RFP Template - apps.hhs.texas.gov · Web viewRegistration with the Executive Council of Physical...

Charles Smith, Executive Commissioner

Open Enrollment

for

Post-Acute Rehabilitation Services

Enrollment Number: HHS0000023

Enrollment Period Opens: October 20, 2016

Enrollment Period Closes: August 31, 2019

NIGP Class/Item Codes:

948-86 Therapy and Rehabilitation Services952-15 Case Management

952-21 Counseling Services

Addendum #1: 03/22/2018

Post-Acute Rehabilitation ServicesEnrollment Number: HHS0000023

TABLE OF CONTENTS

1. GENERAL INFORMATION..........................................................................................................31.1. SCOPE...........................................................................................................................................................31.2. POINT OF CONTACT......................................................................................................................................31.3. PROCUREMENT SCHEDULE...........................................................................................................................41.4. TERMS AND CONDITIONS.............................................................................................................................41.5. BACKGROUND..............................................................................................................................................41.6. ELIGIBLE APPLICANTS.................................................................................................................................51.7. STRATEGIC ELEMENTS AND SPECIAL TERMS AND CONDITIONS..................................................................61.8. AMENDMENTS AND ANNOUNCEMENTS REGARDING THIS OPEN ENROLLMENT..........................................71.9. APPLICANT NOTIFICATIONS AND QUESTIONS..............................................................................................8

2. STATEMENT OF WORK...............................................................................................................92.1. PROGRAM PURPOSE......................................................................................................................................92.2. APPLICANT/CONTRACTOR REQUIREMENTS..................................................................................................92.3. SERVICE DELIVERY AREA(S).......................................................................................................................92.4. APPLICANT’S PHYSICAL ADDRESS...............................................................................................................92.5. ELIGIBLE POPULATION.................................................................................................................................92.6. CONSUMER CHARACTERISTICS..................................................................................................................102.7. MINIMUM QUALIFICATIONS.......................................................................................................................122.8. GOAL AND PERFORMANCE MEASURES......................................................................................................13

3. UTILIZATION AND PAYMENT..................................................................................................153.1. UTILIZATION..............................................................................................................................................153.2. PAYMENT...................................................................................................................................................153.3. INVOICING PROCESS...................................................................................................................................163.4. UTILIZATION AND REVIEW.........................................................................................................................16

4. INFORMATION AND SUBMISSION INSTRUCTIONS...............................................................174.1. OPEN ENROLLMENT CANCELLATION/PARTIAL AWARD/NON-AWARD......................................................174.2. RIGHT TO REJECT APPLICATIONS OR PORTIONS OF APPLICATIONS...........................................................174.3. JOINT APPLICATIONS..................................................................................................................................174.4. WITHDRAWAL OF APPLICATIONS...............................................................................................................174.5. COSTS INCURRED.......................................................................................................................................174.6. APPLICATION SUBMISSION INSTRUCTIONS.................................................................................................174.7. ORGANIZATION OF APPLICATION AND REQUIRED DOCUMENTS................................................................184.8. ALTERNATE DELIVERY OF APPLICATIONS.................................................................................................194.9. REQUIREMENTS FOR MAILED OR DELIVERED APPLICATIONS.....................................................................20

5. ELIGIBILITY DETERMINATION...............................................................................................215.1. INITIAL COMPLIANCE SCREENING..............................................................................................................215.2. UNRESPONSIVE APPLICATIONS..................................................................................................................215.3. CORRECTIONS TO APPLICATION.................................................................................................................215.4. REVIEW AND VALIDATION OF APPLICATIONS...........................................................................................225.5. ADDITIONAL INFORMATION.......................................................................................................................225.6. METHOD OF ALLOCATION..........................................................................................................................225.7. DEBRIEFING................................................................................................................................................225.8. PROTEST PROCEDURES...............................................................................................................................22

6. GLOSSARY.................................................................................................................................. 23

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1. GENERAL INFORMATION

1.1. Scope

The State of Texas, by and through the Health and Human Services Commission (“HHSC”), seeks to contract Post-Acute Rehabilitation Services for people who have a traumatic brain injury“”, traumatic spinal cord injury“”, or both from vendors licensed by HHSC or Department of State Health Services (“DSHS”), as applicable, and operating as one of these facilities prior to contract execution:

1.1.1. An Assisted Living Facility;

1.1.2. A Home and Community Support Services Agency;

1.1.3. A nursing facility;

1.1.4. A general hospital; or

1.1.5. A specialty hospital.

In conjunction with appropriate licensing, each Applicant must have an accreditation, or obtain it no later than two years after contract execution, by the Commission on Accreditation of Rehabilitation Facilities (“CARF”) or Joint Commission on Accreditation of Healthcare Organizations (“JCAHO”) in accordance with the specifications contained in this open enrollment.

1.2. Point of Contact

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

Point of Contact: Blair Gossett, Project Manager

Address: Health and Human Services CommissionOffice of Independence Services

5806 34th StreetLubbock, Texas 79407

Phone: 806-791-7533

Email: [email protected]

Office Hours: 8:00 AM to 5:00 PM Monday through Friday

Applicant must direct all procurement communications and questions relating to this open enrollment to HHSC Point of Contact named above, unless specifically instructed to an alternate Contact by HHSC.

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mailto:[email protected]


An alternate contact will be provided to Applicants by email upon completion of the initial screening conducted by the HHSC Project Manager.1.3. Procurement Schedule

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

Procurement ScheduleOpen Enrollment Period Opens October 20,2016

Open Enrollment Period Closes 5:00 PM CSTAugust 31, 2019

Anticipated Contract Start Date Approximately Thirty (30) days after all screening requirements are met.

1.3.1. Adjustments to Closing Date

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

1.3.2. Re-Opening the Open Enrollment

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

1.4. Terms and Conditions

The terms and conditions outlined throughout this open enrollment govern the open enrollment and any resulting contract. Any Contract awarded under this open enrollment includes the following, found at the end of this document, Attachments:

1.4.1. HHSC Vendor Uniform Contract Terms and Conditions Version 2.15

1.4.2. HHSC Special Conditions Version 1.2

1.4.3. HHSC CRS Supplemental Conditions Version 1.0

1.5. Background

1.5.1. Overview of HHSC

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

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

1.5.2. Project Overview

HHSC will work in collaboration with Contractors to provide an array of training and support services to consumers who have a traumatic brain injury (“TBI”) and/or traumatic spinal cord injury (“TSCI”) to function more independently in the home and community.

1.6. Eligible Applicants

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

1.6.1. Submit the required and completed Application, supporting documentation, and forms.

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

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

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

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

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

1.6.7. Hold one (1) of the following current and valid licenses or acceptance letters issued by HHSC or DSHS:

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

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

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

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

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

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

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


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

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

1.6.7.3. A nursing facility license issued by HHSC Regulatory Services Division; or1.6.7.4. A Hospital license issued by DSHS; or1.6.7.5. A chemical dependency treatment center license issued by DSHS; or1.6.7.6. An acceptance letter from HHSC Regulatory Services Division or from DSHS

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

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

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

1.7. Strategic Elements and Special Terms and Conditions

1.7.1. Contract Type and Term

HHSC will award one or more Contracts for Post-Acute Rehabilitation Services as described in Section 2. The initial resulting Contract term will be for two (2) years, unless renewed, extended, or terminated pursuant to the terms and conditions of the Contract. HHSC reserves the option to amend the term of the resulting Contract for a period or periods of time no greater than a cumulative total of five (5) years, which five-year period includes the original contract term.

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

1.7.2. Contract Elements

The term “Contract” means any contract awarded as a result of this open enrollment and all exhibits, amendments or addenda to the Contract. At a minimum, the following documents will be incorporated into the Contract: any modifications, addenda, or amendments issued in conjunction with this open enrollment; applicable HHSC Uniform Terms and Conditions; HHSC Special Conditions; HHS CRS Supplemental Conditions; and the successful Applicant’s Application. However, any term, condition, or other part of Applicant's Application that has been rejected by HHSC that is not accepted in writing by HHSC, or that conflicts with applicable law, the Contract, this open enrollment solicitation, exhibits to this

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


open enrollment or the Contract, or applicable terms and conditions will not constitute part of the Contract.

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

1.7.3. Insurance

Unless otherwise specified in this Contract, Applicant will acquire and maintain, prior to contract execution and for the duration of this Contract, insurance coverage necessary to ensure proper fulfillment of this Contract and potential liabilities thereunder with financially sound and reputable insurers licensed by the Texas Department of Insurance. All required insurance coverage must be issued from a company or companies that have both: (1) a Financial Strength Rating of "A" or better from A.M. Best Company, Inc.; and (2) a Financial Size Category Class of "VII" or better from A.M. Best Company, Inc. Upon request by HHSC,Contractor will provide evidence of insurance as required under this Contract, including a schedule of coverage or underwriter’s schedules establishing to the satisfaction of HHSC the nature and extent of coverage granted by each such policy. In the event that any policy is determined by HHSC to be deficient to comply with the terms of this Contract, Contractor will secure such additional policies or coverage as HHSC may request or that are required by law or regulation. If coverage expires during the term of this Contract, Contractor must produce renewal certificates for each type of coverage.

These and all other insurance requirements under the Contract apply to both Contractor and its Subcontractors, if any. Contractor is responsible for ensuring its Subcontractors' compliance with all requirements. All insurance contracts must:

(1) be written on a primary and non-contributory basis with any other insurance coverages the Applicant currently has in place; and(2) include a waiver of subrogation. Applicant must ensure that all insurance policies and certificates of insurance for required coverage are written to include all services and locations related to Applicant's performance under the Contract.

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

1.8. Amendments and Announcements Regarding this Open Enrollment

HHSC will post all official communication regarding this open enrollment on the HHS Open Enrollment Opportunities web page located at: https://apps.hhs.texas.gov/pcs/openenrollment.cfm .

HHSC reserves the right to revise this open enrollment at any time. It is the responsibility of each Applicant to comply with any changes, amendments, or clarifications posted to the HHS Open Enrollment Opportunities web page. Applicant must check the HHS Open Enrollment

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

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


Opportunities web page frequently for changes and notices of matters affecting this open enrollment.

An Applicant’s failure to check the HHS Open Enrollment Opportunities web page will in no way release the Applicant from the requirements of any revisions, addenda, or additional information.

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

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

1.9. Applicant Notifications and Questions

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

(The remainder of this page is intentionally left blank.)

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2. STATEMENT OF WORK

2.1. Program Purpose

The purpose of the Comprehensive Rehabilitation Services (“CRS”) program is to help eligible consumers who have a TBI and/or TSCI to improve their ability to function independently in the home and the community. The program focuses on mobility, self-care, and communication, and it sponsors three (3) core services to address functional ability.

2.2. Applicant/Contractor Requirements

Contractors must:

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

2.3. Service Delivery Area(s)

The geographic service area for the CRS program is state-wide, but specific provider services area(s) within the state are individually approved by HHSC.

2.4. Applicant’s Physical Address

The Applicant’s physical address, as shown on the Application, must be identical to the address on the applicable license.

2.5. Eligible Population

Consumer eligibility is determined by applicable law.

2.5.1. For the CRS Program, basic requirements for consumer eligibility are set forth in 40 Texas Administrative Code (“TAC”) §107.707. To meet the current basic eligibility criteria for the CRS Program, there must a reasonable expectation that services will benefit the person by improving his or her ability to function within the home environment or within the community, and the person must:

2.5.1.1. Have a traumatic brain injury or traumatic spinal cord injury that constitutes or results in a substantial impediment to the person's ability to function within the home environment or the community;

2.5.1.2. Be at least fifteen (15) years of age;

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https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=40&pt=2&ch=107&rl=707

https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=40&pt=2&ch=107&rl=707

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



2.5.1.3. Be a U.S. citizen or lawful permanent resident, and a Texas resident (as defined by applicable rule);

2.5.1.4. Not be participating in, or be eligible for and able to access, another rehabilitation program offering similar rehabilitation treatment or therapy services; however, the person may participate in rehabilitation programs that offer complementary rehabilitation services;

2.5.1.5. Be willing to participate in services; and2.5.1.6. Be medically stable, including no progression of deficits, no deterioration of

physical and cognitive status, or both; and2.5.1.7. not be in imminent need of any acute care; and be functioning at a Level IV of

the Rancho Los Amigos Levels of Cognitive Functioning Scale or equivalent.

2.6. Consumer Characteristics

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

2.6.1. Cognitive deficits

2.6.1.1. Attention2.6.1.2. Concentration2.6.1.3. Distractibility2.6.1.4. Memory2.6.1.5. Speed of Processing2.6.1.6. Confusion2.6.1.7. Perseveration2.6.1.8. Impulsiveness2.6.1.9. Language Processing2.6.1.10. Executive functions

2.6.2. Speech and Language deficits

2.6.2.1. Not understanding the spoken word (receptive aphasia)2.6.2.2. Difficulty speaking and being understood (expressive aphasia)2.6.2.3. Slurred speech2.6.2.4. Speaking very fast or very slow2.6.2.5. Problems reading2.6.2.6. Problems writing

2.6.3. Sensory deficits

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

2.6.4. Perceptual deficits

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

2.6.5. Vision deficits

2.6.5.1. Partial or total loss of vision2.6.5.2. Weakness of eye muscles and double vision (diplopia)2.6.5.3. Blurred vision2.6.5.4. Problems judging distance2.6.5.5. Involuntary eye movements (nystagmus)2.6.5.6. Intolerance of light (photophobia)

2.6.6. Hearing deficits

2.6.6.1. Decrease or loss of hearing2.6.6.2. Ringing in the ears (tinnitus)2.6.6.3. Increased sensitivity to sounds

2.6.7. Smell deficits

Loss or diminished sense of smell (anosmia)

2.6.8. Taste deficits

Loss or diminished sense of taste

2.6.9. Seizures

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

2.6.10. Physical Changes

2.6.10.1. Physical paralysis/spasticity2.6.10.2. Chronic pain2.6.10.3. Control of bowel and bladder2.6.10.4. Sleep disorders2.6.10.5. Loss of stamina2.6.10.6. Appetite changes2.6.10.7. Regulation of body temperature2.6.10.8. Menstrual difficulties

2.6.11. Social-Emotional deficits

2.6.11.1. Dependent behaviors2.6.11.2. Emotional ability2.6.11.3. Lack of motivation2.6.11.4. Irritability

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2.6.11.5. Aggression2.6.11.6. Depression2.6.11.7. Disinhibition2.6.11.8. Denial / lack of awareness

2.7. Minimum Qualifications

2.7.1. Minimum Organizational Qualifications

2.7.1.1. All Applicants must:

2.7.1.1.1. Have at least three (3) years’ experience providing the rehabilitation services for which the Applicant is applying through this open enrollment (e.g., traumatic brain injury, traumatic spinal cord injury, or both); and

2.7.1.1.2. Adhere to the standards for providers (see, Subsection 2.2.1 of this open enrollment).

2.7.1.2. Each Contractor must:

2.7.1.2.1. Have an accreditation, or obtain it no later than two (2) years after contract execution, by the Commission on Accreditation of Rehabilitation Facilities (CARF) or Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in accordance with the specifications contained in this open enrollment.

2.7.1.2.2. Have and maintain a current and valid Certificate of Occupancy for the location at which services are to be provided.

2.7.1.2.3. Hold one (1) of the following current and valid licenses or acceptance letter issued by HHSC or DSHS, or:

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

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

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

2.7.1.2.3.4. A Hospital or Specialty Hospital license by DSHS; or2.7.1.2.3.5. A chemical dependency treatment center license issued by DSHS;

or2.7.1.2.3.6. An acceptance letter from HHSC Regulatory Services Division or

from DSHS stating that an application for the license or license subset identified in sections 2.7.1.2.3.7 through 2.7.1.2.3.7.2 under which the Applicant is applying for a contract is complete and has been accepted by HHSC or DSHS, as applicable, prior to submission of an Application under this open enrollment.

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

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

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

2.7.2. Minimum Personnel Qualifications

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

2.8. Goal and Performance Measures

Contractor performance evaluation is based on assessment of the output and outcome measures outlined below and in compliance with the terms and conditions of the Contract, as indicated by HHSC contract management and contract monitoring performed by HHSC staff.

2.8.1. Goal

Goal of the Contract: The goal of the Post-Acute Rehabilitation Services contract is to ensure that consumers who have a traumatic brain injury or traumatic spinal cord injury, or both, receive individualized rehabilitation services to aid in attaining independence in the home and community.

2.8.2. Performance Measures

In addition to the Contractor's compliance with all of its obligations and duties under the Contract resulting from this open enrollment, HHSC will evaluate the performance of the Contractor on the basis of the following performance measures:

Performance MeasuresGoal of the Contract: To provide individualized rehabilitation services to eligible

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https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/home-community-support-services-agencies-hcssa/how-become-a-licensed-hcssa-provider

https://hhs.texas.gov/doing-business-hhs/provider-porta

https://hhs.texas.gov/doing-business-hhs/provider-porta

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



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


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3. UTILIZATION AND PAYMENT

3.1. Utilization

An indicator of the level of need for this service is historical utilization data. However, no level of service is guaranteed by this procurement or constitutes any promise or guarantee of service utilization on the part of HHSC. The methodology to determine a per diem state-wide rate includes a base rate, evaluation rate, and a core rate for residential services and base rate and billed services for non-residential services.

3.1.1. Residential Rates

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

3.1.2. Non-Residential Rates

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

3.1.3. Adopted Rates

Adopted rates for the Comprehensive Services Program will be effective on September 1, 2016, with the published rates being currently available online and can be accessed at: https://rad.hhs.texas.gov/long-term-services-supports/comprehensive-rehabilitation-services-program-crs.

3.2. Payment

3.2.1. Method of Payment

The Contract resulting from this open enrollment will be paid on a combination of fee-for-service, and per diem reimbursement methods funded by state, or state and federal, money

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

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


based on services provided. Total funding for these services is projected at $12,000,000.00 annually.

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

If the Contractor is providing services for a CRS consumer, then the Contractor must follow the CRS Standards for Providers, which are accessible at the following link: https://hhs.texas.gov/laws-regulations/handbooks/comprehensive-rehabilitation-services-crs-standards-providers.

3.2.1.2. Contractor will not be paid for services provided:

3.2.1.2.1. If a comparable benefit is available to fund services;3.2.1.2.2. Without a Service Authorization from HHSC; 3.2.1.2.3. Outside the date range authorized in the Service Authorization; or 3.2.1.2.4. Without a denial of benefits and explanation of benefits, as applicable.

3.3. Invoicing Process

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

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

3.4. Utilization and Review

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


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4. INFORMATION AND SUBMISSION INSTRUCTIONS

4.1. Open Enrollment Cancellation/Partial Award/Non-Award

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

4.2. Right to Reject Applications or Portions of Applications

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

4.3. Joint Applications

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

4.4. Withdrawal of Applications

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

4.5. Costs Incurred

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

4.6. Application Submission Instructions

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

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

4.6.1 Electronic Submission

Applicant may submit application packet by email to: [email protected]

4.6.2. Regular Mail Submission

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mailto:[email protected]


Applicant must submit two (2) electronic copies of all required documents as scanned versions (.pdf) on separate portable media devices, such as flash drives.

4.6.2.1. These devices and their content must be compatible with Microsoft Office 2010. Applicants must ensure there are no encryptions on these devices that would prevent HHSC from opening the documents. The electronic Application submission must be organized as directed in Subsection 4.7 of this open enrollment. If Applicant is having difficulty providing an electronic Application submission, contact the HHSC Point of Contact identified in Subsection 1.2 of this open enrollment for hard copy submittal accommodations.

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

4.6.2.3. Submission of an Application does not execute a Contract.

4.7. Organization of Application and Required Documents

Applicant must organize its scanned and signed Application packets in the following order and format. Each ( Select acceptable form of submission: flash drive, compact disc, E-mail or paper) submission of the Application packet must include the documents listed below. The documents must be in the appropriate order, numbered, and labeled accordingly.

File Folder 1: Application

Package A: Application Package B: HHSC Uniform Contract Terms and Conditions Version 2.15 Package C: HHSC Special Conditions Version 1.2 Package D: HHSC CRS Supplemental Conditions Version 1.0

File Folder 2: Required Forms

Package 1: Affirmation and Solicitation Acceptance Package 2: Work Experience Package 3: Application for Texas Identification Number Package 4: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary

Exclusion for Covered Contracts Package 5: Direct Deposit Authorization Package 6: Respondent Information and Disclosures

File Folder 3: Supporting Documentation

Assumed Name Certificate (If applicable); LLC Articles of Formation (If applicable); Certificate of Incorporation (If applicable); or Copy of Partnership Agreement and Signatory Assignment (If applicable).

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

A copy of the Applicant’s current and valid: License issued by HHSC as a:– Assisted Living Facility (“ALF”);– A Home and Community Support Services Agency (“HCSSA”);– Nursing facility; or

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

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

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

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

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

All CMS 2567, HHSC 3724 deficiency reports, and Statements of Deficiencies for up to and including the two (2) calendar years preceding the date of Application submittal; or if Applicant has no CMS 2567, HHSC 3724 deficiency reports, or Statements of Deficiencies for up to and including the two (2) calendar years preceding the date of Application submittal, a statement from Applicant attesting to that fact;

Narrative of Work experience, available in Form 2 of this Enrollment’s main mage, describing the organization's three (3) years of experience working with people who have a traumatic brain injury, traumatic spinal cord injury, or both including dates of service, positions held and place of employment;and

Investigation reports for the two (2) calendar years preceding the date of Application submittal; or if Applicant has no investigation reports for the two calendar years preceding the date of Application submittal, a statement from Applicant attesting to that fact.

4.8. Alternate Delivery of Applications

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

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

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

Delivery OptionPhysical Address for delivery

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

Attn: Blair Gossett5806 34th Street

Lubbock, Texas 79407

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

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

4.9. Requirements for Mailed or Delivered Applications

Submit one original set of all required documents and an electronic media device (flash drive or compact disc) containing the required documents. Documents and electronic media device must be placed in a sealed package and correctly identified with the Procurment Number of this open enrollment and in the order listed in Section 4.7. It is the Applicant’s responsibility to appropriately mark and deliver the application and related materials in response to this Enrollment.

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

Full Legal Name of the Organization; Organization’s point of contact; Organization’s point of contact’s job title; Organization’s point of contact’s telephone number and Email address; HHSC procurement number of this open enrollment; and Date of submission.


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5. ELIGIBILITY DETERMINATION

5.1. Initial Compliance Screening

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

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

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

5.2. Unresponsive Applications

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

5.2.1. The Applicant fails to meet major open enrollment specifications, including:

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

5.2.1.2. The Applicant is not eligible under Subsection 1.5 of this open enrollment.

5.2.1.3. The Applicant does not accept the payment rate established in this open enrollment.

5.2.2. The Application is not signed.

5.2.3. The Applicant’s Application is not clearly legible. Typewritten is preferred.

5.2.4. The Application is not received by the closing of the open enrollment period provided in Subsection 1.3 of this open enrollment.

5.3. Corrections to Application

Applicants have the right to amend their Application at any time prior to the completion of HHSC's initial screening and prior to sending the Application to HHSC for further screening (see, Subsection 5.2., Unresponsive Applications). To make corrections, Applicant must submit a written amendment to the HHSC Point of Contact, as designated in Subsection 1.2.

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5.4. Review and Validation of Applications

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

5.5. Additional Information

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

5.5.1. Past business history, practices, and conduct;

5.5.2. Prior regulatory compliance with federal and state statutes and rules;

5.5.3. Ability to supply the goods and services; and

5.5.4. Ability to comply with Contract requirements.

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

5.6. Method of Allocation

Method of allocation is based on a per diem state-wide rate that includes a base rate and a core rate for services the Contractor will provide consumers (residential or non-residential services) and the established CRS rates. The residential rate and non-residential rate will differ, as described in Section 3.1.

Because services provided are contingent upon the CRS consumer, any successful Applicant will be awarded a contract to provide services; however, there is no guarantee that any successful Applicant will receive any consumers for residential or non-residential services as a result of any awarded contract.

5.7. Debriefing

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

5.8. Protest Procedures

The protest procedure for an Applicant who is not awarded a Contract to protest an award or tentative award made by any HHS agency, is allowed for competitive Procurements. This Procurement is non-competitive and cannot be protested as provided in 1 TAC §391.403.

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http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=1&pt=15&ch=391&rl=403


6. GLOSSARY

TERM DEFINITION

Applicant Any individual or entity that submits an Application for enrollment pursuant to this open enrollment.

Application An Application submitted by an Applicant in response to this open enrollment.

Consumer Person receiving services who has a traumatic brain injury, traumatic spinal cord injury, or both.

Expectation Applicant’s perception of satisfaction as indicated by responses made to the items on the Applicant Satisfaction Survey Questionnaire.

Fiscal Year (State of Texas) The period beginning September 1 and ending August 31 of each year.

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

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

Post-Acute Brain Injury Services (PABI)

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

Post-Acute Rehabilitation Services

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

Post-Acute Spinal Cord Injury Services

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

Procurement The acquisition of goods or services.

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

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TERM DEFINITION

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

State The State of Texas.

State Agency Agency of the State of Texas as defined in Texas Government Code 2056.001.


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RFP Template - apps.hhs.texas.gov · Web viewRegistration with the Executive Council of Physical...

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Transcript of RFP Template - apps.hhs.texas.gov · Web viewRegistration with the Executive Council of Physical...