TITLE 26. HEALTH AND HUMAN SERVICES
PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 357. INDEPENDENT LIVING SERVICES PROGRAM
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §357.101, concerning Purpose; §357.103, concerning Legal Authority; §357.105, concerning Definitions; §357.201, concerning Allocation of Funds; §357.305, concerning Eligibility; §357.307, concerning Independent Living Plan; §357.309, concerning Waiting List; §357.311, concerning Scope of Services; §357.401, concerning Consumer Participation System; §357.403, concerning Fee Schedule Amount; §357.405, concerning Insurance Payments; §357.501, concerning Personal Rights; §357.503, concerning Complaint Process; §357.601, concerning Technical Assistance Provided by HHSC; and §357.701, concerning Referrals Received by HHSC Employees; and new §357.107, concerning Service Provider Standards and Contract Requirements.
Sections 357.105 and 357.305 are adopted with changes to the proposed text as published in the February 7, 2025, issue of the Texas Register (50 TexReg 742). These rules will be republished.
Sections 357.101, 357.103, 357.107, 357.201, 357.307, 357.309, 357.311, 357.401, 357.403, 357.405, 357.501, 357.503, 357.601, and 357.701 are adopted without changes to the proposed text as published in the February 7, 2025, issue of the Texas Register (50 TexReg 742). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015, required the dissolution of the Department of Assistive and Rehabilitative Services (DARS). Independent Living Services (ILS) transferred to HHSC from the legacy DARS as part of the Health and Human Services Transformation. The ILS Program was subsequently outsourced to the Centers for Independent Living (CIL) on September 1, 2016, as required by House Bill (H.B.) 2463, 84th Legislature, Regular Session, 2015. HHSC continues to oversee the ILS Program, except for Independent Living Services for Older Individuals who are Blind, which transferred to the Texas Workforce Commission as required by S.B. 208, 84th Legislature, Regular Session, 2015.
The amendments update references from DARS to HHSC, outdated terms such as "individual" or "consumer," and references to "person" or "people" to align with the agency's person-centered language policy. The new rule requires service providers to adhere to the service provider standards and clarifies that they are responsible for the quality of any services subcontracted to a vendor. An amendment changes the eligibility criteria to require a person to reside in Texas, instead of merely being present in Texas.
COMMENTS
The 31-day comment period ended March 10, 2025.
During this period, HHSC received comments regarding the proposed rules from five organizations: the Texas State Independent Living Council (SILC), REACH CIL, ARCIL, RISE CIL and TEXCIL. Many of the comments shared identical wording across the different organizations. A summary of the comments relating to the rules and HHSC's responses follows.
Comment: One commenter provided a statement from the 2025 Texas State Plan for Independent Living (SPIL) and recommended that HHSC add the designated state entity (DSE) assurances to the "background information" because adding it provides more transparency and clarity of the role of TXHHS as the DSE for both the Centers for Independent Living (CILs) and the SILC.
Response: HHSC believes that the commenter's use of "background information," means the background information in the adoption preamble. HHSC declines to add the information as recommended because that information is in the 2025 - 2027 Texas State Plan for Independent Living (SPIL) available on the SILC website.
Comment: Four commenters requested to change the purpose of the program in §357.101 and replace it with the definition of a CIL in the Rehabilitation Act of 1973, as amended.
Response: HHSC declines to change the rule in response to this comment. The purpose statement is intended to succinctly describe what the program does rather than a CIL. Much of the additional wording is incorporated either elsewhere in the chapter or in the standards for providers.
Comment: Five commenters requested to keep the original wording of §357.103(b) that "in case of a conflict, federal law prevails."
Response: HHSC declines to change the rule in response to this comment. The language is not necessary for the operation of the program.
Comment: One commenter requested inclusion of the definition of the State Plan for Independent Living (SPIL) and the State Independent Living Council (TXSILC) in §357.105.
Response: HHSC declines to change the rule in response to this comment. Chapter 357 explains how independent living services are provided by CILs contracting with HHSC. The State Plan for Independent Living includes some CILs that do not contract with HHSC. Additionally, there are some goals and objectives in the state plan which are not part of the array of services covered by CIL contracts with HHSC. Similarly, including the definition of the SILC is not necessary to explain the process for services provided by CILs contracted with HHSC.
Comment: Four commenters requested to change the term "consumer participation" in 357.105(11) and throughout the rule to "consumer financial match" to better reflect a financial responsibility.
Response: HHSC declines to change the rule in response to this comment. The definition of consumer participation in §357.105(11) states that it is a financial contribution a person may pay to receive independent living services. "Financial match" would imply that the person and the ILS program would pay the same amount, which is usually not the case.
Comment: Four commenters requested to change the definition of "nonprofit" in §357.105(19) to be less confusing.
Response: HHSC agrees to change the rule in response to this comment. HHSC has revised the definition of "nonprofit" to align with the definition found in 45 CFR §75.2, applicable per the authority found in 45 CFR §1329.3(c).
Comment: Four commenters requested to remove the definition of the Independent Living Services Program in §357.108 and replace it with the wording of the Rehabilitation Act of 1973, as amended.
Response: HHSC declines to change the rule in response to this comment. This definition is related to the state program operated by HHSC, rather than a definition of what independent living services are.
Comment: Four commenters requested to remove the new wording in §357.305(a) that a person must reside in Texas to be eligible for services.
Response: HHSC declines to change the rule in response to this comment. In addition to aligning the program with other programs at HHSC that require a person to reside in Texas, the rule's revision came at the request of several CILs, who felt the previous language of being "present in Texas" was challenging to implement. Section 357.305(a) is only for services where eligibility determination is required. For example, residency verification is not necessary to provide information and referral services, as it does not require eligibility or an independent living plan.
Comment: Five commenters requested removal of the phrase "eligibility is based on the documented diagnosis of a licensed practitioner" from §357.305(b).
Response: HHSC agrees to change the rule with modifications. The ILS program consists of two grants. For the purchased services grant, the requirement for the documented diagnosis of a licensed practitioner is important to ensure that people need the services being purchased for them. The CIL, not the person receiving services, pays for any medical records or evaluations required to obtain a diagnosis. However, there is not a requirement in the base grant (core services) standards to obtain a diagnosis. Therefore, HHSC has revised §357.305(b) to clarify that for purchased services, a service provider determines eligibility based on the documented diagnosis of a licensed practitioner, either at the at the time of eligibility or prior to the purchase of goods and services, and added that for core services, a service provider may determine eligibility without a documented diagnosis.
Comment: Four commenters requested to remove the word "must" when describing Independent Living Plans in §357.307.
Response: HHSC declines to change the rule in response to this comment. The term "must" is used in this context to describe obligations of the CIL, not the consumer, and does not impact flexibilities related to consumer needs or preference, nor impact a CIL's ability to terminate a plan, when necessary.
Comment: Five commenters requested to keep the original wording in §357.311 of "consumer information programs for persons who are minorities and who have been traditionally unserved and underserved."
Response: HHSC declines to change the rule in response to this comment. CILs are expected to engage with consumer information programs for all persons served by the CIL. The additional wording is not necessary.
Comment: Four commenters requested to replace all instances of "person" with "consumer."
Response: HHSC declines to change the rule in response to this comment. HHSC uses person-centered language, and while the term "consumer" is used when describing aspects of the ILS program (such as consumer participation or consumer satisfaction survey), "person" is used to describe anyone who has requested, applied for, or is receiving services through the Independent Living Services Program.
Comment: Three commenters recommended inclusion of the definition of "minorities" and "underserved populations" in Texas Human Resources Code §117.080.
Response: HHSC declines to make the requested change. This comment is outside the scope of the rule project. Further, HHSC does not have the authority to amend statutes such as the Texas Human Resources Code.
SUBCHAPTER
A.
STATUTORY AUTHORITY
The amendments and new are adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system; and Texas Human Resources Code §117.080(e), which authorizes the executive commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to CILs providing independent living services under the program.
§
357.105.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.
(1) Ability to pay--The determination that a person is able to contribute financially toward the cost of independent living services.
(2) Accessible format--An alternative way of providing to a person with disabilities the same information, functionality, and services provided to a person without a disability. Examples of accessible formats include braille, accessible digital content, large print, American Sign Language, and recorded audio.
(3) Act--The Rehabilitation Act of 1973, as amended.
(4) Adjusted income--The dollar amount that is equal to a household's annual gross income, minus allowable deductions.
(5) Allotment--Funds distributed to a service provider by HHSC to provide services under this chapter.
(6) Allowable deductions--Certain unreimbursed household expenses that are subtracted from a household's annual gross income to calculate the adjusted income.
(7) Blind--A condition of having no more than 20/200 visual acuity in the better eye with correcting lenses or having visual acuity greater than 20/200 but with a field of vision in which the widest diameter subtends an angle no greater than 20 degrees.
(8) CAP--Client Assistance Program. A federally funded initiative that provides information, assistance, and advocacy for people with disabilities who are seeking or receiving services from CAPs funded under the Act. The CAP is implemented by Disability Rights Texas (DRTx), a legal services organization whose mission is to protect the human, service, and legal rights of persons with disabilities in Texas.
(9) CIL--Center for Independent Living. A private nonprofit agency for people with significant disabilities (regardless of age or income) that is not residential, is consumer-controlled, is community-based, takes a cross-disability approach; and
(A) is designed and operated within a local community by persons with disabilities; and
(B) provides an array of independent living services, including, at a minimum, independent living core services as they are defined in 29 United States Code (U.S.C.) §705(17).
(10) Comparable services or benefits--Services and benefits that are provided or paid for, in whole or part, by other federal, state, or local public programs; by health insurance, third-party payers, or other private sources; or by the employee benefits that are available to a person and are commensurate in quality and nature to the services that the person would otherwise receive from a service provider.
(11) Consumer participation--The financial contribution that a person may be required to pay for receiving independent living services.
(12) Consumer participation agreement--A document signed by a person and a CIL that outlines the percentage of adjusted income a person is required to contribute toward the cost of services.
(13) Consumer participation system--The system for determining and collecting the financial contribution that a person may be required to pay for receiving independent living services.
(14) Federal poverty level guidelines--The poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under the authority of 42 U.S.C. §9902(2).
(15) Fee--A percentage of the full cost for a purchased service that a person pays. The percentage is based on the HHSC fee schedule and the fee does not exceed the maximum amount prescribed by HHSC.
(16) HHSC--The Texas Health and Human Services Commission.
(17) Independent living plan--A written plan in which a person and service provider have collaboratively identified the services that are needed to achieve the person's goal of living independently.
(18) Independent Living Services Program--The group authorized to oversee the services outlined in 29 U.S.C. §705(17) and (18). In Texas, that authority rests with HHSC. May also be referred to as "the program."
(19) Nonprofit organization--Any corporation, trust, association, cooperative, or other organization, not including an institution of higher education, that:
(A) is operated primarily for scientific, educational, service, charitable, or similar purposes in the public interest;
(B) is not organized primarily for profit; and
(C) uses net proceeds to maintain, improve, or expand the operations of the organization.
(20) Person--Anyone who has requested, applied for, or is receiving services through the Independent Living Services Program.
(21) Private--An agency, organization, or institution that is not under federal or public supervision or control.
(22) Representative--Anyone chosen by a person served in the program, including the person's parent, guardian, other family member, or advocate. If a court has appointed a guardian or representative, that person is the representative. Unless documentation is provided showing otherwise, a parent or court-appointed guardian is presumed to be the representative for a person who is under 18 years of age and is not emancipated or married.
(23) Service provider--A CIL, nonprofit organization, organization, or other person who contracts with HHSC to provide independent living services.
(24) Severe visual impairment--A condition of having a visual acuity with best correction of 20/70 or less in the better eye, a visual field of 30 degrees or less in the better eye, or having a combination of both.
(25) Significant disability--A severe physical, mental, cognitive, or sensory impairment that substantially limits a person's ability to function independently in the family or community.
(26) Sliding fee scale--The fee scale HHSC uses to determine the maximum financial contribution that a person may be required to pay for receiving independent living services. The scale is based on the federal poverty level guidelines.
(27) Support services--Accommodations provided to a person to assist the person at an appointment with a service provider or vendor. Examples include translators, interpreters, braille, large print, and transportation.
(28) Transition services--Services that:
(A) facilitate the transition of a person with a significant disability from nursing homes and other institutions to home and community-based residences, with the requisite supports and services;
(B) provide assistance to a person with a significant disability who is at risk of entering an institution so that the person may remain in the community; and
(C) facilitate the transition of youth with significant disabilities, who were eligible for individualized education programs under section 614(d) of the Individuals with Disabilities Education Act, 20 U.S.C. §1414(d), and have completed secondary education or have otherwise left school to postsecondary life.
(29) Vendor--A person or organization subcontracted by a service provider to provide independent living services.
(30) Waived independent living plan--A written plan in which the service provider identifies on the behalf of the person the services that are needed to achieve the person's goal of living independently. The service provider writes the plan because the person has signed a waiver giving up the person's right to participate in the development of such a written plan.
(31) Youth with a disability--A person with a disability who is at least 14 years of age but younger than 24 years of age.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 14, 2025.
TRD-202501645
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: June 3, 2025
Proposal publication date: February 7, 2025
For further information, please call: (817) 458-1902
SUBCHAPTER
B.
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system; and Texas Human Resources Code §117.080(e), which authorizes the executive commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to CILs providing independent living services under the program.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 14, 2025.
TRD-202501646
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: June 3, 2025
Proposal publication date: February 7, 2025
For further information, please call: (817) 458-1902
SUBCHAPTER
C.
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system; and Texas Human Resources Code §117.080(e), which authorizes the executive commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to CILs providing independent living services under the program.
§
357.305.
(a) To be eligible for independent living services, a person must:
(1) have a significant disability as defined in §357.105 of this chapter (relating to Definitions); and
(2) reside in Texas.
(b) For purchased services, a service provider determines eligibility based on the documented diagnosis of a licensed practitioner, either at the at the time of eligibility or prior to the purchase of goods and services. For core services, a service provider may determine eligibility without a documented diagnosis.
(c) Eligibility requirements are applied without regard to a person's race, religion, color, national origin, disability, age, sex, or in retaliation for prior civil rights activity.
(d) After a service provider documents a person is eligible for services, the service provider:
(1) notifies the person or the person's representative in writing about the person's fee, as described in §357.401 of this chapter (relating to Consumer Participation System);
(2) verifies all potential comparable services or benefits that may be covered for independent living services, as provided under this chapter; and
(3) maintains all related documentation.
(e) If a service provider determines that a person is ineligible based on the criteria described in this section, the service provider must document the determination of ineligibility and provide HHSC with a copy that is signed and dated by the service provider's executive director or designee.
(1) A service provider may determine a person to be ineligible for independent living services only after consultation with the person or the person's representative or after providing a clear opportunity for consultation.
(2) A service provider notifies a person in writing of the action taken and informs the person or the person's representative about the person's rights and the means by which the person may appeal the action taken or file a complaint.
(3) A service provider refers the person to other agencies and facilities, if appropriate, including to the Texas Workforce Commission's vocational rehabilitation program.
(4) If a service provider determines that a person is ineligible for independent living services, the service provider reviews the person's status again within 12 months of the determination and whenever the service provider determines that the person's status has materially changed.
(5) A service provider does not conduct a review of an ineligibility determination if:
(A) the person refuses one;
(B) the person no longer resides in Texas; or
(C) the person's whereabouts are unknown.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 14, 2025.
TRD-202501647
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: June 3, 2025
Proposal publication date: February 7, 2025
For further information, please call: (817) 458-1902
SUBCHAPTER
D.
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system; and Texas Human Resources Code §117.080(e), which authorizes the executive commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to CILs providing independent living services under the program.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 14, 2025.
TRD-202501648
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: June 3, 2025
Proposal publication date: February 7, 2025
For further information, please call: (817) 458-1902
SUBCHAPTER
E.
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system; and Texas Human Resources Code §117.080(e), which authorizes the executive commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to CILs providing independent living services under the program.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 14, 2025.
TRD-202501649
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: June 3, 2025
Proposal publication date: February 7, 2025
For further information, please call: (817) 458-1902
SUBCHAPTER
F.
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system; and Texas Human Resources Code §117.080(e), which authorizes the executive commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to CILs providing independent living services under the program.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 14, 2025.
TRD-202501650
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: June 3, 2025
Proposal publication date: February 7, 2025
For further information, please call: (817) 458-1902
SUBCHAPTER
G.
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system; and Texas Human Resources Code §117.080(e), which authorizes the executive commissioner of HHSC to adopt rules necessary to implement that section, including requirements applicable to CILs providing independent living services under the program.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 14, 2025.
TRD-202501651
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: June 3, 2025
Proposal publication date: February 7, 2025
For further information, please call: (817) 458-1902