ࡱ> 7 N bjbj ;kdkd  OOOOOccc8,c3( q"("""t#%&`$[؁O't#t#''؁OO""+++'FO"O"+'++.Dw""7MejV'2f|@03|\ˇ)ˇˇO''+'''''؁؁*0'''3''''ˇ'''''''''  :  Home and Community-Based Services - Adult Mental Health Services Provider Agreement Procurement Number: HHS0000075 Addendum #7 Revised on August 4, 2020ItemPurpose of ChangePreviousRevision1.Update Enrollment Period Close Date on pg. 1August 31, 2020August 31, 2021 Addendum #6 Revised on March 9, 2020ItemPurpose of ChangePreviousRevision1.How to Obtain Technical Assistance with this OE The last paragraph in Article I, Letter A, Introduction, Currently States: Respondents may seek technical assistance in completing this OE and HCBS-AMH program implementation support via Texas Institute for Excellence in Mental Health. For more details on the specific assistance available, email  HYPERLINK "mailto:txinstitute4mh@austin.utexas.edu" txinstitute4mh@austin.utexas.edu. The last paragraph in Article I, Letter A, Introduction, Revised to State: SYSTEM AGENCY recommends Respondents seek technical assistance in completing this OE and HCBS-AMH program implementation support via The University of Texas Health Science Center- San Antonio (UTHSCSA). For more details on the specific assistance available, email Dr. Matt Brown at  HYPERLINK "mailto:brownma@uthscsa.edu" brownma@uthscsa.edu. Dr. Matt Brown is a subject matter expert on the HCBS-AMH OE document and process, and can provide comprehensive, no-cost technical assistance to OE Respondents. Dr. Matt Brown and UTHSCSA are prepared to assist Respondents with completing all aspects of the OE. Respondents that are unsuccessful in three attempts to submit a complete and acceptable application will be restricted from reapplying for 365 days from the date of the last rejected application. 2.Update OE Point of ContactArticle VI, Letter A, OE Point of Contact Currently States: For purposes of submitting questions concerning this OE, the only contact is Tracie Deloach unless otherwise delegated by the OE Point of Contact. All communications concerning this OE must be submitted by email to: OE Point of Contact Email:  HYPERLINK "mailto:Tracie.DeLoach01@hhsc.state.tx.us" Tracie.DeLoach01@hhsc.state.tx.us Ref: OE# HHS0000075 Article VI, Letter A, OE Point of Contact is now: For purposes of submitting questions concerning this OE, the only contact is the Mental Health Contract Management Unit unless otherwise delegated by the OE Point of Contact. All communications concerning this OE must be submitted by email to: OE Point of Contact Email: MHContracts@hhsc.state.tx.us Ref: OE# HHS0000075  Addendum #5 Revised on May 31, 2019ItemPurpose of ChangePreviousRevision1.Update Enrollment Period Close Date on pg. 1August 31, 2019August 31, 20202.Update Open Enrollment Point of ContactArticle VI, Letter A, OE Point of Contact was: Christopher Dickinson  HYPERLINK "mailto:Christopher.Dickinson@hhsc.state.tx.us" Christopher.Dickinson@hhsc.state.tx.usArticle VI, Letter A, OE Point of Contact is now: Tracie Deloach  HYPERLINK "mailto:Tracie.DeLoach01@hhsc.state.tx.us" Tracie.DeLoach01@hhsc.state.tx.us3.URL Updates throughout Open Enrollment  HYPERLINK "http://www.dshs.state.tx.us/mhsa/hcbs-amh" http://www.dshs.state.tx.us/mhsa/hcbs-amh HYPERLINK "https://hhs.texas.gov/doing-business-hhs/provider-portals/behavioral-health-services-providers/home-community-based-services-adult-mental-health" https://hhs.texas.gov/doing-business-hhs/provider-portals/behavioral-health-services-providers/home-community-based-services-adult-mental-health4.Update Enrollment Period Close Date and initial award period in Section I. A.The enrollment period begins December 18, 2014, and will remain open through August 31, 202019. Respondents deemed qualified to provide services shall be awarded a Contingency Contract which shall be effective on the day of execution through 8/31/2019. SYSTEM AGENCY may, at its sole discretion, extend the closing date of this OE. As stated in Sec. II, SYSTEM AGENCY may also, at its sole discretion, withdraw this OE before the stated date the enrollment period ends.The enrollment period begins December 18, 2014, and will remain open through August 31, 2020. Respondents deemed qualified to provide services shall be awarded a Contingency Contract which shall be effective on the day of execution through 8/31/2022. SYSTEM AGENCY may, at its sole discretion, extend the closing date of this OE. As stated in Sec. II, SYSTEM AGENCY may also, at its sole discretion, withdraw this OE before the stated date the enrollment period ends.5.Update Enrollment Period Close Date and initial award period in Section III. C.Contingency contracts awarded under this OE will be effective on the date of execution through August 31, 2019. SYSTEM AGENCY may, at its sole discretion, renew a contingency contract after the initial term. Contracts may be renewed up to three additional one- year period contract terms. Renewal is contingent upon the availability of funds and the satisfactory performance of the contractor during the prior contract period.Contingency contracts awarded under this OE will be effective on the date of execution through August 31, 2022.6.Update Appendix DRegion 16 was: DallasRegion 16 is now: Dallas, Ellis, Navarro, Kaufman, Rockwall, Hunt7.Update Appendix DRegion 25 was: Ellis, Navarro, Kaufman, Rockwall, Hunt, Hopkins, Lamar, Delta, Franklin, Titus, Camp, MorrisRegion 25 is now: Hopkins, Lamar, Delta, Franklin, Titus, Camp, Morris Addendum #4 Revised on March 26, 2019ItemPurpose of ChangePreviousRevision1.Update Open Enrollment Point of ContactArticle VI, Letter A, OE Point of Contact was: Amy Hess  HYPERLINK "mailto:Amy.Hess@hhsc.state.tx.us" Amy.Hess@hhsc.state.tx.usArticle VI, Letter A, OE Point of Contact is now: Christopher Dickinson  HYPERLINK "mailto:Christopher.Dickinson@hhsc.state.tx.us" Christopher.Dickinson@hhsc.state.tx.us Addendum #3 Revised on January 13, 2017ItemPurpose of ChangePreviousRevision1.Update enrollment Cover Page including enrollment title and agency nameEnrollment Cover Page read in part as follows: Notice of Open Enrollment (OE) Home and Community Based Services - Adult Mental Health Services Provider Agreement (MH/HCBS-AMH PA) Department of State Health Services Enrollment Cover Page now reads in part as follows: Notice of Open Enrollment (OE) Home and Community Based Services Adult Mental Health Provider Agency Health and Human Services Commission 2.To update agency nameDepartment of State Health Services or DSHSAll references to Department of State Health Services, DSHS or Department are replaced with Health and Human Services Commission(HHSC) or System Agency3.To add language to the Introduction Section I. A. Introduction read in part as follows: The Department of State Health Services (DSHS or Department), Home and Community Based Services-Adult Mental Health (HCBS-AMH) Services Program announces this notice of Open Enrollment (OE) requesting applications to enter into a contingency contract with DSHS. The contingency contract will require the contractor to provide home and community-based services to adults with extended tenure in psychiatric hospitals in lieu of remaining as long term residents of those facilities. The contingency contract will provide an array of services, appropriate to each individuals needs, to enable these individuals to live and experience successful tenure in their community. Section I. A. Introduction is revised to read in part as follows: The Health and Human Services Commission (SYSTEM AGENCY), Home and Community Based Services-Adult Mental Health (HCBS-AMH) Services Program announces this notice of Open Enrollment (OE) requesting applications to enter into a contingency contract with SYSTEM AGENCY. Respondents are hereby notified that the HCBS-AMH Services Program and all functions associated with the HCBS-AMH Services Program have been transferred by the Department of State Health Services to the SYSTEM AGENCY with all rights, responsibilities and obligations thereto, as provided in Texas Government Code, Section 531.0201. The contingency contract will require the contractor to provide home and community-based services to adults with a diagnosis of serious mental illness and have a history of at least one of the following additional criteria: Long-term psychiatric hospitalization(s); Frequent arrests and psychiatric crisis; Frequent emergency department (ED) visits and psychiatric crisis. The contingency contract will provide an array of services, appropriate to each individuals needs, to enable these individuals to live and experience successful tenure in their community. Contractor will select the population(s) they will serve. 4.To revise language in the introductionSection I. A. Introduction read in part as follows: The enrollment period begins December 18, 2014, and will remain open through August 31, 2018. Contingency contracts awarded under this OE will begin on the day of execution through 8/31/2018. DSHS may, at its sole discretion, extend the closing date of this OE. As stated in Sec. II, DSHS may also, at its sole discretion, withdraw this OE before the stated date the enrollment period ends. Section I. A. Introduction is revised to read in part as follows: The enrollment period begins December 18, 2014, and will remain open through August 31, 2018. Respondents deemed qualified to provide services shall be awarded a Contingency Contract which shall be effective on the day of execution through 8/31/2018. SYSTEM AGENCY may, at its sole discretion, extend the closing date of this OE. As stated in Sec. II, SYSTEM AGENCY may also, at its sole discretion, withdraw this OE before the stated date the enrollment period ends. 5.To revise language in the introductionSection I. A. Introduction read in part as follows: Respondents may seek technical assistance in completing this OE and HCBS-AMH program implementation support thru 8/31/2016 via Texas Institute for Excellence in Mental Health (TIEMH). For more details on the specific assistance available, email  HYPERLINK "mailto:txinstitute4mh@austin.utexas.edu" txinstitute4mh@austin.utexas.edu. Section I. A. Introduction is revised to read in part as follows: Respondents may seek technical assistance in completing this OE and HCBS-AMH program implementation support via Texas Institute for Excellence in Mental Health. For more details on the specific assistance available, email  HYPERLINK "mailto:txinstitute4mh@austin.utexas.edu" txinstitute4mh@austin.utexas.edu. 6.To add or revise DefinitionsSection I. B. Definitions is revised in part to add or revise definitions.Section I. B. Definitions, is revised in part to add or revise the following definitions: Center for Medicare and Medicaid Services The Federal agency within the United States Department of Health and Human Services that administers the Medicare program and works collaboratively with state governments to administer Medicaid. Contingency Contract Also called a contract in this OE, a written agreement referring to promises or agreements for which the law establishes enforceable duties and remedies between a minimum of two parties and which is contingent on one or more factors. A SYSTEM AGENCY contract is assembled using a core contract (base), one or more program attachments, and other required exhibits (general provisions, etc.). Contract Term The period of time during which the contract or program attachment will be effective from execution date to end, or renewal date. The contract term may or may not be the same as the budget period. Cost Reimbursement- A payment mechanism in which funds are provided to carry out approved contract activities. Reimbursement is based on actual allowable costs incurred that comply with contractual requirements. Entity- A person, business, organization, or LLC that submits a response to solicitation. For purposes of this document, entity is intended to include such phrases as offeror, respondent, bidder, responder, or other similar terminology employed by SYSTEM AGENCY to describe the person, business, organization or LLC that responds to a solicitation. Fee For Service Payment mechanism for services that are reimbursed on an agreed rate per unit of service. Rates are available through SYSTEM AGENCYs website at  HYPERLINK "http://www.hhsc.state.tx.us/Rad/long-term-svcs/%20" http://www.hhsc.state.tx.us/Rad/long-term-svcs/ Individual Recovery Plan A written, individualized plan, developed in consultation with the individual and legally authorized representative, if applicable, which identifies the necessary HCBS to be provided to the individual and also serves as the treatment plan or recovery plan. Medicaid Management Information System Automated management and control system for Medicaid payments. Provider of Last Resort An entity that is the only willing and qualified entity in a geographic area that the individual chooses to provide the service. Unit Rate Payment mechanism for services that are reimbursed at a set rate per unit of service; for example, treatment services at a prescribed rate per hour. Also known as fee-for-service. Rates are available through SYSTEM AGENCYs website at  HYPERLINK "http://www.hhsc.state.tx.us/Rad/long-term-svcs/" http://www.hhsc.state.tx.us/Rad/long-term-svcs/. 7.To add language to Section II. LimitationsSection II. Limitations read as follows: Issuance of this OE in no way constitutes a commitment by DSHS or the State of Texas to execute a contract or to pay any costs incurred by any provider who may submit an enrollment application. The resulting contingency contract will be subject to the availability of state and federal funds. Contingency contracts awarded under this OE and any anticipated contract renewals are contingent upon the continued availability of funding. DSHS reserves the right to alter, amend or withdraw this OE at any time prior to the execution of a contingency contract. If a contingency contract has been fully executed and this OE is altered, amended, or withdrawn, DSHS and contractors obligations and rights will be determined in accordance with the provisions of the contract.Section II. Limitations is revised to read as follows: Issuance of this OE in no way constitutes a commitment by SYSTEM AGENCY or the State of Texas to execute a contract or to pay any costs incurred by any Respondent who may submit an enrollment application. The resulting contingency contract will be subject to the availability of State and Federal funds and the need for HCBS-AMH services. Contingency contracts awarded under this OE and any anticipated contract renewals are contingent upon the continued availability of funding. SYSTEM AGENCY reserves the right to alter, amend or withdraw this OE at any time prior to the execution of a contingency contract. If a contingency contract has been fully executed and this OE is altered, amended, or withdrawn, SYSTEM AGENCY and contractors obligations and rights will be determined in accordance with the provisions of the contract. 8.To revise language to Use of FundsSection III. Use of Funds read in part as follows: DSHS will provide a one-time disbursement of $40,000 for infrastructure development to the contractor. Infrastructure development is demonstrated by enrollment of and HCBS-AMH service provision to an individual prior to August 31, 2016. Service provision will be validated through HCBS-AMH service claims submission on the HCBS-AMH invoice template located at  HYPERLINK "http://www.dshs.state.tx.us/mhsa/hcbs-amh/" http://www.dshs.state.tx.us/mhsa/hcbs-amh/. Section III. Use of Funds is revised in part as follows: SYSTEM AGENCY will provide a one-time disbursement of $40,000 for infrastructure development to eligible contractors for as long as allocated funds are available. Infrastructure development is demonstrated by an executed contract and enrollment of and HCBS-AMH service provision to an individual. Service provision will be validated through HCBS-AMH service claims submission on the HCBS-AMH invoice template located at HYPERLINK "http://www.dshs.state.tx.us/mhsa/hcbs-amh/"http://www.dshs.state.tx.us/mhsa/hcbs-amh/. There is a maximum of one disbursement per Respondent allowed regardless of the number of contracts the Respondent may hold under this OE. 9.To Add language in Eligibility Requirements and AffirmationsSection IV. A. Eligibility Requirements and Affirmations reads in part as follows: Respondent must be a Medicaid provider prior to the provision of HCBS-AMH services. Respondent must be established as an appropriate legal entity as described in the paragraph above, under state statutes and must have the authority and be in good standing to do business in Texas and to conduct the activities described in the OE. Respondent must have a Texas address. A post office box may be used when the enrollment application is submitted, but the respondent must conduct business at a physical location in the service area prior to the date that the contract is awarded. Respondent must be in good standing with the U.S. Internal Revenue Service. Respondent is ineligible to apply for funds under this OE if currently debarred, suspended, or otherwise excluded or ineligible for participation in Federal or State assistance programs. Respondents staff members, including the executive director, must not serve as voting members on their employers governing board. In compliance with Comptroller of Public Accounts and Texas Procurement and Support Services rules, a name search will be conducted using the websites listed in this sectionprior to the development of a contract. A respondent is not considered eligible to contract with DSHS if a name match is found on any of the following lists: The System for Award Management (SAM) is an official U.S. Government system that consolidated the capabilities of CCR/Fed Reg, ORCA and EPLS. Search the federal excluded list at the following website: HYPERLINK "https://www.sam.gov/portal/public/SAM"https://www.sam.gov/portal/public/SAM; and Texas Comptroller of Public Accounts (CPA) Debarment List located at HYPERLINK "http://www.window.state.tx.us/procurement/prog/vendor_performance/debarred/"http://www.window.state.tx.us/procurement/prog/vendor_performance/debarred/. Respondent must have established organizational policies and procedures. Topics include, but are not limited to the following. Please refer to the Manual located at http://www.dshs.state.tx.us/mhsa/hcbs-amh/ for guidance on how topics below shall meet the minimum standards). Confidentiality and retention of client records and progress notes; Provision of services / coordination of care (including routine and emergency appointment availability, and assurance that all HCBS-AMH services will be available to individuals in each service area. This includes notification of DSHS when HCBS-AMH service is unavailable for any period of time); Quality management plan; Utilization management; Determination of respondents capacity to serve individuals; Notification to DSHS of respondents capacity to serve individuals; Housing and placement policies and procedures (monitoring and tracking placement, expansion of community housing relationship plan, and other procedures identified on Form H); Compliance with 1915(i) federal regulations, including settings requirements for provider owned and operating settings; Managing Conflicts of Interest; Personnel recordkeeping / management; Critical incident reporting; Personnel and client safety (behavior management, restraint, suicide precaution/prevention); Personnel credentialing and training (including verification of licensure, qualifications, training requirements, and certification records for employees and subcontractors); Medication safety; Payment of employees and subcontractors; Process to submit reports and billing invoices to DSHS (including verification of the individuals Medicaid for a billing period); Medicaid fair hearing; Consumer rights and grievances; Reporting abuse, neglect, and exploitation; Critical incidents; Transfer of individuals to another HCBS-AMH provider; and Discharge of individuals from HCBS-AMH. Respondent must affirm audit and financial statements are complete and accurate, and demonstrate financial solvency or sufficient cash balances to operate for a minimum of two months. Respondent must affirm they have not violated federal law in connection with any contract awarded by the federal government for relief, recovery or reconstruction efforts as a result of Hurricanes Katrina or Rita or any other disaster occurring after September 25, 2005, in accordance with Texas Government Code 2155.006 and 2261.053. Respondent affirm they will comply with Human Resources Code, Section 48.253, requiring a provider to: Cooperate completely with an investigation of alleged abuse, neglect, or exploitation conducted by the Department of Family and Protective Services. Provide complete access to the Department of Family and Protective Services during an investigation to: All sites owned, operated, or controlled by the provider; and Clients and client records. Respondents who are local mental health authorities shall affirm they and their subcontractors will comply with the Texas Administrative Code, Chapter 414, Subchapter L. This includes, but is not limited to: Amending contracts to ensure contractors compliance with this subchapter. Implementing policies and procedures addressing disciplinary and other action in confirmed cases of abuse, neglect, and exploitation involving employees and agents, in accordance with Section 414.557. Ensuring that a Client Abuse and Neglect Reporting form (AN-1-A) is completed within 14 calendar days of the receipt of the investigative report from the Department of Family and Protective Services or a decision made after review or appeal using the CANRS Definitions and the CANRS Classifications, when the perpetrator or alleged perpetrator is an employee or agent of the local mental health authority, community center, or contractor, or if the perpetrator is unknown. Ensuring, within one working day after completion of the AN-1-A form, that: The information contained in the completed AN-1-A form is entered into the Client Abuse and Neglect Reporting System (CANRS); or If access to CANRS is unavailable, a copy of the completed AN-1-A form is forwarded for data entry to the Office of Consumer Services and Rights ProtectionOmbudsman, P.O. Box 12668, Austin, TX 78711-2668. Respondent must affirm a contract or Provider Agreement has not been suspended or terminated, license has not been surrendered, or license has not been suspended or revoked by any local, state or federal department or agency or non-profit entity. Respondent must affirm all pending or threatened litigation has been disclosed to DSHS. Respondent must affirm identification to DSHS of any related party transactions involving parties that may perform part of the work under the Provider Agreement. Respondent must affirm identification to DSHS whether any person who has an ownership, controlling interest in the organization, employee, or volunteer of the organization has pending criminal charges, been placed on community supervision (probation or parole), received deferred adjudication or convicted of a criminal offense. All respondents must have general liability insurance. Minimum eligibility requirements for direct service providers of HCBS-AMH services are set forth in the Manual. Section IV. A. Eligibility Requirements and Affirmations are revised to read in part as follows: Respondent must meet the following: Have at least 2 years of experience working with individuals with serious mental illness; or Currently is a provider of a HCBS Waiver program. Prior to receiving referrals for the provision of HCBS-AMH services, Respondent must be authorizedas an active Medicaid Provider. Respondent must be established as an appropriate legal entity as described in the paragraph above, under state statutes and must have the authority and be in good standing to do business in Texas and to conduct the activities described in the OE. Respondent must have an encrypted e-mail extension that is exclusively associated with the respondents organization and have capacity to assign employees an e-mail address with the exclusive e-mail extension. Respondent must have a Texas address. A post office box may be used when the enrollment application is submitted, but the respondent must conduct business at a physical location in the service area or within 30 miles of an adjacent service area. This physical location must be zoned to conduct business, be compliant with property agreements, and be obtained prior to the site review as well as prior to date the contract is awarded. If respondents business address is their home respondent shall attach proof that the building is approved to be zoned for business or if leased that the building owner approves the space to be used for business purposes. Respondent shall provide SYSTEM AGENCY, upon request, with the personnel files of any or all HCBS-AMH staff (including administration, owners and board members) prior to the commencement of HCBS-AMH services and at the request of SYSTEM AGENCY. Personnel files shall include: Credentialing for employees and subcontractors (including verification of licensure, qualifications, training requirements, certification records; and Criminal History Background and all Abuse Registry checks Respondent and all administrative staff shall complete HCSB-AMH Pre-application modules located at the following website:  HYPERLINK "http://sites.utexas.edu/mental-health-institute/home-and-community-based-services-adult-mental-health-2/" http://sites.utexas.edu/mental-health-institute/home-and-community-based-services-adult-mental-health-2/ prior to completion of the OE application. Respondents shall submit Pre-application certificates with the OE application to verify completion of all HCBS-AMH Pre-application modules. Respondent must be in good standing with the U.S. Internal Revenue Service. Respondent is ineligible to apply for funds under this OE if currently debarred, suspended, or otherwise excluded or ineligible for participation in Federal or State assistance programs. Respondents staff members, including the executive director, must not serve as voting members on their employers governing board. In compliance with Comptroller of Public Accounts and Texas Procurement and Support Services rules, a name search will be conducted using the websites listed in this sectionprior to the development of a contract. A respondent is not considered eligible to contract with SYSTEM AGENCY if a name match is found on any of the following lists: The System for Award Management (SAM) is an official U.S. Government system that consolidated the capabilities of CCR/Fed Reg, ORCA and EPLS. Search the federal excluded list at the following website: HYPERLINK "https://www.sam.gov/portal/public/SAM"https://www.sam.gov/portal/public/SAM; and Texas Comptroller of Public Accounts (CPA) Debarment List located at HYPERLINK "http://www.window.state.tx.us/procurement/prog/vendor_performance/debarred/"http://www.window.state.tx.us/procurement/prog/vendor_performance/debarred/. Please refer to the Manual located at http://www.dshs.state.tx.us/mhsa/hcbs-amh/ for guidance on how topics below shall meet the minimum standards. Respondent must have established organizational policies and procedures. Topics include, but are not limited to the following: Confidentiality and retention of client records and progress notes; Provision of services / coordination of care (including routine and emergency appointment availability, and assurance that all HCBS-AMH services will be available to individuals in each service area. This includes notification of SYSTEM AGENCY when HCBS-AMH service is unavailable for any period of time); Quality management plan; Utilization management; Determination of respondents capacity to serve individuals; Notification to SYSTEM AGENCY of respondents capacity to serve individuals; Housing and placement policies and procedures (monitoring and tracking placement, expansion of community housing relationship plan, and other procedures identified on Form H); Compliance with 1915(i) federal regulations, including settings requirements for provider owned and operating settings; Managing Conflicts of Interest if applying for both Open Enrollment Applications: Provider Agency Agreement and Recovery Management Agreement (include organizational chart that clearly defines separation between Recovery Manager and Provider functions, audit process for managing conflicts of interest, employee training and attestation that no conflict of interest exists, reporting of conflicts of interest to SYSTEM AGENCY such as a change in administrative structure, billing practice and invoice submission). Personnel recordkeeping / management; Critical incident reporting; Personnel and client safety (behavior management, restraint, suicide precaution/prevention); (Including but not limited to: TAC Title 25, Part 1, CH-415 Rules 415.259-415.273) Personnel credentialing and training (including verification of licensure, qualifications, training requirements, and certification records for employees and subcontractors); Medication safety; Process to submit reports and billing invoices to SYSTEM AGENCY (including verification of the individuals Medicaid for a billing period); Medicaid fair hearing; Consumer rights and grievances; Reporting abuse, neglect, and exploitation; Critical incidents; Transfer of individuals to another HCBS-AMH provider; and Discharge of individuals from HCBS-AMH. Respondent must affirm audit and financial statements are complete and accurate, and demonstrate financial solvency or sufficient cash balances to operate for a minimum of two months. Respondent must affirm they have not violated federal law in connection with any contract awarded by the federal government for relief, recovery or reconstruction efforts as a result of Hurricanes Katrina or Rita or any other disaster occurring after September 25, 2005, in accordance with Texas Government Code 2155.006 and 2261.053. Respondent affirm they will comply with Human Resources Code, Section 48.253, requiring a provider to: Cooperate completely with an investigation of alleged abuse, neglect, or exploitation conducted by the Department of Family and Protective Services. Provide complete access to the Department of Family and Protective Services during an investigation to: All sites owned, operated, or controlled by the provider; and Clients and client records. Respondents who are local mental health authorities shall affirm they and their subcontractors will comply with the Texas Administrative Code, Chapter 414, Subchapter L. This includes, but is not limited to: Amending contracts to ensure contractors compliance with this subchapter. Implementing policies and procedures addressing disciplinary and other action in confirmed cases of abuse, neglect, and exploitation involving employees and agents, in accordance with Section 414.557. Ensuring that a Client Abuse and Neglect Reporting form (AN-1-A) is completed within 14 calendar days of the receipt of the investigative report from the Department of Family and Protective Services or a decision made after review or appeal using the CANRS Definitions and the CANRS Classifications, when the perpetrator or alleged perpetrator is an employee or agent of the local mental health authority, community center, or contractor, or if the perpetrator is unknown. Ensuring, within one working day after completion of the AN-1-A form, that: The information contained in the completed AN-1-A form is entered into the Client Abuse and Neglect Reporting System (CANRS); or If access to CANRS is unavailable, a copy of the completed AN-1-A form is forwarded for data entry to the Office of Consumer Services and Rights ProtectionOmbudsman, P.O. Box 12668, Austin, TX 78711-2668. Respondent must affirm a contract or Provider Agreement has not been suspended or terminated, license has not been surrendered, or license has not been suspended or revoked by any local, state or federal department or agency or non-profit entity. Respondent must affirm all pending or threatened litigation has been disclosed to SYSTEM AGENCY. Respondent must affirm identification to SYSTEM AGENCY of any related party transactions involving parties that may perform part of the work under the Provider Agreement. Respondent must affirm identification to SYSTEM AGENCY whether any person who has an ownership, controlling interest in the organization, employee, or volunteer of the organization has pending criminal charges, been placed on community supervision (probation or parole), and received deferred adjudication or convicted of a criminal offense. Respondent must affirm they have a history of compliance with the laws relating to the respondents business operations and the affected services and whether the respondent is currently in compliance; All respondents must have general liability insurance (Form N) All documents submitted must be numbered in numerical sequence in the lower right corner. Any additions to the original submission may be added, but the application must be renumbered to ensure the final packet is sequentially numbered and the entire packet resubmitted. If a contingency contract has been fully executed and the Respondent requests to contract to serve additional service region(s) or additional target population(s), Respondent will complete the following: Updated Form-A-Face Page Updated Form-C-Contact Person Information Updated Form G-Organizational Chart Updated Form-J-Proof of General Liability Insurance Updated Form-K-Organizational Brochure or Biographical Information Updated electronic Policy and Procedure Manual from the Respondent to reflect the additional proposed service region(s), target population(s), or programmatic changes due to expansion. Provide addresses to physical locations within the requested expansion service region(s). On site reviews of Respondent offices and residential setting in requested service region(s) designated for individuals enrolled in HCBS-AMH will be conducted at the discretion of SYSTEM AGENCY. Onsite reviews for additional service regions are subject to the terms identified in Section VI.C.4. Minimum eligibility requirements for direct service providers of HCBS-AMH services are set forth in the Manual. 10.To revise language in Required Activities for Contractors Receiving an award under This OESection IV. B. Required Activities for Contractors Receiving and Award under This OE reads in part as follows: Respondent must directly or indirectly, through subcontractor, provide the following HCBS-AMH services. Services shall be delivered according to the individuals IRP approved by DSHS. Respondent must provide one of the services demarcated by (*) directly Section IV. B. Required Activities for Contractors Receiving and Award under This OE is revised to read in part as follows: Respondent must directly or indirectly, through subcontractor, provide the following HCBS-AMH services. Services shall be delivered according to the individuals IRP approved by SYSTEM AGENCY. Respondent must provide at a minimum one of the services demarcated by (*) directly. A minimum of one directly provided service shall not also be provided through a subcontractor.. 11.To revise language in Required Activities for Contractors Receiving an award under This OESection IV. B. Required Activities for Contractors Receiving and Award under This OE reads in part as follows: 10. Respondent shall provide DSHS, upon request, with the personnel files of any or all HCBS-AMH staff (including administration) prior to the commencement of HCBS-AMH services and at the request of DSHS. Personnel files shall include: Credentialing (including verification of licensure, qualifications, training requirements, and certification records for employees and subcontractors); and Criminal History Background and Abuse Registry checks 11.Respondent shall receive approval from DSHS on their determined capacity to serve prior to the provision of HCBS-AMH services. 12. Respondent shall maintain appropriate documentation of all HCBS-AMH services in the format prescribed by DSHS. Information shall be collected, maintained, and reported by Respondent in accordance with the following specifications: All reports shall be submitted to DSHS within the time frame and formats, and including subject matter, specified in this Provider Agreement. Respondent shall respond within five working days to requests for ad hoc reports by DSHS. Respondent shall submit all Critical Incident Reporting Forms to the Recovery Manager within 72 hours of notification of an incident report, in accordance with DSHS policy. Section IV. B. Required Activities for Contractors Receiving and Award under This OE is revised to read in part as follows: 10. Respondent shall provide SYSTEM AGENCY, upon request, with the personnel files of any or all HCBS-AMH staff (including administration, owners and board members) prior to the commencement of HCBS-AMH services and at the request of SYSTEM AGENCY. Personnel files shall include: Credentialing (including verification of licensure, qualifications, training requirements, and certification records for employees and subcontractors) and Criminal History Background and Abuse Registry checks 11. Respondent shall receive approval from SYSTEM AGENCY on their determined capacity to serve prior to the provision of HCBS-AMH services. 12. Respondent shall affirm they have a history of compliance with the laws relating to the respondents business operations and the affected services and whether the respondent is currently in compliance. 13. Respondent shall maintain appropriate documentation of all HCBS-AMH services in the format prescribed by SYSTEM AGENCY. Information shall be collected, maintained, and reported by Respondent in accordance with the following specifications: a. All reports shall be submitted to SYSTEM AGENCY within the time frame and formats, and including subject matter, specified in this Provider Agreement. b. Respondent shall respond within five working days to requests for ad hoc reports by SYSTEM AGENCY. c. Respondent shall submit all Critical Incident Reporting Forms within 72 hours of notification of an incident report, in accordance with SYSTEM AGENCY policy. 12.To correct Civil Rights Office website addressSection V., C. Program Requirements reads in part as follows: Contractors are required to conduct Project activities in accordance with federal and state laws prohibiting discrimination. Guidance for adhering to non-discrimination requirements can be found on the  HYPERLINK "http://www.hhs.state.tx.us/aboutHHS/CivilRights.shtml" HHSC Civil Rights Office website at:  HYPERLINK "http://www.hhs.state.tx.us/aboutHHS/CivilRights.shtml" http://www.hhs.state.tx.us/aboutHHS/CivilRights.shtml. Section V., C. Program Requirements is revised to read in part as follows: Contractors are required to conduct Project activities in accordance with federal and state laws prohibiting discrimination. Guidance for adhering to non-discrimination requirements can be found on the  HYPERLINK "http://www.hhs.state.tx.us/aboutHHS/CivilRights.shtml" SYSTEM AGENCY Civil Rights Office website at:  HYPERLINK "http://www.hhsc.state.tx.us/about_hhsc/civil-rights/" http://www.hhsc.state.tx.us/about_hhsc/civil-rights/ 13.To add language in Program RequirementsSection V., C. Program Requirements is revised to add the following: SYSTEM AGENCY reserves the right to perform a Quality Management review at SYSTEM AGENCYs sole discretion. 14.To add Form O to the evaluation processSection VI., C. Evaluation Process reads in part as follows: 2. Other preliminary screening criteria as needed and appropriate, including: FORM A: Face Page; FORM B: Open Enrollment Application checklist; FORM C: Contact Person Information; FORM D: Board Member Information (if applicable); FORM E: Vendor Information; FORM F: Plan of HCBS-AMH service provision; FORM G: Subcontracted Providers (if applicable); FORM H: Access to Housing; FORM I: Articles of Incorporation and Bylaws, including amendment (if applicable); FORM J: Organizational Overview, Philosophy, or Mission Statement; FORM K: Organizational Chart/Structure; FORM L: Policies and Procedures; and FORM M: Job Descriptions. FORM N: Proof of General Liability Insurance Section VI., C. Evaluation Process is revised to reads in part as follows: 2. Other preliminary screening criteria as needed and appropriate, including: a. FORM A: Face Page; b. FORM B: Open Enrollment Application checklist; c. FORM C: Contact Person Information; d. FORM D: Board Member Information (if applicable); e. FORM E: Vendor Information; f. FORM F: Plan of HCBS-AMH service provision; g. FORM G: Subcontracted Providers (if applicable); h. FORM H: Access to Housing; i. FORM I: Articles of Incorporation and Bylaws, including amendment (if applicable); j. FORM J: Organizational Overview, Philosophy, or Mission Statement; k. FORM K: Organizational Chart/Structure; l. FORM L: Policies and Procedures; and m. FORM M: Job Descriptions. n. FORM N: Proof of General Liability Insurance o. FORM O: Organization Brochure or Biographical Information 15.To add language regarding onsite reviews.Section VI., C. Evaluation Process is revised to add the following paragraph: On site reviews of Respondent offices and residential setting in requested service region(s) designated for individuals enrolled in HCBS-AMH will be conducted at the discretion of SYSTEM AGENCY. Respondents will provide addresses to physical locations within the requested service region(s). 16.To add language to Rejection of Enrollment ApplicationsSection VI. D. Rejection of Enrollment Applications reads in part as follows: 5. If a Respondent wishes to re-apply for the Open Enrollment after receiving a rejection letter: Respondent is not permitted to re-apply for 6 months from the date of the rejection letter; and Respondent must correct the item(s) identified in the rejection letter. Section VI. D. Rejection of Enrollment Applications is revised to reads in part as follows: 5. If a Respondent wishes to re-apply for the Open Enrollment after receiving a rejection letter: Respondent is not permitted to re-apply for 6 months from the date of the rejection letter; Respondent must correct the item(s) identified in the rejection letter prior to re-applying: and Respondent must complete and submit a new OE PA Application. 17. To add Form O. as a required documentSection VII. Application Instructions and Criteria For Acceptance read in part as follows: The following application documents are required: FORM A: Face Page; FORM B: Open Enrollment Application Checklist; FORM C: Contact Person Information; FORM D: Board Member Information (if applicable); FORM E: Vendor Information Form; FORM F: Plan of HCBS-AMH Service Component Provision; FORM G: Subcontracted Providers (if applicable); FORM H: Access to Housing; FORM I: Articles of Incorporation and Bylaws, including amendment (if applicable); FORM J: Organizational Overview, Philosophy, or Mission Statement; FORM K: Organizational Chart/Structure; FORM L: Policies and Procedures; and FORM M: Job Descriptions FORM N: Proof of General Liability Insurance Section VII. Application Instructions and Criteria For Acceptance is revised to read in part as follows: The following application documents are required: FORM A: Face Page; FORM B: Open Enrollment Application Checklist; FORM C: Contact Person Information; FORM D: Board Member Information (if applicable); FORM E: Vendor Information Form; FORM F: Plan of HCBS-AMH Service Component Provision; FORM G: Subcontracted Providers (if applicable); FORM H: Access to Housing; FORM I: Articles of Incorporation and Bylaws, including amendment (if applicable); FORM J: Organizational Overview, Philosophy, or Mission Statement; FORM K: Organizational Chart/Structure; FORM L: Policies and Procedures; and FORM M: Job Descriptions FORM N: Proof of General Liability Insurance FORM O: Organization Brochure or Biographical Information 18.To add Form O Section VIII. Blank Forms and Instructions is revised to add Form O: Organization Brochure or Biographical Information Addendum #2 Revised on January 15, 2016ItemPurpose of ChangePreviousRevision1.To add language regarding technical assistance completing the Open EnrollmentNew language added to the end of Section I. A. Introduction.Language was added as follows: Respondents may seek technical assistance in completing this OE and HCBS-AMH program implementation support thru 8/31/2016 via Texas Institute for Excellence in Mental Health (TIEMH). For more details on the specific assistance available, email  HYPERLINK "mailto:txinstitute4mh@austin.utexas.edu" txinstitute4mh@austin.utexas.edu. 2.To add language regarding the use of funds and funding methodology.New language added to Section III. A, Use of Funds Language was added as follows: DSHS, at its sole discretion, may adjust the funding amount of a Program Attachment based on performance measures, outcome measures, waitlist, and/or other criteria determined by DSHS, and contingent on availability of funds allocated for the adjustments DSHS may implement an alternative reimbursement methodology using the rates set forth herein (or using the rates that exist at the time a contract is executed). This alternative methodology may include the use of a case rate based on expected lengths of stay.3.To extend the date for one-time disbursements for infrastructure development.Section III. A, Use of Funds, contained language that read, in part, as follows: DSHS will provide a one-time disbursement of $40,000 for infrastructure development to the contractor. Infrastructure development is demonstrated by enrollment of and HCBS-AMH service provision to an individual prior to January 1, 2016.Said language was changed as follows: DSHS will provide a one-time disbursement of $40,000 for infrastructure development to the contractor. Infrastructure development is demonstrated by enrollment of and HCBS-AMH service provision to an individual prior to August 31, 2016.4.To add funding obligation languageSection III. B. Term of Contract, contained language that read, in part, as follows: Contingency contracts awarded under this OE will begin on the date of execution through August 31, 2018. DSHS may, at its sole discretion renew a contingency contract after the initial termSection III. B. is now Funding Obligation and reads as follows: This Contract is contingent upon the availability of funding. If funds become unavailable through lack of appropriations, budget cuts, transfer of funds between programs or health and human services agencies, amendment of the Appropriations Act, Health and Human Services agency consolidation, or any other disruptions of current appropriated funding for this Contract, DSHS may restrict, reduce or terminate funding under this Contract. Notice of any restriction or reduction shall include instructions and detailed information on how DSHS shall fund the services and/or goods to be procured with the restricted or reduced funds5.To inform that Section III. B. Term of Contract is now Section III. CSection III. B. Term of Contract is now located in Section III. CSection III. C. Term of Contract Contingency contracts awarded under this OE will begin on the date of execution through August 31, 2018. DSHS may, at its sole discretion renew a contingency contract after the initial term..6.To revise language in eligibility requirements and affirmationsSection IV. A. Eligibility Requirements and Affirmations, contained language that read, in part, as follows: Eligible respondents include organizations established as a legal entity under state statutes and have the authority to do business in Texas. Eligible respondents must comply with the criteria listed below. 1. Respondent must be a Medicaid provider of the necessary provider type for HCBS-AMH services.Said language was changed as follows: Eligible respondents include organizations established as a legal entity under state statutes and have the authority to do business in Texas. Eligible respondents must comply with the criteria listed below. 1. Respondent must be a Medicaid provider prior to the provision of HCBS-AMH services.7.To revise language in eligibility requirements and affirmationsSection IV. A Eligibility Requirements and Affirmations, contained language that read, in part as follows: 9. Respondent must have established organizational policies and procedures. Topics include, but are not limited to the following. Please refer to the Manual for guidance on how topics below shall meet the minimum standards). a. Confidentiality and retention of client records and progress notes; b. Provision of services / coordination of care (including routine and emergency appointment availability, and assurance that all HCBS-AMH services will be available to individuals in each service area. This includes notification of DSHS when HCBS-AMH service is unavailable for any period of time); c. Quality management plan; d. Utilization management; e. Determination of respondents capacity to serve individuals; f. Notification of DSHS of respondents capacity to serve individuals; g. Housing and placement policies and procedures (monitoring and tracking placement, expansion of community housing relationship plan, and other procedures identified on Form H); h. Compliance with 1915(i) federal regulations, including settings requirements for provider owned and operating settings; i. Personnel recordkeeping / management; j. Critical incident reporting; k. Personnel and client safety (behavior management, seclusion and restraint); l. Personnel credentialing and training (including verification of licensure, qualifications, training requirements, and certification records for employees and subcontractors); m. Medication safety; n. Payment of employees and subcontractors; o. Process to submit invoices to DSHS (including verification of the individuals Medicaid for a billing period); p. Medicaid fair hearing; q. Consumer rights and grievances; r. Reporting abuse, neglect, and exploitation; s. Critical incidents; t. Transfer of individuals to another HCBS-AMH provider; and u. Discharge of individuals from HCBS-AMH.Said language was changed as follows: 9. Respondent must have established organizational policies and procedures. Topics include, but are not limited to the following. Please refer to the Manual located at http://www.dshs.state.tx.us/mhsa/hcbs-amh/ for guidance on how topics below shall meet the minimum standards). a. Confidentiality and retention of client records and progress notes; b. Provision of services / coordination of care (including routine and emergency appointment availability, and assurance that all HCBS-AMH services will be available to individuals in each service area. This includes notification of DSHS when HCBS-AMH service is unavailable for any period of time); c. Quality management plan; d. Utilization management; e. Determination of respondents capacity to serve individuals; f. Notification to DSHS of respondents capacity to serve individuals; g. Housing and placement policies and procedures (monitoring and tracking placement, expansion of community housing relationship plan, and other procedures identified on Form H); h. Compliance with 1915(i) federal regulations, including settings requirements for provider owned and operating settings; i. Managing Conflicts of Interest; j. Personnel recordkeeping / management; k. Critical incident reporting; l. Personnel and client safety (behavior management, restraint, suicide precaution/prevention); m. Personnel credentialing and training (including verification of licensure, qualifications, training requirements, and certification records for employees and subcontractors); n. Medication safety; o. Payment of employees and subcontractors; p. Process to submit reports and billing invoices to DSHS (including verification of the individuals Medicaid for a billing period); q. Medicaid fair hearing; r. Consumer rights and grievances; s. Reporting abuse, neglect, and exploitation; t. Critical incidents; u. Transfer of individuals to another HCBS-AMH provider; and v. Discharge of individuals from HCBS-AMH.8. To revise language and numbering in eligibility requirements and affirmationsSection IV. A Eligibility Requirements and Affirmations, contained language that read, in part as follows: 11. Respondent must affirm they have not violated federal law in connection with any contract awarded by the federal government for relief, recovery or reconstruction efforts as a result of Hurricanes Katrina or Rita or any other disaster occurring after September 25, 2005, in accordance with Texas Government Code 2155.006 and 2261.053. 12. Respondent must affirm a contract or Provider Agreement has not been suspended or terminated, license has not been surrendered, or license has not been suspended or revoked by any local, state or federal department or agency or non-profit entity. 13. Respondent must affirm all pending or threatened litigation has been disclosed to DSHS. 14. Respondent must affirm identification to DSHS of any related party transactions involving parties that may perform part of the work under the Provider Agreement. 15. Respondent must affirm identification to DSHS whether any person who has an ownership, controlling interest in the organization, employee, or volunteer of the organization has been placed on community supervision (probation or parole), received deferred adjudication or convicted of a criminal offense. 16. All respondents must have general liability insurance.Said language and numbering was changed as follows: 11. Respondent must affirm they have not violated federal law in connection with any contract awarded by the federal government for relief, recovery or reconstruction efforts as a result of Hurricanes Katrina or Rita or any other disaster occurring after September 25, 2005, in accordance with Texas Government Code 2155.006 and 2261.053. 12. Respondent affirm they will comply with Human Resources Code, Section 48.253, requiring a provider to: a. Cooperate completely with an investigation of alleged abuse, neglect, or exploitation conducted by the Department of Family and Protective Services. b. Provide complete access to the Department of Family and Protective Services during an investigation to: i. All sites owned, operated, or controlled by the provider; and ii. Clients and client records. 13. Respondents who are local mental health authorities shall affirm they and their subcontractors will comply with the Texas Administrative Code, Chapter 414, Subchapter L. This includes, but is not limited to: a. Amending contracts to ensure contractors compliance with this subchapter. b. Implementing policies and procedures addressing disciplinary and other action in confirmed cases of abuse, neglect, and exploitation involving employees and agents, in accordance with Section 414.557. c. Ensuring that a Client Abuse and Neglect Reporting form (AN-1-A) is completed within 14 calendar days of the receipt of the investigative report from the Department of Family and Protective Services or a decision made after review or appeal using the CANRS Definitions and the CANRS Classifications, when the perpetrator or alleged perpetrator is an employee or agent of the local mental health authority, community center, or contractor, or if the perpetrator is unknown. d. Ensuring, within one working day after completion of the AN-1-A form, that: i. The information contained in the completed AN-1-A form is entered into the Client Abuse and Neglect Reporting System (CANRS); or ii. If access to CANRS is unavailable, a copy of the completed AN-1-A form is forwarded for data entry to the Office of Consumer Services and Rights ProtectionOmbudsman, P.O. Box 12668, Austin, TX 78711-2668. 14. Respondent must affirm a contract or Provider Agreement has not been suspended or terminated, license has not been surrendered, or license has not been suspended or revoked by any local, state or federal department or agency or non-profit entity. 15. Respondent must affirm all pending or threatened litigation has been disclosed to DSHS. 16. Respondent must affirm identification to DSHS of any related party transactions involving parties that may perform part of the work under the Provider Agreement. 17. Respondent must affirm identification to DSHS whether any person who has an ownership, controlling interest in the organization, employee, or volunteer of the organization has pending criminal charges, been placed on community supervision (probation or parole), received deferred adjudication or convicted of a criminal offense. 18. All respondents must have general liability insurance.9.To revise language and numbering in Required Activities for Contractors Receiving an Award Under this OESection IV. B. Required Activities for Contractors Receiving an Award Under This OE, contained language that read, in part as follows: 9. Respondent shall have and maintain HIPAA compliant encrypted email to provide the department with reporting data that includes HIPAA-related information. 10. Respondent shall maintain appropriate documentation of all HCBS-AMH services in the format prescribed by DSHS. Information shall be collected, maintained, and reported by Respondent in accordance with the following specifications: a. All reports shall be submitted to DSHS within the time frame and formats, and including subject matter, specified in this Provider Agreement. b. Respondent shall respond within five working days to requests for ad hoc reports by DSHS. c. Respondent shall submit all Critical Incident Reporting Forms to the Recovery Manager within 72 hours of notification of an incident report, in accordance with DSHS policy.Said language and numbering was changed as follows: 9. Respondent shall have and maintain HIPAA compliant encrypted email to provide the department with reporting data that includes HIPAA-related information. 10. Respondent shall provide DSHS, upon request, with the personnel files of any or all HCBS-AMH staff (including administration) prior to the commencement of HCBS-AMH services and at the request of DSHS. Personnel files shall include: a. Credentialing (including verification of licensure, qualifications, training requirements, and certification records for employees and subcontractors); and b. Criminal History Background and Abuse Registry checks 11. Respondent shall receive approval from DSHS on their determined capacity to serve prior to the provision of HCBS-AMH services. 12. Respondent shall maintain appropriate documentation of all HCBS-AMH services in the format prescribed by DSHS. Information shall be collected, maintained, and reported by Respondent in accordance with the following specifications: a. All reports shall be submitted to DSHS within the time frame and formats, and including subject matter, specified in this Provider Agreement. b. Respondent shall respond within five working days to requests for ad hoc reports by DSHS. c. Respondent shall submit all Critical Incident Reporting Forms to the Recovery Manager within 72 hours of notification of an incident report, in accordance with DSHS policy.10.To revise language and numbering in Evaluation ProcessSection VI. C. Evaluation Process, contained language that read, in part as follows: 4. The respondent may be subject to an Onsite Review which may include, but is not limited to, the review and verification of: a. Information submitted as a part of the OE application; b. Policies and Procedures Manuals or Operational Handbooks to include the following policies and procedures: i. Confidentiality and retention of client records and progress notes; ii. Provision of services / coordination of care (including routine and emergency appointment availability, and assurance that all HCBS-AMH services will be available to individuals in each service area. This includes notification of DSHS when HCBS-AMH service is unavailable for any period of time); iii. Quality management plan; iv. Utilization management; v. Determination of respondents capacity to serve individuals; vi. Housing and placement policies and procedures (monitoring and tracking placement, expansion of community housing relationship plan, and other procedures identified on Form H); vii. Compliance with 1915(i) federal regulations, including settings requirements for provider owned and operating settings; viii. Personnel recordkeeping / management; ix. Critical incident reporting; x. Personnel and client safety (behavior management, seclusion and restraint); xi. Personnel credentialing and training (including verification of licensure, qualifications, training requirements, and certification records for employees and subcontractors); xii. Medication safety; xiii. Payment of employees and subcontractors; xiv. Process to submit invoices to DSHS (including verification of the individuals Medicaid for a billing period); xv. Medicaid fair hearing; xvi. Consumer rights and grievances; xvii. Reporting abuse, neglect, and exploitation; xviii. Critical incidents; xix. Transfer of individuals to another HCBS-AMH provider; and xx. Discharge of individuals from HCBS-AMH. Said language and numbering was changed as follows: 4. The respondent may be subject to an Onsite Review which may include, but is not limited to, the review and verification of: a. Information submitted as a part of the OE application; b. Policies and Procedures Manuals or Operational Handbooks to include the following policies and procedures: i. Confidentiality and retention of client records and progress notes; ii. Provision of services / coordination of care (including routine and emergency appointment availability, and assurance that all HCBS-AMH services will be available to individuals in each service area. This includes notification of DSHS when HCBS-AMH service is unavailable for any period of time); iii. Quality management plan; iv. Utilization management; v. Determination of respondents capacity to serve individuals; vi. Housing and placement policies and procedures (monitoring and tracking placement, expansion of community housing relationship plan, and other procedures identified on Form H); vii. Compliance with 1915(i) federal regulations, including settings requirements for provider owned and operating settings; viii. Managing Conflicts of Interest; ix. Personnel recordkeeping / management; x. Critical incident reporting; xi. Personnel and client safety (behavior management, restraint, suicide precaution/prevention); xii. Personnel credentialing and training (including verification of licensure, qualifications, training requirements, and certification records for employees and subcontractors); xiii. Medication safety; xiv. Payment of employees and subcontractors; xv. Process to submit reports and billing invoices to DSHS (including verification of the individuals Medicaid for a billing period); xvi. Medicaid fair hearing; xvii. Consumer rights and grievances; xviii. Reporting abuse, neglect, and exploitation; xix. Critical incidents; xx. Transfer of individuals to another HCBS-AMH provider; and xxi. Discharge of individuals from HCBS-AMH.11.To add language on re-applying for the open enrollment.Section VI.D of the open enrollment, Rejection of Enrollment Applications, adds item number 5.Language was added as follows: 5. If a Respondent wishes to re-apply for the Open Enrollment after receiving a rejection letter: a. Respondent is not permitted to re-apply for 6 months from the date of the rejection letter; and b. Respondent must correct the item(s) identified in the rejection letter Addendum #1 Revised on April 24, 2015ItemPurpose of ChangePrevious Revision To add a one-time disbursement for infrastructure development.Section III. Funding and Term, of the open enrollment, A. Use of Funds, contained language that read, in part, as follows: Contingency contracts will be awarded for the purpose specifically defined in this OE. DSHS will review applications in the order in which they are received. The Medicaid rates will be the payment methodology for services provided by a contractor under this contingency contract. DSHS does not guarantee a minimum amount to be paid to a contractor pursuant to a contingency contract awarded through this OE."Said language was changed as follows: Contingency contracts will be awarded for the purpose specifically defined in this OE. DSHS will review applications in the order in which they are received. The Medicaid rates will be the payment methodology for services provided by a contractor under this contingency contract. DSHS will provide a one-time disbursement of $40,000 for infrastructure development to the contractor. Infrastructure development is demonstrated by enrollment of and HCBS-AMH service provision to an individual prior to January 1, 2016. Service provision will be validated through HCBS-AMH service claims submission on the HCBS-AMH invoice template located at http://www.dshs.state.tx.us/mhsa/hcbs-amh/. DSHS does not guarantee a minimum amount to be paid to a contractor pursuant to a contingency contract awarded through this OE. To extend the enrollment closing date to 08/31/2018.Cover Page read, in part, as follows: Enrollment Period Opens: 12/18/2014 Enrollment Period Closes: 08/31/2015Said language was changed as follows: Enrollment Period Opens: 12/18/2014 Enrollment Period Closes: 08/31/2018      P. O. 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