Charles Smith, Executive CommissionerOpen Enrollment

For

Health & Human Services CommissionComprehensive Rehabilitation Services

Enrollment Number: HHS0000073

Enrollment Period Opens: April 17, 2017

Enrollment Period Closes: August 31, 2021

NIGP Class/Item Code:

948-46 952-59948-76 952-68948-86 952-81952-21 952-85952-53 952-92

Addendum #4: 02/08/18Addendum #3: 07/13/17Addendum #2: 06/27/17Addendum #1: 05/19/17

TABLE OF CONTENTS

1. GENERAL INFORMATION...............................................................................................31.1. SCOPE............................................................................................................................31.2. POINT OF CONTACT.........................................................................................................31.3. PROCUREMENT SCHEDULE...............................................................................................31.4. TERMS AND CONDITIONS..................................................................................................41.5. BACKGROUND..................................................................................................................41.6. ELIGIBLE APPLICANTS......................................................................................................51.7. STRATEGIC ELEMENTS.....................................................................................................61.8. AMENDMENTS AND ANNOUNCEMENTS REGARDING THIS OPEN ENROLLMENT.....................71.9. DELIVERY OF NOTICES.....................................................................................................8

2. STATEMENT OF WORK...................................................................................................92.1. PROGRAM PURPOSE........................................................................................................92.2. APPLICANT REQUIREMENTS............................................................................................102.3. SERVICE DELIVERY AREA(S)..........................................................................................102.4. ELIGIBLE POPULATION....................................................................................................112.5. CONSUMER CHARACTERISTICS.......................................................................................11

3. PAYMENT.......................................................................................................................133.1. PAYMENT.......................................................................................................................133.2. INVOICING PROCESS......................................................................................................14

4. INFORMATION AND SUBMISSION INSTRUCTIONS...................................................154.1. OPEN ENROLLMENT CANCELLATION/PARTIAL AWARD/NON-AWARD.................................154.2. RIGHT TO REJECT APPLICATIONS OR PORTIONS OF APPLICATIONS..................................154.3. JOINT APPLICATIONS......................................................................................................154.4. WITHDRAWAL OF APPLICATIONS.....................................................................................154.5. COSTS INCURRED..........................................................................................................154.6. APPLICATION SUBMISSION INSTRUCTIONS.......................................................................154.7 ORGANIZATION OF (ELECTRONIC OR PAPER) SUBMISSION OF APPLICATION.........................164.8. ELECTRONIC (OR PAPER) COPY.....................................................................................174.9 DELIVERY OF APPLICATIONS...............................................................................................17

5. ELIGIBILITY DETERMINATION.....................................................................................195.1. INITIAL COMPLIANCE SCREENING....................................................................................195.2. UNRESPONSIVE APPLICATIONS.......................................................................................195.3. CORRECTIONS TO APPLICATION......................................................................................195.4. REVIEW AND VALIDATION OF APPLICATIONS....................................................................195.5. ADDITIONAL INFORMATION..............................................................................................205.6. METHOD OF ALLOCATION...............................................................................................205.7. DEBRIEFING...................................................................................................................205.8. PROTEST PROCEDURES.................................................................................................20

6. GLOSSARY.....................................................................................................................21

1. GENERAL INFORMATION

1.1. ScopeThe State of Texas, by and through the Health and Human Services Commission (HHSC), seeks to contract inpatient, outpatient hospital services and acute inpatient comprehensive medical rehabilitation services provided to individuals with traumatic spinal cord injury (TBI) and/or traumatic spinal cord injury (SCI) in accordance with the specifications contained in this open enrollment.

1.2. Point of ContactThe Health and Human Services Commission (HHSC) Point of Contact for inquiries concerning this open enrollment until the completion of the initial application screening is:

Point of Contact: Blair Gossett, Project Manager

Address: Health and Human Services AgencyOffice of Independence ServicesBlair Gossett5806 34th StreetLubbock, Texas 79407

Phone: 806-791-7533

Email: blair.gossett@hhsc.state.tx.us

Office Hours: 8:00 AM to 5:00 PM Monday through Friday Applicant must direct all procurement communications relating to this open enrollment to the HHSC Point of Contact named above unless specifically instructed to an alternate Contact by HHSC.

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

1.3. Procurement ScheduleAll dates are subject to change at HHSC's discretion. Applications must be received by the HHSC Point of Contact identified above 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 04/13/ 2017Open Enrollment Period Closes 08/31/2021 5:00 PM CST

1.3.1. Adjustments to Closing DateHHSC may, at our sole discretion and without additional notice adjust the closing date for the 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 EnrollmentHHSC may without additional notice close or re-open the enrollment period for the 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 ConditionsThe 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 1.0

1.4.4. HHSC Data Use Agreement and the HHSC Information Security and Privacy Initial Inquiry (SPI).

1.5. Background

1.5.1. Overview of the Health and Human Services Commission (HHSC)

Since 1991, the Texas Health and Human Services Commission (HHSC) has overseen and coordinated the planning and delivery of health and human service programs in 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). HHSC’s chief executive officer is Charles Smith, Executive Commissioner of Health and Human Services.

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 HHSC. As such, HHSC will administer the initial stages of the procurement process, including enrollment announcement and publication, handling of communications from the applicant, as well as managing the receipt and handling of valid applications.

1.5.2. Project OverviewThe purpose of the Health and Human Services Commission- Comprehensive Rehabilitation Services program is to enroll qualified providers who provide medical and rehabilitation services in inpatient and outpatient hospital settings to individuals with traumatic brain injury and/or traumatic spinal cord injury improve self-care,

communication, and mobility in order to function more independently in the home and community.

1.6. Eligible ApplicantsTo be eligible to apply for a contract and receive an award through this open enrollment, Applicants 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. Be a:

Sole Proprietorship; General Partnership; Corporation; Limited Liability Company; or Limited Partnership;

1.6.8. Hold either one or more of the following credentials:

1.6.8.1. Hospital license issued by the Department of State Health Services (“DSHS”) and be in compliance the licensing regulations that are available online and can currently be accessed at: http://dshs.texas.gov/facilities/hospitals/laws-rules.aspx; or

1.6.8.2. Be accredited by the Commission on Accreditation of Rehabilitation Facilities (“CARF”) and in compliance with its standards that are

available online and can currently be accessed at: http://bookstore.carf.org/category/int-pubs.html; or

1.6.8.3. Be certified by the Joint Commission on Accreditation of Healthcare Organizations (“JCAHO”) and in compliance with its standards that are available online and can currently be accessed at: https://www.jointcommission.org/standards_information/edition.aspx.

1.7. Strategic Elements

1.7.1. Contract Type and Term

HHSC will award one or more Contracts for Hospital Services as described in the Statement of Work. The initial resulting Contract term will be effective for two years from the date of execution, 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 period or periods of time no greater than a cumulative total of five years, which five-year period includes the original contract term.

1.7.2.Contract Elements

1.7.2.1. 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: this open enrollment and all exhibits and attachments thereto; 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; the Data Use Agreement for Contractors who access agency confidential information and who are not exempt; 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 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. Security and Privacy Initial Inquiry (SPI)

All Contractors who are subject to the terms of the HHSC Data Use Agreement will also be required to complete a Security and Privacy Inquiry (SPI) if they are not

exempt. HHSC, in its sole discretion, will determine whether an Applicant's Contract will require the Applicant to be subject to a Data Use Agreement and SPI. Unless HHSC has determined that the Applicant is not subject to a Data Use Agreement and SPI, by entering into a contract with a Texas Health & Human Services agency, Applicant agrees to be bound by the terms of the HHSC DUA and SPI.

The HHS Data Use Agreement along with the HHS Information Security and Privacy Initial Inquiry (SPI) form is available at the end of this solicitation in (See Subsection of this open enrollment). Information can also be found at https://hhs.texas.gov/doing-business-hhs/business-and-contracting-opportunities

1.7.4. 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 Enrollment Opportunities (https://apps.hhs.texas.gov/pcs/openenrollment.cfm). HHSC

reserves the right to revise the open enrollment at any time and to make unilateral amendments to correct grammar, organization, and clerical errors. It is the responsibility of each Applicant to comply with any changes, amendments, or clarifications posted to the HHS Enrollment Opportunities. Applicant must check HHS Enrollment Opportunities frequently for changes and notices of matters affecting this open enrollment.

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.

All questions and comments regarding this open enrollment should be sent to the HHSC Point of Contact identified in subsection 1.2. Questions must reference the appropriate page and section number. HHSC’s will post subsequent answers to questions to the HHS Enrollment Opportunities as appropriate. HHSC reserves the right to amend answers prior to the open enrollment closing date.

Applicants should notify HHSC of any ambiguity, conflict, discrepancy, omission or other error in the open enrollment.

1.9. Delivery of Notices

Any notice required or permitted under this announcement by one party to the other party must be in writing and correspond with the contact information noted in subsection 1.2 of this open enrollment. 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.

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 traumatic brain injury (TBI) and/or traumatic spinal cord injury (TSCI) improve their ability to function independently in the home and the community. The program focuses to improve self-care, communication, and mobility in order to function more independently in the home and community. Hospital services may include the following:

Hospital Services: Inpatient or outpatient services necessary to correct or substantially modify, within a reasonable period of time, a condition that is stable or slowly progressive. Inpatient services include room, board, and professional services for more than a 24-hour duration. Outpatient services are less than 24 hours in duration and do not require admission to the hospital for an overnight stay. Inpatient comprehensive medical rehabilitation services (ICMRS) are part of hospital services that address medical and rehabilitation issues that require 24-hour-a-day nursing services, and are provided as recommended by an interdisciplinary team in a hospital setting. The services are specified in the service array and, unless otherwise specified, should be considered all inclusive. If a consumer requires medication, the medication is provided by the hospital pharmacy. Pharmacy charges appear as a line item on the invoice and are paid according to the contracted rate. Goods or services approved by the CRS program that are not part of the contracted rate for inpatient comprehensive medical rehabilitation services are considered ancillary and must be pre-authorized before service is rendered if services are not preauthorized then there is no guarantee of payment.

Implantable Device: Implantable device means an object or device that is surgically:

(A) Implanted;(B) Embedded;(C) Inserted;(D)or otherwise applied; and(E) Related equipment necessary to operate, program and recharge the implantable.

Medical Records: The written history of those services provided to an individual during a hospital stay or while receiving outpatient services. Medical records may include an admitting history and physical narrative; operative reports; progress notes; or discharge summaries.

Psychological Services: Psychological testing and psychological counseling provided by or under the supervision of a licensed psychologist.

A general diagnostic battery includes but is not limited to: Diagnostic interview and history; full scale intelligence test, projective or objective personality test; standardized academic achievement test; review and evaluation with a written report.

A neuropsychological testing battery includes but is not limited to: Diagnostic interview and review of history, assessments, and test data provided from the general diagnostic battery; evaluation of verbal-cognitive factors resulting from general diagnostic battery; evaluation of emotional coping factors resulting from general diagnostic battery; standard neuropsychological batteries, or series of appropriate tests accepted in the field; written narrative report.

Third Party Payment: Payment by a financial agent, including but not limited to self-insured plans, commercial/private insurance plans, Medicare, Medicaid, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. CRS is considered the payor of last resort. If a consumer has third party benefits the contractor is required to provide CRS with the explanation of benefits (EOB) or denial from other pay sources(s). It is the contractor's responsibility to communicate with CRS staff regarding pre-authorizations or estimated third party payment prior to service delivery in order for CRS staff to provide appropriate authorization of services.

2.2. Applicant Requirements

The Applicant must:

2.2.1. Based upon its credentialing provide services in compliance with one or more of the following:

2.2.1.1. DSHS hospital licensing regulations currently located at http://dshs.texas.gov/facilities/hospitals/laws-rules.aspx; or

2.2.1.2. CARF standards currently located at http://bookstore.carf.org/category/INT-PUBS.html; or

2.2.1.3. JCAHO standards currently located at https://www.jointcommission.org/standards_information/edition.aspx

2.2.2. Comply with 40 Texas Administrative Code (TAC) Chapter 107 and the CRS Standards for Providers Manual that is available online and can currently be accessed at https://hhs.texas.gov/laws-regulations/handbooks/comprehensive-rehabilitation-services-crs-standards-providers.

2.2.3. The Contractor will ensure programmatic supporting records are:

sufficient to support performance in accordance with the contract; adequate to document compliance with applicable standards; easily retrievable; and available to HHSC upon request.

2.3. Service Delivery Area(s)

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

2.4. Eligible Population

Consumer eligibility is determined by applicable law 40 TAC §107.707 and consumers must meet eligibility requirements as outlined in the CRS Standards for Providers Manual (https://hhs.texas.gov/laws-regulations/handbooks/comprehensive-rehabilitation-services-crs-standards-providers).

2.5. Consumer Characteristics

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

2.5.1. Cognitive deficits

2.5.1.1. Attention2.5.1.2. Concentration2.5.1.3. Distractibility2.5.1.4. Memory2.5.1.5. Speed of Processing2.5.1.6. Confusion2.5.1.7. Perseveration2.5.1.8. Impulsiveness2.5.1.9. Language Processing2.5.1.10. Executive functions

2.5.2. Speech and Language deficits

2.5.2.1. Not understanding the spoken word (receptive aphasia)2.5.2.2. Difficulty speaking and being understood (expressive aphasia)2.5.2.3. Slurred speech2.5.2.4. Speaking very fast or very slow2.5.2.5. Problems reading2.5.2.6. Problems writing

2.5.3. Sensory deficits

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

2.5.4. Perceptual deficits

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

2.5.5. Vision deficits

2.5.5.1. Partial or total loss of vision

2.5.5.2. Weakness of eye muscles and double vision (diplopia)2.5.5.3. Blurred vision2.5.5.4. Problems judging distance2.5.5.5. Involuntary eye movements (nystagmus)2.5.5.6. Intolerance of light (photophobia)

2.5.6. Hearing deficits

2.5.6.1. Decrease or loss of hearing2.5.6.2. Ringing in the ears (tinnitus)2.5.6.3. Increased sensitivity to sounds

2.5.7. Smell deficitsLoss or diminished sense of smell (anosmia)

2.5.8. Taste deficitsLoss or diminished sense of taste

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

2.5.10. Physical Changes

2.5.10.1. Physical paralysis/spasticity2.5.10.2. Chronic pain2.5.10.3. Control of bowel and bladder2.5.10.4. Sleep disorders2.5.10.5. Loss of stamina2.5.10.6. Appetite changes2.5.10.7. Regulation of body temperature2.5.10.8. Menstrual difficulties

2.5.11. Social-Emotional deficits

2.5.11.1. Dependent behaviors2.5.11.2. Emotional ability2.5.11.3. Lack of motivation2.5.11.4. Irritability2.5.11.5. Aggression2.5.11.6. Depression2.5.11.7. Disinhibition2.5.11.8. Denial / lack of awareness

3. PAYMENT

3.1. Payment

3.1.1. Method of Payment

The Contract resulting from this open enrollment will be paid in accordance with the contract requirements and based on negotiated rates with facilities to provide services based on data from the Healthcare Cost Report Information System of the Centers for Medicare and Medicaid Services unless otherwise specified.

3.1.1.1. 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 based on negotiated contract rate(s).

3.1.1.2. 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

3.1.1.3. Contractor will not be paid for services provided:

3.1.1.3.1. If a comparable benefit is available to fund services;3.1.1.3.2. Without a Service Authorization from HHSC; 3.1.1.3.3. Outside the date range authorized in the Service Authorization;or 3.1.1.3.4. Without a denial of benefits and explanation of benefits, as applicable.

3.1.2. Hospital Services: Inpatient and outpatient rates will be based upon the final contracted rate.

3.1.3. Implantable Device: Payment for an implantable device, excluding eye-related implants, shall be the manufacturer’s invoice amount or the net cost to the hospital, whichever is less, plus 10 percent. Along with the hospital invoice requesting payment, submit either:

3.1.3.1. The manufacturer’s invoice; or3.1.3.2. Other acceptable supporting documentation showing the net cost to

hospital.

3.1.4. Robotic Surgery: HHSC will pay for the primary surgical procedure that the surgeon deems necessary, but will not permit an additional payment allowance for a robotic surgical technique or use of a robotic surgical system.

3.1.5. Psychological Services: Psychological services are paid based upon the final contracted rate, unless otherwise specified on the Services Authorization.

3.1.6. Medical Records: Contractor's customary charges, not to exceed $18 per request.

3.2. Invoicing Process

The Contractor will submit to HHSC a total bill each month in the format prescribed by HHSC and in accordance with the contracted rate.

3.2.1.To receive payment, a Contractor must submit an invoice to HHSC and the invoice must be in accordance with 34 TAC §20.487, Invoicing Standards, which should in include, but is not limited to:

Contractor’s Legal Name, State of Texas Vendor number or federal tax Identification number, Remit-to address, Contractor's Telephone number, Invoice number, HHSC Contract Number, State agency name of requestor, Description of goods and services provided, including CPT (current

procedural terminology) codes, CRS service authorization number Date of Service, Quantity and unit-cost being billed (as documented in the service

authorization, Invoice guidelines outlined in the CRS Manual for Providers

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

If there is a third party benefit the contractor is required to provide CRS with the explanation of benefits (EOB) or denial from other pay sources(s),

The name and telephone number of a person designated by the contract to answer questions regarding the invoice.

3.2.2. Due Date

Program and financial information must be submitted to HHSC by the 10 th of the following month for each month of the contract period and must contain the established reporting information. If there is a third party benefit contractor must provide all applicable communication and status of pending claims.

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

4. 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 responses or portions thereof.

4.3. Joint Applications

HHSC will not consider joint or collaborative responses that require it to contract with more than one Applicant in a single contract.

4.4. Withdrawal of Applications

Applicants have the right to withdraw their Application 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

Applicants understand that issuance of this open enrollment in no way constitutes a commitment by the HHS agency 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. The HHS agency 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

Applicant's responsibility of interested parties to periodically check HHS Enrollment Opportunities for updates to the procurement prior to submitting an application. The 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.

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

4.6.1 Electronic Submission

Applicant may submit application packet by email to: blair.gossett@hhsc.state.tx.us

4.6.2. Regular Mail Submission

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, so as to 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 (Electronic or Paper) Submission of Application

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

Attachment A: Application Attachment B: Contract Information Attachment C: HHSC Data Use Agreement Attachment D: HHSC Special Conditions Version 1.2 Attachment E: HHSC Information Security and Privacy Initial Inquiry (SPI) Attachment F: HHSC CRS Supplemental Conditions 1.0

File Folder 2: Required Forms

Form 1: Affirmation and Solicitation Acceptance Form 2: Anti-Trust Certification Form 3: Application for Texas Identification Number Form 4: Certification Regarding Debarment, Suspension, Ineligibility and

Voluntary Exclusion for Covered Contracts Form 5: Certification Regarding Federal Lobbying Form 6: Child Support Certification Form 7: Direct Deposit Authorization Form 8: Payee Change Request Form 9: Respondent Information and Disclosures

File Folder 3: Supporting Documentation

IRS Letter Assigning Federal Tax ID Number Copy of Hospital License(s), JCAHO Accreditation, and/or CARF

Certification. G-3 Worksheet from the last two (2) Medicare cost reports submitted to the

Centers for Medicare and Medicaid Services. Provide a list of locations and services provided at each location. Include

the name of the facility, address, and service provided.

NOTE: Each individual document requested in File Folders 1, 2, and 3 must be collated; in sequential order; labeled; and submitted as delineated in this subsection.

4.8. Electronic (or Paper) Copy

Label the (Electronic Media Device (flash drive or compact disc), E-mail Application submittal, or Paper copy of the Application).

4.8.1 Each (flash drive, compact disc, E-mail submission, or paper copy) must be labeled with the:

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

4.8.2 Each flash drive must be in an envelope and the envelope must be labeled with the:

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

4.9 Delivery of Applications

4.9.1 Submit all copies of the Application to HHSC Division 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 CommissionOffice of Independence Services

Blair Gossett5806 34th Street

Lubbock, Texas 79407

4.9.2 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. All Applications must be submitted by hand delivery, by courier, or by mail.

HHSC will not accept Applications by any other method of delivery (e.g., telephone, facsimile, or email).

4.9.3 All Applications become the property of HHSC after submission.

The remainder of this page is intentionally left blank.

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 evaluation.

If the Application passes the initial screening, the contract manager will contact the Applicant for further instructions or actions.

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. 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 response 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 an unresponsive decision or Contract award decision by submitting a written amendment to the HHSC Point of Contact, as designated in subsection 1.2. HHSC may request modifications to the Application at any time.

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 information from any lawful source regarding the Applicant’s, its directors’, officers’, and employees:

5.5.1. Past business history, practices, and conduct;

5.5.2. Ability to supply the goods and services; and

5.5.3. 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 the Applicant. HHSC may take such information into consideration in screening or the validation of information on Applications or supporting documentation.

5.6. Method of Allocation

A referral for services will be made to the Contractor who can best meet the child's needs, and placement with the Contractor is in the best interest of the consumer.

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 provided in subsection 1.2 of this open enrollment. The debriefing provides information to the Applicant on the strengths and weaknesses of their 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 .

The remainder of this page is intentionally left blank.

6. GLOSSARY

TERM DEFINITIONAgreement A promise or a set of promises, for breach of which the law

gives a remedy, or the performance of which the law in some way recognizes as a duty. It is an agreement between two or more parties creating obligations that are enforceable or otherwise recognizable at law. The term also encompasses the written document that describes the terms of the agreement. For state contracting purposes, it generally describes the terms of a purchase of goods or services from a vendor or service provider.

Amendment A formal revision or addition to a contract.

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.

Best Interests of the State

Most advantageous to the state in light of all relevant circumstances.

Business Day Any day other than a Saturday, Sunday, or day in which Texas state offices are authorized or obligated by law or executive order to be closed.http://www.hr.sao.texas.gov/Holidays

Commission Texas Health and Human Services Commission.

Complaint A concern reported to HHSC contract staff about the Contractor’s professionalism and/or quality of work.

TERM DEFINITIONConfidential Information Any communication or record (whether oral, written

electronically stored or transmitted, or in any other form) that consist of:

(1) Confidential Client information, including Protected Health Information; (2) All non-public budget, expense, payment and other financial information; (3) All privileged Work Product; (4) All information designated by HHSC or any other State agency as confidential, including all information designated as confidential under the Texas Public Information Act, Texas Government Code, Chapter 552; (5) Unless publicly disclosed by HHSC or the State, the pricing , payments, and terms and conditions of the Agreement; and (6) Information that is utilized developed, received, or maintained by HHSC, the Contractor, or participating State agencies for the purpose of fulfilling a duty or obligation under this Agreement and that has not been publicity disclosed.

Conflict of Interest A conflict of interest is a situation that creates a risk that professional judgement or actions will be unduly influenced by a personal interest or relationship and creates substantial conflicts with the proper discharge of duties required by this contract and the public interest

Contact To get in touch with or communicate with via face-to-face, electronic communication (telephone, text, email, or computer/webcam) or letter.

Contract A promise or a set of promises, for breach of which the law gives a remedy, or the performance of which the law in some way recognizes as a duty. It is an Agreement between two or more parties creating obligations that are enforceable or otherwise recognizable by law. The term also encompasses the written document that describes the terms of the Agreement. For State Contracting purposes, it generally describes the terms of a purchase of goods or services from a vendor or service provider.

Contract Action The exercise of any action authorized under the terms of the contract related to the contract. Contract actions include, but are not limited to, modifications, renewals, and assessment of remedies.

TERM DEFINITIONContract Management Contract management is a core function that involves the

continual monitoring of a contractor's performance to ensure its compliance with terms and conditions of a contract. It begins once all parties have signed a contract.

Contract Performance Measures Report

A tool developed and utilized by HHSC to evaluate the Contractor’s performance during the life of the contract against the Performance Measures.

Contract Renewal The act of time beginning with the commencement date or effective date of a contract and ending when the contract expires in accordance with its terms, or when it has been terminated. The contract term includes renewal options exercised.

Contract Term The period beginning with the commencement date or effective date of a contract and ending when the contract expires in accordance with its terms, or when terminated. The contract term includes actual exercised renewal options.

Contractor Any Applicant who is awarded a contract pursuant to this open enrollment or who has an existing contract to provide inpatient, outpatient hospital services and acute inpatient comprehensive medical rehabilitation services

Credentialing Documents Documents that support the provider met the required qualifications for provision of service, such as a license, background check results, and insurance coverage.

Deliverable A written, recorded, or otherwise tangible work product prepared, developed, or procured by the contractor and provided as part of the contractor’s obligations under the contract. A discrete type or increment of work. The work may involve the delivery of goods or services.

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

Evaluation Services An array of methods to aid in the identification of conditions and events directly related to risk and safety

Face-to-Face Contact In person; directly.

Fair Billing The standard, usual, and customary rate charged by the Contractor, which should be consistent with the amounts charged to any other party for similar services.

Fiscal Year (State of Texas)

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

TERM DEFINITIONHealth and Human Services Agency A state agency identified in § 531.001, Government Code.

Health and Human Services Commission (HHSC)

Means the administrative agency established under Chapter 531, Texas Government Code or its designee.

Hospital Services Inpatient or outpatient services necessary to correct or substantially modify, within a reasonable amount of time, a condition that is stable or slowly progressive. Inpatient services include room, board, and professional services for more than 24 hour duration. Outpatient services are less than 23 hours in duration and do not require admission to the hospital or overnight stay.

Implantable Device Implantable device means an object or device that is surgically: (A) Implanted(B) Embedded(C) Inserted(D)Or otherwise applied; and(E) Related equipment necessary to operate, program and

recharge the implantable.

Inpatient Comprehensive Medical Rehabilitation Services

Medical and rehabilitation services that require 24-hour-a-day nursing services to individuals who have a traumatic brain injury (TBI), a traumatic spinal cord injury (TSCI), or both. An interdisciplinary team of professionals closely coordinates services to achieve the team’s treatment goals, thereby minimizing a person's physical or cognitive disabilities and maximizing a person's functional capacity to function more independently in the home and community.

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

Medical Records The written history of those services provided to an individual during a hospital stay or while receiving outpatient services. Medical records may include an admitting history and physical narrative; operative report; progress notes or discharge summaries.

Procurement The acquisition of goods or services.

Procurement Protest Procedures

Procedures for resolving vendor protests relating to purchasing issues.

Professional and Respectful Manner

Behavior, appearance, and interactions exhibit courtesy, consideration, and competence.

TERM DEFINITIONPsychological Services Psychological testing and psychological counseling

provided by or under the supervision of a licensed psychologist. A general diagnostic battery includes: Diagnostic Interview and review of history; assessments, test data provided from the general diagnostic battery; evaluation of verbal -cognitive factors resulting from general diagnostic battery; evaluation of emotional coping factors resulting from general diagnostic battery; or series of appropriate test accepted in the field; written narrative report.

Remedies Rights or opportunities under the terms of a contract or applicable law to take action against a contracting party to ensure performance or to redress wrongs. Some examples include the right to pursue actual damages, require corrective action plans, assess liquidated damages, seek an injunction, withhold payment, or terminate the contract.

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

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

State The State of Texas.

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

System Agency Means HHSC or any of the agencies of the State of Texas that are overseen by HHSC under authority granted under State law and the officers, employees, and designees of those agencies. These agencies include: the Department of Aging and Disability Services, the Department of Assistive and Rehabilitative Services, the Department of Family and Protective Services, and the Department of State Health Services.

Third Party Payment Payment by a financial agent, including but not limited to self-insured plans; commercial/private insurance plans, Medicare, Medicaid, or other parties that by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service.