse or parents, Social Security disability received by the customer's spouse or parents, and so on)

Requires:

  • an award letter;
  • a check stub;
  • an income tax return; or
  • a bank statement.

The following income received by the customer:

  • Public support payments
  • VA income benefits
  • Unemployment compensation income
  • Workers' Compensation income
  • Private disability insurance
  • Annuities

Requires:

  • an award letter;
  • a check stub;
  • an income tax return; or
  • a bank statement.

Child support payments received by the customer

Requires:

  • an award letter;
  • a check stub;
  • an income tax return;
  • a court order; or
  • a bank statement.

 

Liquid Assets

Proof Required

Cash and assets from savings or other accounts.

Account statements

Refusal to Provide Financial Information

Customers have the right not to disclose their financial information. However, when a customer declines to provide the information, VR assumes that the customer has resources that exceed the BLR level, after including any allowable BLR additions. In such a case, the customer must fully participate in the cost of planned services, except in the case of the services listed in "Services Exempt from the Customer's Cost Participation" below.

Calculating Customer Participation

The customer's required contribution to the cost of services is referred to as the Basic Living Requirements (BLR).

RHW is designed to automatically calculate a customer's participation based on:

  • 200 percent of the United States Health and Human Services Poverty Guidelines; and
  • the customer's income, family status, and economic need, as entered in RHW.

See the U.S. Department of Health and Human Services Poverty Guidelines for the current fiscal year and see VR's BLR tables; these tables are available to the public upon request.

RHW determines the amount that a customer must contribute to the cost of services, based on the customer's net monthly income and family size as related to the poverty guidelines for the current fiscal year.

The amount is calculated as monthly but is applied only in the months that a service or good is provided that requires participation in cost of services.

Allowable Additions to BLR

The total monthly costs of the allowable additions below are automatically added to the BLR when entered in RHW.

Allowable Additions

Proof Required

Monthly home mortgage or rental payments

Required:

  • statement;
  • canceled check;
  • money order stub;
  • contract; and
  • lease.

Prescribed diet and medicines used by the customer

Required:

  • itemized receipts; or
  • canceled checks.

Debts imposed by court order

Court record

Medical costs and disability-related expenses of the customer

Based on 34 CFR §361.54(b)(2)

Required:

  • itemized statements; or
  • canceled checks.

Payments

When feasible, a customer who is participating in the cost of goods and/or services pays the service provider directly.

When direct payment is not feasible, the VR counselor arranges for the customer to refund VR by check or money order.

The VR counselor or RA:

  • documents the receipt of the check or money order in a case note in RHW;
  • draft a memo that includes the customer's identifying information, including case i.d. and specific details that explain the purpose of the funds and the date received in the field office and mailed to TWC Revenue and Trust Management;
  • make a paper copy of the check or money order and the memo;
  • file copies in the customer's paper casefile; and
  • mail the original check or money order and the memo to:

    Texas Workforce Commission
    Revenue & Trust Management
    PO Box 149261
    Austin, TX 78714

For questions, contact TWC Revenue and Trust Management Depository section at (512) 463-2611.

In-kind payments

The customer may pay "in kind" for certain services listed on the IPE; for example, paying for transportation to receive services, or paying for uniforms, textbooks, and the like.

Services Exempt from the Customer's Cost Participation

The VR counselor reviews with the customer the customer's agreement to pay for the cost of services.

Services exempt from the customer's cost participation include the costs for:

  • the assessment for determining the customer's eligibility;
  • the assessment for determining the customer's VR needs, including associated maintenance and transportation;
  • VR counseling and guidance and referral for other services;
  • in-house services provided directly by VR staff;
  • job-related services, including job search and placement assistance, job retention services, follow-up services, and follow-along services;
  • personal attendant services;
  • any auxiliary aid or service (for example, interpreter services) that a customer with a disability requires to participate in the VR program; and
  • Preemployment Transition Services (PreETS).

This policy must be applied uniformly to all customers in similar circumstances.

SSI and/or SSDI Recipients

Customers eligible for SSI or SSDI because of a disability are exempt from the cost participation requirement. Limitations on payments (for example, on payment of tuition and fees) are also not applied; however, VR policy on the use of best value and comparable services and benefits must be followed for all VR customers.

Potentially Eligible Customers

BLR does not apply to services that are provided directly to potentially eligible VR customers; however, policy on the use of best value and comparable services and benefits must be followed for all VR customers.

Students or Youth with Disabilities

The BLR does not apply to:

  • the cost of training for students or youth with disabilities; or
  • the cost of parents or legal guardians to participate in the training with the student to further the student's vocational adjustment or vocational rehabilitation.

The BLR is applied for:

  • incidental expenses and transportation costs for the student to participate in the services; and
  • transportation costs for family members, unless a parent or representative is required to participate in the activity for the student to attend.

VR policy on the use of best value and comparable services and benefits must be followed for all VR customers.

D-203-5: Separation of Duties

To minimize conflict of interest, RHW is designed so that the same VR staff member may not authorize payment for an SA that the staff member created or made changes to at any point in the purchasing process.

At least two staff members must complete each purchase—that is, issue, receive, and authorize payment—to ensure that integrity is maintained throughout the purchasing process.

For additional information about processing an SA in RHW, see the ReHabWorks User's Guide, Chapter 17: Case Purchase Order, 17.4 New PO.

D-203-6: Ethics of Purchasing

As stewards of VR funds, VR staff members have a personal and professional responsibility to maintain a high level of ethical standard when purchasing goods and services for VR customers. VR staff members are expected to follow all purchasing policies and procedures published in the VRSM and the VR-SFP.

Purchasing ethics for state government are also governed by the Texas Ethics Commission, which interprets laws governing the conduct of state officers and employees.

The following state laws apply:

  • Texas Government Code, Chapters 305 and 572
  • Texas Penal Code, Chapters 36 and 39

State Ethics Policy

In addition to the content below, VR staff members must also comply with the TWC Personnel Manual, 1.9 Ethics/Standards of Conduct (PDF) and TWC's Ethics policy (PDF).

"State law mandates that no State Officer or employee shall have a direct or indirect interest in, or engage in, any business transaction or professional activity, or incur any obligation that conflicts with the proper discharge of that individual's duties for the state.

Further, a state employee shall not:

  1. accept or solicit any gift, favor, or service deemed to be of personal benefit or value that might reasonably tend to influence the performance of official duties or that the employee knows, or should know, is being offered to intentionally influence the employee's official conduct;
  2. accept employment or engage in any business or professional activity that the employee might reasonably expect would require the employee to disclose confidential information that is obtained through the employee's official position, including information that is excepted from public disclosure by law or TWC rule under the Texas Public Information Act, or information that has been ordered sealed by a court;
  3. accept other employment, including self-employment, or compensation or engage in a business activity that could reasonably be expected to impair the employee's independence of judgment in performing official duties;
  4. make personal investments that could reasonably be expected to create a substantial conflict between the employee's private interest and the public interest; or
  5. intentionally or knowingly solicit, accept, or agree to accept any benefit for having exercised official powers or performed official duties as a favor."

Ethical Violations

"Agency employees who violate provisions of the ethics policy are subject to disciplinary action, up to and including dismissal from employment. Further, any employee who violates the ethics policy is subject to any applicable civil or criminal penalty if the violation also constitutes a violation of another statute or rule."

Bribery

Texas Penal Code §36.02

"A. The Texas Penal Code states that a state employee commits an offense if that employee knowingly or intentionally offers, gives, or agrees to give to another person any benefit as a consideration for the employee's decision, opinion, recommendation, vote or other exercise of discretion as the employee or any benefit as consideration for a violation of a duty imposed by law on the employee.

B. Under the Texas Penal Code, any TWC employee who exercises any discretion as to TWC contracts is forbidden from accepting any benefit from any person interested in any TWC contract or from any person who is likely to become interested in any TWC contract in which the employee exercises discretion. Such behavior is a criminal offense under the Texas Penal Code."

Gifts, Favors, or Services

Texas Penal Code §36.07 and §36.08

"TWC employee shall not accept or agree to accept, directly or indirectly, any favor, gift, loan, free service, or other item deemed to be of personal benefit or value in any form from any person or organization outside of TWC if it is intended, or would appear, to reward or influence the employee's official actions. This simply means that you should never accept anything if it might make you do your job differently, if you think the person giving it to you has the hope you will do your job differently, or if it might appear to others that you have done your job differently."

Appearance of Impropriety

In addition to following purchasing policies and procedures, VR staff members must also avoid the appearance of impropriety when they are representing TWC-VR.

VR staff members must consult with their VR Supervisor or VR Manager, as needed, when they have questions or concerns about purchasing-related ethics.

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D-204: The Purchasing Process

D-204-1: Steps in the Purchasing Process

VR staff completes the following steps.

Step 1

Identifies the good or service needed.

Researches the good or service.

Collects the required approval (as identified in the appropriate program manual).  

Step 2

Documents the need for and type of purchase in:

  • a service justification case note;
  • an IPE; or
  • an IPE amendment.

Step 3

Creates a service record. For more information, see the ReHabWorks User's Guide, Chapter 16: Case Service Record.

Completes the specification on the service record to identify the precise good or service and obtains and documents the required consultations and or approvals, according to policy.

Edits the level-four specification descriptions to match the good or service to be purchased. All specifications can be customized—except MAPS specifications.

Note: Staff must use the correct specification for the good or service being authorized. For questions about specification levels for specific services, VR staff can email vr.rhw.datamaintenance@twc.state.tx.us

Step 4

Creates an SA to obligate the budget. For more information, see the ReHabWorks User's Guide, Chapter 17: Case Purchase Order.

If the customer is eligible, uses the Pre-Employment Transition Services budget. For more information, refer to C-1300: Transition Services for Students and Youth with Disabilities.

Step 5

Prints the SA. (The printed SA must be signed by the issuer).

Sends the SA to the vendor by mail, fax, or encrypted email. Depending on the manner in which the SA is sent to the vendor, the VR staff member files the original, signed SA, or a copy of it, in the customer's case folder.

If the SA is revised, VR staff:

  • completes these steps again;
  • sends the new or updated SA to the vendor; and
  • files the SA in the paper case file.

For more information about revising an SA, see D-204-2: After-the-Fact Purchases.

For more information about requirements for maintaining printed copies of SA's in the paper casefile, see D-202-1: Documentation Requirements.

Step 6

If it becomes apparent that the total committed budget will not be used, VR staff reduces the quantity and/or unit cost in the SA.

For information about closing an SA, refer to the ReHabWorks User's Guide, Chapter 17: Case Purchase Order, 17.10 PO Change.

For more information about requirements for maintaining printed copies of SAs in the paper casefile, see D-202-1: Documentation Requirements.

Step 7

Receives and documents the receipt of goods and services. Verifies that goods and/or services were delivered in good condition and met the specifications.

Step 8

Processes the invoice within seven calendar days.

D-204-2: After-the-Fact Purchases

The purchase of goods and services must be authorized with an SA in RHW before the good or service is ordered or received. However, when a delay of services may have endangered a customer's well-being, the VR counselor may authorize an after-the-fact hospital or medical service service authorization. See C-701-4: Necessary, Unplanned Medical Services for additional information details.

All after-the-fact service authorizations must be reviewed and approved by the VR Supervisor, if issued by local office, or VR regional management, if issued by regional Medical Services Coordinator.

D-204-3: After-the-Fact Ancillary Service Authorizations

An after-the-fact ancillary SA is one that is issued after a service has been provided.

All after-the-fact service ancillary authorizations must be reviewed and approved by the VR Supervisor, if issued by local office, or regional Program Support Manager, if issued by regional Medical Services Coordinator (MSC) or Medical Services Technician (MST).

After-the-Fact Ancillary SAs are issued:

  • when a service is unanticipated, arising from services previously authorized;
  • because of complications from services previously authorized; or
  • because additional services are needed to directly support an existing SA.

Keep after-the-fact ancillary SAs to an absolute minimum.

Before generating an after-the-fact ancillary SA, the VR staff must:

  • justify the SA in a case note;
  • include in the case note the SA number of the original SA; and
  • include in the comments section of the after-the-fact ancillary SA the SA number of the original SA.

After the start date of an existing SA, it may be necessary to:

  • document unanticipated ancillary services (for example, pathology, radiology, and consultations);
  • document the change in the Comments section of the original SA, provided a change in services is not significant; or
  • replace the existing SA with a new one when the change is significant (for example, when the specification or the provider has changed).

For more information about revising an SA, see the ReHabWorks User's Guide, Chapter 17: Case Purchase Order, 17.10 PO Change.

For more information about requirements for maintaining printed copies of SAs in the paper casefile, see D-202-1: Documentation Requirements.

D-204-4: Replacement Service Authorizations

The specifications in an SA may change after the delivery of services.

If a change is needed to services that are delivered by the same vendor (for example, if a change is needed to the MAPS codes), and approval by the VR Manager or state medical director was required on the initial SA, the staff member does as follows before issuing a replacement SA:

  1. Obtains approval from the VR Manager or state medical director, as required on the backdated replacement service authorization.
  2. Places documentation of the approval in the paper case file before the replacement SA is issued.

If approval was not required for the original SA or the new SA, then no additional approval is required.

D-204-5: No-Show Payments

A no-show occurs when a VR customer:

  • misses an appointment for a VR-sponsored service provided by a psychiatrist, social worker, licensed professional counselor, or psychologist; and
  • does not properly cancel the appointment in accordance with the provider's policy.

VR accepts no-show billings for consideration only from the following:

  • Psychiatrists
  • Social workers
  • Licensed professional counselors
  • Psychologists

The service provider must notify the VR counselor within one working day of the customer's failure to appear.

The acceptable fee for a no-show is limited to 50% of the payment allowed by MAPS for the codes authorized on the SA.

No-show billings from other disciplines, specialties, and contractors are not eligible for payments.

Exception for Interpreter Services Under Contract

Interpreters that have a contract with TWC to provide interpreter services can be paid for no-shows at 50% of the allowable payment rate according to the conditions of their contract. However, if a scheduled interpreter does not have a contract with TWC to provide interpreter services, they cannot be paid for no-shows.

Processing a No-Show Payment in RHW

A no-show specification is different from the specification for the service that would have been provided; therefore, the VR staff member either:

  1. closes the SA, so that a new one can be created; or
  2. adds a line item to the SA.

VR staff members:

  1. create a service record;
  2. select No Show for the specification; and
  3. enter the correct Begin Date and End Date (even though both dates occurred in the past).

Once the SA includes a line item for the no-show payment, the VR staff member processes the payment in the same manner as any other payment to a provider.

For more information about creating a service record or adding a line item to an existing SA, refer to the ReHabWorks User's Guide, Chapter 16: Case Service Record.

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D-205: Purchasing Thresholds and Restrictions

Purchasing thresholds are established to ensure that management oversees high-cost and high-risk purchases. VR counselors must review associated chapters in the VRSM and SFP in addition to reviewing the table published below in D-205-1: Purchasing Thresholds—Approval and Bid Requirements prior to authorizing the purchase of any good or service.

If the product or service is not under contract or is not a MAPS purchase and the cost is less than $5,000, the purchase must be completed as a spot purchase; that is, using a commercial source, under noncompetitive purchasing procedures.

Purchasing thresholds and restrictions apply to all VR purchases.

D-205-1: Purchasing Thresholds—Approval and Bid Requirements

The approval and type of bid needed for each purchasing threshold is shown in the table below.

For all purchases over $2,000, a case review must be completed in TxROCS and noted in RHW by the administrative supervisor or purchasing specialist prior to the purchase.

Purchase costs, per item

Approval required from…

Competitive bid required

$2,000 or less

VR counselor approval.

No

Greater than $2,000, but less than or equal to $5,000

Case review by the administrative supervisor or purchasing specialist required.

VR counselor approval.

No

Greater than $5,000 to $15,000

Case review by the administrative supervisor or purchasing specialist required.

VR counselor and VR Manager approval.

Required for goods or services greater than $5,000, if the purchase is:

  • not a contracted item;
  • not purchased using MAPS; and/or
  • not for tuition.

Greater than $15,000 to $25,000

Case review by the administrative supervisor or purchasing specialist required.

VR counselor, VR Manager, and Regional director or deputy regional director approval.

Required, if the purchase is:

  • not a contracted item;
  • not purchased using MAPS; and/or
  • not for tuition.

Greater than $25,000

Case review by the administrative supervisor or purchasing specialist required.

VR counselor, VR Manager, Regional director or deputy regional director, and VR Division Director.

Required, if the purchase is:

  • not a contracted item;
  • not purchased using MAPS; and/or
  • not for tuition.

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D-206: Purchasing Restrictions

*VR does not pay for or purchase the following for customer use:

  • Bonding fees
  • Buildings or other structures that require a fixed foundation and/or that are not movable
  • Criminal or civil fines or penalties, including traffic tickets
  • Fees for registration of inventions, patents, trademarks, or copyrights
  • Fees for use of a franchise name
  • Firearms of any kind or components of a firearm
  • Insurance
  • Land
  • Operating capital (for example, for self-employment)
  • State or municipal tax assessments on occupations
  • Vehicles to be used on public roads or highways that have not or will not be modified for accessibility and require a certificate of title or registration to be used on roads. Check with the Department of Public Safety (DPS) for more information.
  • Trailers, boats, or other items that require a certificate of title or registration to be used on public roads, highways, or waterways. (Check with DPS for more information and specific regulations. For example, many small trailers do not require a title of ownership.)

*Exceptions are not allowed to this policy.

D-206-1: Paying Professional Dues

VR does not pay dues to a professional association or trade union, unless the purchase is justified as critical to the success of the customer's employment.

If the VR counselor believes that payment of professional dues is critical to the success of the customer's employment, the VR counselor must enter a case note in RHW that explains the justification for the decision.

Once the case note is entered by the VR counselor, the VR counselor submits the case for review and approval by the regional director or deputy regional director through the VR counselor's management.

The regional director (RD) or deputy regional director (DRD) ensures that VR remains in compliance with the restriction that precludes state agencies from paying VR funds to organizations that financially support a lobbyist.

D-206-2: Payee Restrictions

*To prevent a conflict of interest, VR must not purchase goods or services for the customer from a provider who is serving as the customer's representative.

Goods and services may be purchased from a provider who is serving as the customer's representative only:

  • before the customer designates the provider as his or her representative; or
  • after the customer has revoked the provider's authority to act as his or her representative.

*Exceptions are not allowed to this policy.

D-206-3: Out-of-State Purchases

The following restrictions and approval requirements apply purchase of:

  • Out-of-state tuition rates at any college or university requires VR Manager and regional director.
  • Out-of-state services that are ordinarily regulated in Texas, but are not regulated in the state where the services are provided, require the approval of the VR Manager and regional director.
  • MAPS service from an out-of-state provider requires review and consultation by the state office program specialist for MAPS Provider Services to ensure that the provider is properly credentialed.
  • Services that are purchased under contract in Texas, such as employment services, contracted medical goods and services, or rehab technology services that are being purchased from an out-of-state provider require consultation with the state office program specialist and VR Manager approval.

If customer chooses to to attend an out-of-state training program that is readily available in Texas, see C-415-17: Tuition and Fees for additional documentation and approval requirements.

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D-207: Ordering Goods or Services for Customers

Goods and services must be authorized with an SA before obtaining a good or service. The issue date of the SA must be dated on or before the start date.

D-207-1: Free-on-Board (FOB) Destination

When issuing an SA for goods that will be shipped to the VR office or directly to the customer, include "FOB destination" on the SA as a condition of the purchase.

If the provider does not ship FOB destination, the VR counselor locates another vendor, if possible.

FOB means that VR does not own the goods until they arrive and are accepted at the destination identified on the SA. The risk of loss to goods does not pass to VR until the goods are delivered and the shipment is accepted. When goods are damaged in transit or are not accepted or received, the provider ships new or replacement goods without additional expense to VR.

D-207-2: Verifying Receipt of Goods and Services

An essential part of the purchasing process is to confirm that:

  • the goods were delivered in good condition and met the specifications; or
  • the services were completed according to the specifications.

D-207-3: Accepting a Delivery of Goods

When customer purchases are delivered to a VR office, the deliveries are processed in the same way that other administrative deliveries are processed.

Before accepting the delivery, VR staff:

  1. verify that the shipment is addressed to the appropriate office;
  2. inspect the shipping packages for any visible damage; and
  3. ensure that the shipment contains the number of packages stated on the shipping documentation; and
  4. acknowledge the shipment by signing the shipping document, if the shipment:
    • appears undamaged;
    • matches the quantity on the shipping document; and
    • is correctly addressed to the receiving VR office.

After accepting the delivery, VR staff assesses and documents the shipment's status in an RHW case note.

If the shipment appears damaged but the damage seems minor, VR staff:

  • accepts the shipment, noting the number of damaged packages on the shipping document; or
  • refuses the shipment, noting that the refusal is due to damages to the shipment.

If the damage is or appears to be severe, VR staff:

  • refuses the shipment, noting the refusal and the damages on the shipping document; and
  • notifies the vendor and the VR counselor about the damaged shipment.

VR staff does not accept:

  • goods that arrive COD (that is, collect or cash on delivery); or
  • deliveries made to the wrong office.

If a vendor erroneously ships COD, the VR staff member refuses the shipment.

If goods or services do not meet the appropriate conditions listed above, the VR staff member initiates corrections. When the goods or services meet the conditions, the VR staff member documents the receipt in RHW.

Recording Serial Numbers

When a good that is received at a VR office has a serial number, the serial number must be recorded as part of the documentation when delivery of a good is accepted. Until a field is added to RHW for recording the information as part of the receipt process, the VR staff member enters it in a RHW case note for future reference.

D-207-4: Documenting Receipt of Services

To verify that services were delivered, VR staff:

  1. contacts the customer or the customer's representative by email, by phone, or in person; or
  2. obtains written documentation that includes the customer's or representative's signature.

Verification by Email, Phone, or In Person

VR staff documents contacts with the customer or the customer's representation in a case note in RHW. VR staff contacts the customer to verify that the service met the specifications and documents the contact in a case note.

If the customer is not available to verify receipt of the service, VR staff must document in case notes, in a timely manner, all attempts to verify receipt of the service.

If 20 days have passed since receipt of the invoice and attempts to contact the customer have been unsuccessful, VR staff:

  1. continues to attempt contacting the customer; and
  2. records in case notes each attempt.

Verification by Written Documentation

Some goods and services require that the customer verify receipt of the good or service by signing a specific document or form. These requirements are stated in the chapter that corresponds to the service or in the SFP and can also be stated on the required form.

When VR staff obtains written documentation that includes the customer's signature verifying that the service met the specifications, the documentation is filed in the customer's paper case file.

When a customer's signature is required, but the customer cannot be contacted to obtain the signature, VR staff contacts the VR Supervisor for guidance. VR staff must document in case notes, in a timely manner, all attempts to contact the customer to obtain the required signature.

Verification by the Customer's Representative

If someone other than the customer or the customer's representative serves as the contact, see Business Procedures Manual, Chapter 20: Confidentiality and Use of Customer Records and Information.

Payment Action Items

For payment of services related to maintenance or transportation, RHW automatically creates an action item to receive the records once an SA is generated. See the ReHabWorks User's Guide, Chapter 19: Case Authorizing Payment, 19.2 Maintenance and Transportation for additional instructions.

Provider Reports

In some cases, VR purchases a service that requires the provider to submit a report, for example, submitting the results of a medical examination in the form of a medical report.

The receive date is the date that the examination (the service) takes place.

The invoice receive date is the date that the invoice was received for the service that was provided.

The report receive date is an additional date in RHW that is entered for all services that require a report. The report receive date is the date that the report is received in the office listed on the SA. VR staff enters the receive date for the report in RHW within seven calendar days of receiving a complete and accurate report.

All of these dates must be entered into RHW before the payment can be authorized.

For a detailed list of services that have report requirements, refer to the ReHabWorks User's Guide, Appendix G: Service Category Descriptions.

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D-208: Invoices

Vendors must submit invoices to the office address listed on the SA.

The invoice must comply with:

  • the applicable contract;
  • the policies and procedures published in the VR-SFP;
  • the policies and procedures published in the VRSM; and
  • the terms and conditions of the SA.

Within seven calendar days of receiving an invoice, the staff member must:

  1. verify that the invoice is complete;
  2. acknowledge receipt of the invoice in RHW; and
  3. authorize the payment, if the goods and/or services have been received (for more information, see the ReHabWorks User's Guide, Chapter 19: Case Authorizing Payment).

D-208-1: Date Stamping Invoices

The front of all invoices must be date-stamped upon receipt in the VR office.

If the envelope is date-stamped, the VR staff member keeps the envelope as part of the paper case file.

If the invoice is received by email, the VR staff member:

  1. prints the invoice; and
  2. stamps it with the date received in the office.

If the invoice is received by fax and the date on the fax tagline is correct and up-to-date, then that date reflects the date that the good was received in the office, and the fax are placed in the paper case file.

D-208-2: Elements of an Invoice

Vendor invoices must include, at a minimum:

  • the vendor's complete name and remittance address including city, state, and ZIP code;
  • the vendor's 14-digit Texas vendor identification number;
  • the vendor's telephone number, email address, or fax number;
  • the SA number;
  • the name and address of the VR office, or the delivery address, as applicable;
  • the contract number;
  • a description of the goods or services provided, including the dates of service;
  • the quantity and unit cost being billed, as documented on the current SA;
  • other relevant information supporting and explaining the payment requested or identifying a successor organization to an original vendor, if necessary; and
  • any other information required by applicable state and federal laws, rules, and regulations governing the provision of services under the contract and the relevant policies and standards.

For outcome-based services, such as job placement and supported employment, the date of service is the date that the customer achieved the benchmark.

D-208-3: Incomplete or Inaccurate Invoices

VR staff must not authorize payment for a product or service without an accurate and complete invoice from the provider. When an invoice is inaccurate or incomplete, VR staff return it to the vendor for correction.

VR staff must:

  1. return the invoice and DARS3460, Vendor Invoice Additional Data Request, to the vendor within 21 days of receiving the invoice (the DARS3460 form tells the vendor what additional information TWC requires to process payment);
  2. create a RHW case note to document the date on which the invoice was returned to the vendor and the reason for the return;
  3. date-stamp the corrected invoice and use it as the invoice of record for the purchase; and
  4. do not acknowledge receipt of the invoice in RHW until the provider submits a corrected invoice or until the disputed point is resolved.

Note: Use the date of resolution as the invoice's received date in RHW, and date-stamp the invoice with that date.

If a medical billing lacks the required invoice data, but all other information on the billing is accurate and complete, the VR staff member attaches the RHW system-generated invoice for the SA to the medical billing and uses it in place of an invoice.

D-208-4: Invoice Is Not Received

The VR staff member must not enter an invoice-received-date in RHW before receiving the invoice.

When vendors do not submit invoices in a timely manner, the VR staff member follows up with the service provider by contacting the provider's accounts payable department.

If the provider does not have an invoicing system or template, the VR staff member:

  1. prints the RHW standard invoice for the SA; and
  2. sends the invoice to the provider for completion and resubmission to VR.

D-208-5: Invoice Includes a Late Payment Fee

Fees for late payments are automatically calculated and paid by the state comptroller to meet the requirements of the Texas Prompt Payment Act. Late fees are determined based on the received and invoice dates that are entered into RHW.

VR does not pay late fees that are directly invoiced by the provider.

If a provider submits an invoice that includes a late payment fee, the VR staff member:

  1. does not pay the late fee;
  2. notes the late fee on the invoice;
  3. subtracts the late fee from the invoice total; and
  4. authorizes payment for the corrected amount.

D-208-6: Acknowledging Receipt of an Invoice in ReHabWorks

See the ReHabWorks User's Guide, Chapter 18: Case Acknowledgement of Receipt, 18.1.3 Adding or Updating a Receive Item for detailed instructions.

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D-209: Types of Purchases

Goods and services can be purchased for customers from a variety of community rehabilitation programs and vendors, including contracted providers, noncontracted providers, and medical service providers.

Each type of purchase has steps that must be completed to ensure compliance with state comptroller's purchasing requirements.

D-209-1: Noncompetitive Purchases

Purchases of goods and/or services from a single vendor that cost $5,000 or less do not require competitive bids, but they must conform to the purchasing guidelines and principles stated in this chapter.

Purchases of goods and/or services from a single vendor that cost more than $5,000 (such as tuition) must be competitively bid or approved as a proprietary or sole source purchase. See D-209-2: Proprietary and Sole Source Purchases below.

Exception: MAPS services, contracted services, and tuition and fees do not require a competitive bid.

For information about obtaining required bids (for example, RHW bid requests), VR staff contacts the TWC Purchasing Team at consumer.procurement@twc.state.tx.us.

D-209-2: Proprietary and Sole Source Purchases

A proprietary or sole source purchase is made when only one brand name (manufacturer) or only one provider can meet TWC's specifications for the product or service because of distinctive features or characteristics that are not provided by competing companies, similar products, or comparable services.

When the specifications limit consideration to one product or supplier, the paper case file must contain a complete and approved DARS1322, Proprietary Purchase Justification.

Justification for a proprietary or sole source purchase is required, if the above condition and one or more of the following apply:

  • The planned purchase exceeds $5,000
  • The planned purchase does not involve MAPS
  • The planned purchase is not for tuition and fees
  • No contract is required

A proprietary purchase or sole source transaction must not exceed $25,000. Exceptions are not allowed to this policy.

An example of a proprietary purchase is a Humanware BrailleNote Notetaker, a unique device that is available from only one provider.

D-209-3: Contracted Goods and Services

When purchasing contracted goods and services, refer to the:

Contract Administration staff members solicit and manage contracts for VR goods and services. Some goods or services must be purchased under contract. Before purchasing a good or service, staff members use RHW to find out whether a contract is required. When the SA is generated, RHW assigns the contract number based on the vendor and the type of purchase. Refer to ReHabWorks User's Guide, Chapter 16: Case Service Record for more information about creating a service record.

Customer goods and services that are purchased under contract include the following, but are not limited to:

  • Employment assessments
  • Orientation and Mobility services
  • Hearing aids and related accessories
  • Diabetes Self-Management Education services
  • Durable medical equipment
  • Assistive technology
  • Supportive Residential Services for Persons in Recovery
  • Work Readiness services
  • Work Experience
  • Pre-Employment Transition services
  • Project SEARCH and similar programs
  • Basic Employment services
  • Supported Employment services
  • Self-employment services (including supported self-employment)
  • Post-Acute Brain Injury services
  • Vehicle modifications
  • Intensive Work Preparation and Life Skills Training

Ensuring a Valid Contract

Before issuing an SA, VR must:

  1. note the contract number on the documentation for a good or service purchased under contract; and
  2. ensure that the contract number is current on the service record.

When creating a service record in RHW to purchase goods or services that require a contract, VR staff ensures that the contract for the selected good or service is valid for the entire planned period of service.

To confirm that a contract is valid for the entire planned period of service:

  1. Reviews the provider's contract information in RHW on the Service Record page by selecting:
    • the Vendor Detail button;
    • the vendor's name; and
    • the contract number.
  2. Reads the contract details carefully to ensure that:
    • the contracted good or service is included in the contract; and
    • the dates of service are within the contract's start and end dates.

If the contract is not valid when the good or service is purchased or delivered, VR staff does not use that good or service but instead:

  1. continues to search in RHW for a valid good or service; and
  2. consults with the VR Manager if you are unable to locate a valid good or service.
  3. enters in the comments section of the SA all special instructions or requirements for the specific good or service being purchased.

D-209-4: Billing for Medical and Psychological Services

Payment for medical and psychological services must be authorized by VR and must support VR services and goals.

Medical and psychological services purchased for customers must use MAPS coding and pricing in RHW. No other type of SA may be issued.

Medical and psychological services, including medical goods and supplies, are purchased using MAPS coding and pricing. MAPS codes establish the maximum payment that can be authorized for these services. VR staff members work closely with the provider to ensure that payment corresponds to the correct MAPS codes. Treatment decisions and accurate identification of the applicable MAPS code are the responsibility of the customer's health care provider and designated program staff members or consultants.

Before generating an SA in RHW, VR staff must consult the MAPS Guidelines for instructions about MAPS-related purchases.

The Medical Services Required Practices Handbook (PDF) provides additional guidance to the medical services coordinator (MSC), VR counselors, and rehabilitation assistants who coordinate medical services for VR customers.

For additional information about purchasing medical services, refer to C-700: Medical Services.

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D-210: Exceptions to Contracted Fees and MAPS Fees

Fees are not authorized if they are greater than:

  • the contracted fee for a specific service; or
  • the MAPS fee.

VR staff are not permitted to authorize exceptions to fees that exceed the contracted fee or MAPS fee.

D-210-1: Exceptions to Contracts

Contracts are required for the purchase of most goods and services. Before creating a service record, VR staff checks RHW to verify whether a contract is required.

If a contract is required, case-by-case exceptions to a contract requirement may be approved only in situations where the exception is:

  • in the best interest of VR;
  • in the best interest of the VR customer;
  • necessary and appropriate;
  • in accordance with the customer's plan; and
  • in accordance with state or federal laws.

Exceptions are:

  • reviewed by the VR Manager and regional director; and
  • approved by the VR Rehabilitation Services Division, director.

D-210-2: Process for Exceptions to Non-Hospital Contracts

The following process applies to all contracts except for hospital contracts. For information about exceptions to hospital contracts, see

The VR counselor:

  1. documents a contract exception request in an email or memorandum that describes the customer's need for a specific contracted good or service (the request explains that a noncontracted vendor is needed to best help the customer achieve his or her planned objective); and
  2. sends the email or memo to the VR Manager for review and approval.

The VR Manager:

  1. reviews and either concurs with or denies the request; and
  2. sends the documentation to the regional director or state office Director of Programs Management for review and concurrence or denial.

The regional director or director for programs management:

  1. reviews and concurs with or denies the request; and
  2. sends the request documentation to the director VR Services Division for review and approval.

The Director of the VR Services Division:

  1. reviews the request;
  2. approves or denies the request; and
  3. returns the approved request to the VR counselor through the appropriate levels of management.

If at any time the request for a contract exception is denied, the document is returned through management to the VR counselor.

D-210-3: Exceptions to Hospital Contracts

If a customer needs a medical service at a hospital that does not have a VR contract, the assigned MSC must:

  1. contact the regional quality assurance specialist to negotiate a payment rate for the medical service;
  2. submit a DARS3423, Exception to Contracted Hospital Purchase form—through the regional director, to the Director of the VR Services Division—for final approval.

Hospital contract payments that are below the contracted rate or made in addition to the contracted rate are permitted when the customer's circumstances warrant. See Exceptions to Payment Rate Limits in C-700: Medical Services  for instructions, including information on the use of DARS3422, Reduced Payment Agreement.

To request an exception to a hospital contract, the VR counselor:

  1. creates a request for a contract exception in an email or memorandum that describes the customer's need for a specific contracted good or service (the request explains that a noncontracted vendor is needed to best help the customer achieve his or her planned objective); and
  2. sends DARS3472, Contracted Service Modification Request, to the VR Manager for review and approval.

The VR Manager:

  1. reviews and concurs with or denies the request; and
  2. sends the request to the regional director for review and concurrence or denial.

The regional director:

  1. reviews and concurs with or denies the request; and
  2. sends the request to the VR Division Director for review and approval.

The Director of the VR Services Division:

  1. reviews the request;
  2. approves or denies the request; and
  3. returns the approved request to the VR counselor through management.

For more information about exceptions to hospital contracts, see .

D-210-4: Completing DARS3472, Contracted Service Modification Request

When the VR Manager reviews and concurs with an exception to a contract-related policy (such as changing the service description in order to individualize a service for a customer), the VR Manager's approval must be recorded on DARS3472, Contracted Service Modification Request.

DARS3472, Contracted Service Modification Request, must be signed by:

  • the VR Division Director; and
  • the contractor.

VR staff

  1. places a copy of DARS3472 in the customer's paper case file; and
  2. forwards a copy of DARS3472 to the contract manager.

For additional information, refer to VR-SFP Chapter 3: Basic Standards.

D-210-5: Exceptions to Contracted Fees

Fees greater than the contracted fee for a specific service are not allowed. Exceptions are not allowed to this policy.

D-210-6: Contract Exceptions—Approval and Consultation

For information about approval and consultation required for contract exceptions, refer to specific service-related chapters of the VRSM and to C-100: Introduction to VR Process.

D-210-7: Noncontract Purchases from Contract Providers

Goods or services that do not require a contract can be purchased from a provider that already supplies contracted goods or services to VR.

When creating a service record and SA in RHW, the VR staff must not select a contract number but instead, chooses "none," when prompted.

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D-211: Setting Up and Paying Providers

Before the service record is generated and before the SA is issued, the staff member ensures that:

  • the individual has been established in RHW as a provider; and
  • the individual's RHW account has been linked to the appropriate specifications.

If the individual is not already established as a provider:

Both of these forms include additional instructions for completing and submitting the forms to establish the providers in RHW.

Note: State law prohibits the state comptroller from paying funds directly to anyone who owes the state because of delinquent taxes or a defaulted debt, such as a guaranteed student loan.

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D-212: Creating the Service Authorization

Any VR staff member with access to RHW can create a service record, generate an SA, and pay for a service, as long as the VR counselor or supervisor has documented the authorization for the purchase.

D-212-1: Creating the Service Record—The Program Year

To determine the program year for services, the VR staff member:

  1. selects the program year in which the service occurs; and
  2. prorates when crossing program years.

For goods and supplies, the VR staff member selects the program year in which the goods were ordered.

For more information about how to prorate cost,

D-212-2: Crossing State Fiscal Years

The federal fiscal year starts October 1 and ends September 30.

The state fiscal year starts September 1 and ends August 31.

Ordering and Receiving

The VR staff charges goods to the state fiscal year in which they were ordered. The receive date does not have to fall within the start and end dates and may fall within the following fiscal year.

Example: A special order for a wheelchair is submitted on August 3, 2018, using Program 2018 VR Basic Support funds. The start date is the date that the order was placed; that is, June 3, 2018.

The end date is the anticipated receive date and, because of the RHW requirement, must fall within the state's fiscal year. In this case, the anticipated receive date is after the end of the fiscal year, so the VR staff enters in RHW the end date of the fiscal year ("08/31/2018").

The wheelchair arrived in good condition, so the receive date can be later than the anticipated end date. If the chair arrives on September 27, 2018, the VR staff enters "09/27/2018" as the receive date.

D-212-3: Prorating Services

If there are funds available in the budget in RHW, it is not necessary to prorate services across fiscal years.

The VR staff charges most services to the state fiscal year in which the service occurred.

When part of a service will be provided during the next state fiscal year, the VR staff member charges that part to that fiscal year. When setting up the service record, the staff member creates two line items—one for each state fiscal year—and prorates the charge proportionately.

Example: When one week of service occurs in August and two weeks of service occur in September, charge one-third to August and two-thirds to September.

Tips for Prorating

When prorating, the VR staff member must:

  • not put zero in the Unit Amount or Unit Cost (the staff member makes an informed estimate of the cost and increases or decreases the amount in the SA later);
  • use 30 days for all months when prorating a monthly payment; and
  • enter amounts for line items (line-item amounts do not have to be precise, but the total of the line items must equal the total amount due).

For more information about prorating payment, see the ReHabWorks User's Guide, Chapter 16: Case Service Record, 16.2.8.4 Prorating Payments for Services.

D-212-4: Tuition and Fees Only

To pay the fall tuition at a college or university, the staff member can either:

  • use funds for the fiscal year; or
  • prorate the cost.

For offices and/or caseloads that still have funds available for the current fiscal year, the tuition portion of an SA for the fall semester at a college or university may be encumbered using only the basic budget for the current fiscal year.

When taking this approach, staff members must keep the following critical points in mind:

  • Does the office or caseload have sufficient funding to charge the full tuition to the current fiscal year budget?
  • If funding is sufficient, charge only the tuition portion to the current budget and prorate the costs for dorm rooms, meal plans, parking, lab fees, and all other service expenses, as required by the state comptroller's office; and
  • For RHW to allow the use of only current state fiscal year funds on the tuition line in an SA, the start and end dates must be in August; for example, 08/14/2018 to 08/31/2018 (use the SA comments to document the actual full dates of service).

For additional information about the policies and procedures for paying tuition and fees, refer to C-400: Training Services.

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D-213: Other Types of Payments and Purchases

The types of payments and purchases that can be processed in RHW include:

  • periodic payments;
  • advance payments; and
  • restricted donations.

D-213-1: Periodic Payments

Periodic payments are used when a service is provided and paid over a defined but recurring period (for example, training programs that bill monthly, or reader services that bill at regular intervals).

The receive date for periodic payments is the last day of the billing period. When the periodic payment is for one month, for example, the receive date for each payment is the last day of the month.

For information about how to enter a periodic payment in RHW, see the ReHabWorks User's Guide, Chapter 19: Case Authorizing Payment.

D-213-2: Advance Payments

Advance payment or prepayment occurs when payment for a customer service is issued before the service is delivered. Payment usually is not made until a service is received.

Customer services for which advance payment may be authorized include:

  • customer maintenance;
  • customer transportation (such as airfare, train tickets, and bus tickets);
  • weekly or monthly bus passes;
  • child care; and
  • tuition.

When advance payment is authorized, payment authorization must be delegated in accordance with RHW procedures.

Advance Payment Table

The table below lists the only circumstances under which an advance payment may be issued. Advance payments may be received and authorized anytime from the "pay as early as" date to the actual completion date of the service. The date entered in the receipt acknowledgment field in RHW is the receive date. Use the billing statement as the invoice for receiving and paying.

Advanced Pay Situations

Pay as early as

Maintenance and transportation paid to the customer

Seven days before the start date

Academic and vocational training and training-related services (when provided by an accredited college or university over a semester or quarter)

Time of enrollment

Vocational or technical training (when provided by an accredited training institution)

Time of enrollment

*Room and board paid directly to an accredited college, university, or training institution to support planned training activities. (This does not apply to room and board paid to housing facilities that are associated with, but do not bill directly through, the training institution.)

14 days before the start date

State board licenses the registration for an exam

14 days before the start date

*For example, if a customer's room and board had a start date of 8/16/2018 and an end date of 12/17/2018, the payment could be received any day between 8/2/2018 and 12/17/2018. If the bill or receipt is entered on 8/7/2018, the receive date entered in RHW is 8/7/2018.

D-213-3: Restricted Donations Payments

A restricted donation is a cash donation made to VR to provide services to VR customers for a specific purpose, program, VR office, or caseload. When a restricted donation is received, the receiving office immediately notifies the office of the VR Division Director.

D-213-4: Payment Discounts

For information on how to apply payment discounts, see the ReHabWorks User's Guide, Chapter 18: Case Acknowledgement of Receipt, 18.1.1 Payment Discounts.

D-213-5: Multicustomer Purchases

A multicustomer purchase is made when services are purchased from a single provider for multiple customers. The customers may be the same or different caseloads.

A multicustomer service record completed in RHW serves the same function as an individual service record and is used to create a multicustomer SA.

An invoice with the customers' names is kept in a separate file. Information related to multiple customers must never be filed in an individual customer's file.

For additional information on creating a multicustomer service record and a multicustomer SA, refer to the ReHabWorks User's Guide, Chapter 20: Multicustomer Purchases, 20.1 Multicustomer Service Record.

D-213-6: Food Purchased for Customer Training

This section describes the procedure for purchases of bulk food orders to be used in customer training activities, including:

  • nutrition classes;
  • cooking classes;
  • food preparation classes; and
  • authorized activities where meals are prepared on-site by customers.

Food that is provided in conjunction with other customer activities, such as seminars and workshops and activities in the community, is not categorized as bulk food orders and should be purchased through RHW.

D-213-7: Used Goods

The following policy does not apply to the purchase of medical or assistive devices, such as hearing aids, orthotics, prosthetics, or surgical implantable devices.

Used goods, supplies, or equipment can be purchased with VR funds when new equipment is unavailable or when used equipment meets the customer's needs and provides significant savings (such as purchasing used textbooks).

Include the justification for the purchase of used equipment in the service justification case note.

When buying used goods, the VR staff member processes the order according to the applicable procurement method, which is based on the estimated cost of the equipment.

Documentation of the purchase must include a description of the equipment's condition and value (usually found on the cost estimate or the provider's invoice, but may be added to the SA).

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D-214: Contractor Performance Issues

VR staff members other than the contract manager routinely work closely with contractors and, therefore, might notice issues related to a contractor's performance or noncompliance that are beyond the scope of the formal statewide monitoring process led by the Customer Services Monitoring Unit. If the staff member determines that a performance issue is significant, he or she must notify the contract manager, even if the issue has been resolved.

The VR staff member must send the notification in writing and include the:

  • name of the contractor;
  • contract number assigned by VR, if known;
  • Texas payee identification number, if known;
  • type of service provided by the contractor;
  • date the noncompliance or performance issue occurred;
  • description of the noncompliance or performance issue; and
  • chronology of actions taken by the VR staff member and contractor to address the issue.

VR staff members use DARS1303, Contractor Performance Report, to document issues of performance or noncompliance, or issues with an invoice. The form can also be used to document exceptionally good contractor performance. DARS1303 is for TWC use only.

When the contract manager is notified of a contractor's performance issue, he or she takes appropriate action and can request a remedial action review.

Refer to the following sections in the Customer Processes and Procedures Manual (CPPM) (Word) for examples of what may constitute a significant issue:

  • CPPM Chapter 8: Monitoring Contracts for Customer Goods and Services, 8.5.2 Findings Identified During a Monitoring Review
  • CPPM Chapter 7: Customer Contract Maintenance and Management, 7.13 Contractor Payment Issues
  • CPPM Chapter 10: Customer Contract Remedial Action Reviews, Adverse Actions, Appeals, Requests for Reconsideration, Claims for Breach of Contract, and Vendor Performance Tracking System (VPTS), 10.1.1 Remedial Actions

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D-215: When ReHabWorks Is Not Available

If RHW is not functioning, staff members receive direction from TWC's executive management at state office about the continuation of purchasing processes and procedures.

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D-216: Using Provider Credit Accounts

An SA is the only valid authorization by which purchases are made. No purchase may be made using a provider's credit card.

Some providers (for example, Walmart, Sears, The Home Depot, Office Depot, and Hobby Lobby) require the use of a credit account. Credit account purchases must be made using an SA.

For providers that require the use of a credit card, each VR management unit has an assigned account number. Before using one of these accounts, the VR staff member issuing the SA verifies with the vendor that the account is still active.

When the issuer's management unit has an account with the provider, the account number is printed automatically on the SA. If an account number is not printed on the SA, then the management unit does not have an account and that vendor must not be used.

If a VR staff member identifies a vendor for which an account is needed, the staff member requests approval from the VR Manager to establish an account. Accounts cannot be established by individual office location without approval of the VR Manager. When possible, accounts must be established at the regional level (parent account) with the management units being the authorized buyers.

If an application for a credit account results in receipt of a credit card, the card must be submitted to state office when the account is linked in RHW.

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D-217: Interagency Transfer Vouchers

Texas state agencies provide a variety of goods and services for each other. For example, the Texas Department of Aging and Disability Services (DADS) provides medical records, and the Texas Cosmetology Commission provides state cosmetology licenses.

For some agencies, the state comptroller transfers funds from one agency to another through interagency transfer vouchers (ITV) instead of issuing a warrant to make the payment.

D-217-1: Receiving and Paying Interagency Transfer Vouchers

When receiving and paying ITVs, a VR staff member in the field office verifies the ITV's accuracy.

Note: If the invoice or ITV does not have a recurring transaction index (RTI) number, the VR staff member:

  1. calls the performing agency to get the RTI number; and
  2. writes it on the invoice or ITV.

The staff member then:

  1. verifies that the goods or services have been received;
  2. acknowledges receipt of the invoice, goods, and/or services, and documents in RHW (if applicable):
    • the invoice number in the Invoice Number field in the Receive Items List window, if the performing agency provided an invoice number (if an invoice number is not provided, the customer's Social Security number); and
    • the six-digit RTI number; and
  3. writes the voucher document number assigned in RHW on the invoice or ITV (the number begins with a "T").

Note: Request payment using the SA Payment Authorization window. If the invoice includes fees for late payment, do not pay them.

The state comptroller maintains an Interagency Transactions Contact List, which is a list of agency contacts for RTI numbers.

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D-218: Purchasing Reviews and TxROCS

VR completes case reviews as part of oversight and monitoring of customer purchasing activities. Texas Review, Oversight, and Coaching System (TxROCS) is an application for entering case reviews.

For additional information about technical and purchasing reviews refer to D-400: Quality Assurance Processes.

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D-219: Health Care Professionals—Required Qualifications

Listed below are the required qualifications for physicians, specialists, and other health care professionals.

The TWC-VR state program specialist for physical restoration:

  • verifies in RHW the required qualifications of health care professionals; and
  • provides information about certification or licensure of other health care professionals.

Note: When an intern working under the supervision of a licensed provider provides counseling services, the services are purchased at the rate paid for the supervising licensed provider.

Professional

Job Function

Required Qualifications

Advanced practice nurse

Provides medical evaluation and/or treatment

Licensed by the Texas Board of Nursing

Audiologist

An audiologist:

  • provides audiological examinations;
  • may dispense hearing aids; and
  • may provide basic audiometric assessments.

Licensed by the State Board of Examiners for Speech-Language Pathology and Audiology

To dispense hearing aids, the audiologist also must be licensed by the State Committee of Examiners in the Fitting and Dispensing of Hearing Instruments.

Certified registered nurse anesthetist (CRNA)

Administers anesthesia

Certified by the American Association of Nurse Anesthetists

Chiropractor

Provides manipulative treatment of the spine and functional capacity assessments

For restrictions, see C-703-6: Chiropractic Treatment.

Licensed by the Texas Board of Chiropractic Examiners

Cognitive rehabilitation therapist

Provides cognitive rehabilitation therapy, which focuses on the development of cognitive skills (the ability to perceive, recognize, conceive, judge, imagine, and reason) that were lost or altered because of neurological damage

The aim of treatment is to enhance functional competence in real-world situations.

The process includes:

  • direct retraining;
  • use of compensatory strategies; and/or
  • use of cognitive tools.

One of the following:

  • For a psychologist, a license from the State Board of Examiners of Psychologists
  • For a psychiatrist, a license from the State Board of Medical Examiners
  • For an occupational therapist, a license from the Executive Council of Physical Therapy and Occupational Therapy Examiners
  • For a speech and language pathologist, certification from the State Committee of Examiners for Speech and Language Pathologists and Audiologists

Dentist

Provides dental evaluations and/or treatment

Licensed by Texas State Board of Dental Examiners to practice in the state where services are rendered

Hearing aid specialist

Dispenses hearing aids

May provide basic audiometric assessments (MAPS 92551 - 92559)

May provide hearing aid evaluations

Licensed by the Texas Board of Examiners in the Fitting and Dispensing of Hearing Aids

Licensed marriage and family therapist (LMFT)

Provides goal-oriented or problem-centered counseling services, as recommended or prescribed by a psychiatrist or psychologist

Licensed by the Texas State Board of Examiners of Marriage and Family Therapists

Licensed professional counselor

Provides goal-oriented or problem-centered counseling services as recommended or prescribed by a psychiatrist or psychologist

Licensed by the Texas State Board of Examiners of Professional Counselors

Licensed surgical assistant (LSA)

Provides assistant surgeon services

Licensed by the Texas Medical Board

Occupational therapist

Provides:

  • occupational therapy services recommended or prescribed by a physician;
  • home modifications assessment; and/or
  • job analysis and job-site modification assessments.

Licensed by the Executive Council of Physical Therapy and Occupational Therapy Examiners to practice in the state where services are rendered

Optometrist

Provides vision examinations

Licensed by the Texas Optometry Board

Ophthalmologist

Specializes in diagnosis, treatment, and surgery for diseases of the eye

M.D. (doctor of medicine) licensed by the state of Texas State Board of Medical Examiners to practice in the state where services are rendered

Pedorthist

Fabricates and supplies below-the-ankle orthotics

Certified by the Board for the Certification in Pedorthics (C.Ped: certified pedorthists)

Physical therapist

Provides:

  • physical therapy services recommended or prescribed by a physician;
  • home modifications assessment; and/or
  • job analysis and job-site modification assessments.

Licensed by the Board of Physical Therapy and Occupational Therapy Examiners to practice in the state where services are rendered

Physician

Provides medical examinations and/or treatment

Exception: A podiatrist licensed in the state where services are rendered may provide medical or surgical services limited to foot conditions.

M.D. (doctor of medicine) or D.O. (doctor of osteopathy) licensed by the Texas State Board of Medical Examiners to practice in the state where services are rendered

Physician assistant

Provides medical examinations, medication management, and/or treatment

Licensed by the Texas Physician Assistant Board

Podiatrist

Provides medical examinations and treatment for foot conditions

Licensed by the Podiatric Medical Examiners Board DPM (doctor of podiatric medicine)

Prosthetist and orthoptist

Fabricates and supplies prostheses and orthotics

Licensed by the State Board of Orthotics and Prosthetics

Psychiatric-mental health advanced practice nurse

Provides evaluation, goal-oriented or problem-centered counseling services, and/or medication management

Licensed by the Texas Board of Nursing

Psychologist

Provides or supervises the provision of psychological services

When an individual under the supervision of the licensed psychologist provides services, the licensed psychologist must sign all reports

Licensed by the Texas State Board of Examiners of Psychologists or licensed to practice in the state where service is rendered (unless exempt)

Community-based behavioral health and developmental disability services centers and some state agencies are exempt from the licensing act

Registered nurse first assistant (RNFA)

Provides assistant surgeon services

Licensed by the Texas Board of Nursing

Social Worker

Provides goal-oriented or problem-centered counseling services for customers as recommended or prescribed by a psychiatrist and/or psychologist

Licensed Clinical Social Worker (LCSW) licensed by the Texas State Board of Social Work Examiners

Community-based behavioral health and developmental disability services centers and some state agencies are exempt from the licensing act

Specialist physician

Performs examinations, treatment, and/or surgery

Physician certified by an American Medical Specialty Board, or the American Osteopathy Specialty Board in the needed specialty

When a board-certified physician is not available, refer the customer to the Texas Medical Board Look Up a License page to gather information about the education and experience of a physician without board certification.

Speech-language pathologist

Provides, with concurrence of a physician, speech and hearing therapy after surgery or trauma affecting speech

Certified as a speech-language pathologist by the State Board of Examiners for Speech-Language Pathology and Audiology

Speech trainer

Provides speech training in both expressive (speech language production) and receptive (lip and speech reading) language

May also evaluate and provide training in the use of speech augmentation devices

Certified as a speech-language pathologist by the State Board of Examiners for Speech-Language Pathology and Audiology

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D-220: Health Care Facilities—Required Qualifications

The required qualifications for health care facilities are listed below.

The VR state program specialist for physical restoration:

  • verifies the required qualifications of health care facilities in RHW; and
  • provides information about certification or licensure of health care facilities.

Health Care Facility

Activity

Required Qualifications

Ambulatory surgical center

Primarily provides surgical services to patients who do not require overnight hospital care

Current licensure as an ambulatory surgical center by the Texas Department of State Health Services or accreditation by the American Association for Accreditation of Ambulatory Surgery Facilities

General hospital

Provides inpatient and outpatient hospital services

A current contract with VR, and:

  • Medicare certification;
  • accreditation by the Joint Commission for Accreditation of Health Care Organizations (JCAHO); or
  • accreditation by the American Osteopathic Association.

General or specialty hospital providing inpatient comprehensive medical rehabilitation services

Provides inpatient comprehensive medical rehabilitation services

A current contract with VR and/or:

  • licensure by the Texas Department of State Health Services for comprehensive medical rehabilitation services, unless exempt by law (for example, the University of Texas Medical Branch);
  • accreditation by the JCAHO; or
  • accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF).

CARF accreditation must be as a:

  • Medical Rehabilitation Program—Comprehensive Inpatient Category One, if accredited before July 1, 1998; or
  • Comprehensive Integrated Inpatient Rehabilitation Program, if accredited July 1, 1998, or later.

Nursing home

Provides nursing home or convalescent care

Licensed by the DADS Nursing Home division

Approved by Medicare and Medicaid

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