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Contract Subject: Room, Board and Supervised Living
The contractor and contractor staff that provide services described in this chapter also must comply with Chapters 1–3 of the VR Standards for Providers manual.
On this page:
11.1 Service Overview
The goal of Supportive Residential Services is to assist customers who are in recovery to maintain stability, control, and abstinence from use of substances so they will be able to gain competitive integrated employment. This service is intended to provide a supervised, stable living environment, with additional supports to assist the customer in pursuit of a successful competitive integrated employment outcome in a timely manner.
VR does not sponsor Supportive Residential Services until
- after the customer has been determined eligible for VR services, and
- the service is included on the customer's IPE or IPE amendment.
Supportive Residential Services are NOT intended to serve as a medical detox. For additional information regarding VR-sponsored medical services, refer to Vocational Rehabilitation Services Manual C-700: Medical Services.
Vocational Rehabilitation will only support customers with substance use related to the following classifications:
- Alcohol – Usually composed of ethanol or ethyl liquid that when ingested acts as a psychoactive drug that acts as a depressant on the central nervous system (Caron 2016)
- Cannabis – Dried flowering tops of Cannabis Stavia plant. Smoked or ingested to induce psychotomimetic effects to the central nervous system. Usually goes under the name "Marijuana"
- Hallucinogens – Plant or synthetic compounds capable of causing functional disturbances in the form of psychoses, mainly hallucinations
- Inhalants – Chemical vapors that are inhaled for delusional effects on the central nervous system
- Phencyclidine – Intravenous antiseptic that causes delusions and hallucinations. Usually goes under the name "PCP" or "Angel Dust"
- Opioids – A pain-attenuating peptide, synthetic or natural, that triggers the brain to release analgesia
- Sedatives – Usually combination of drugs used to calm or relax patients
- Stimulants – A drug or other substance used to accelerate or excite the central nervous system
Drug classifications that do not qualify for rehabilitation services:
- Caffeine – A stimulant made of a crystalline compound that affects the central nervous system (Farlex)
- Tobacco – Prepared leaves of certain plants; some having narcotic properties, used for chewing, smoking or sniffing
This chapter outlines VR standards that must be followed by VR-funded facilities providing Supportive Residential services for customers with a history of substance use to ensure the health, safety, and quality of services a customer will receive.
Personal Social Adjustment Training, Vocational Adjustment Training, Job Placement, Job Skills Training Services, and other VR services may be purchased in conjunction with Supportive Residential Services for Persons in Recovery.
Any facility providing services under this chapter shall be remain responsible for compliance with applicable federal, state, or local laws, codes, rules, or ordinances.
11.2 Staff Qualifications
All staff must meet the standards and qualifications outlined in the Texas Administrative Code for Chemical Dependency Treatment Facilities and the Texas Department of State Health Services (TDSHS) as required to maintain licensure. Additional information can be found in section 11.3 Facility Requirements.
If other VR services are also being provided, such as Personal Social Adjustment Training, Vocational Adjustment Training, or any Employment Services qualifications applicable to those services must be met.
The staff-to-customer ratios found in section 11.4 Program Requirements must be maintained.
11.3 Facility Requirements
Each facility must obtain and maintain Texas Department of State Health Services -Substance Abuse Treatment Facilities Licensure. For more information, go to Texas Department of Health and Services Chemical Dependency Treatment Facilities at https://www.hhs.texas.gov/providers/health-care-facilities-regulation/chemical-dependency-treatment-facilities
Facilities must be compliant with all rules, laws, codes and ordinances outlined in the:
VR will not refer new customers to a facility under an action by Texas Department of State Health Services in which it is seeking to deny, suspend or revoke a facility's license, or is refusing to renew, unless and until such action has been resolved with a final Order ensuring continued operations. A facility currently providing services to VR customers is required to notify TWC VR of any such action by TDSHS within ten (10) business days of receiving notification by TDSHS. A facility which fails to timely notify TWC VR of the filing of any such action by TDSHS is considered out of compliance with contract terms and conditions.
VR will only sponsor licensed Treatment Program Services titled "Supportive Residential" in 25 TAC, Chapter 448, Sub Chapter I Treatment Program Services and expects TAC §448.901 Requirements Applicable to All Treatment Services" to be followed.
To be eligible to provide services to VR customers, facilities must allow the use of facility vehicles and/or staff to transport VR customers to and from appointments and activities included within the program, such as AA meetings, in compliance with 25 TAC §448.510 and Chapter 3: Basic Standards of this manual.
VR mandates that, in addition to complying with 25 TAC, Chapter 448, Subchapter L. Residential Physical Plant Requirements, the facility also must comply with the American Disability Act (ADA) and must complete the "ADA Full Checklist for Existing Facilities," based on the 2010 ADA Standards for Accessible Design, found at http://www.adachecklist.org/checklist.html. This document must be kept on file and made available to VR staff upon request.
Each facility is expected to maintain compliance with 25 TAC, Chapter 448, Subchapter G, 448.704 Program Rules. VR requires each facility to establish clear policies regarding the use or possession of controlled substances within the facility. These policies must include:
- clearly defined circumstances under which such substances are allowed in the facility;
- provisions for storage of allowable substances; and
- clearly articulated consequences for residents who violate the facility's controlled substance policies.
The facility must report, in writing, any use of a controlled substance that is not prescribed by a physician, to the VR counselor within one (1) business day of discovery.
The following Subchapters of the Texas Administrative Code, 25 TAC Chapter 448 Substance Abuse Standards of Care do not apply to VR customer's in Supportive Residential Services for Persons in Recovery:
- SUBCHAPTER M. COURT COMMITMENT SERVICES
- SUBCHAPTER N. THERAPEUTIC COMMUNITIES
- SUBCHAPTER O. FAITH BASED CHEMICAL DEPENDENCY PROGRAMS
The contractor maintains proof of a current TDSHS Substance Abuse Treatment Facilities License with the assigned TWC VR contract manager and Regional Program Specialist.
When the facility is inspected, the contractor is required to provide any monitoring/inspection reports by other agencies to the assigned TWC VR Contract Manager and Regional Program Specialist within five business days of receiving the report.
11.4 Program Requirements
11.4.1 Service Description
Supportive Residential Services for Persons in Recovery must include 24 hours per day, 7 days per week of a structured therapeutic environment that ensures the health and safety of the customer while he or she is maintaining abstinence from the use of controlled substances. Supportive Residential Services include: housing, meals, medication supervision, and structured treatment services.
VR will only pay for days the customer is actively in the facility and will not pay for unexcused or excused absences.
Supportive Residential Services must be provided by a facility that is licensed by the Texas Department of State Health Services as a Substance Abuse Treatment Facility, which maintains compliance with TDSHS regulations and which does not have a current action with TDSHS involving license suspension, revocation or denial of renewal.
Supportive Residential Programs providing treatment services as specified in 25 TAC §448.903, Substance Abuse Standards of Care Rules must provide and document at least six hours of treatment services per week for each customer, comprised of at least:
- three hours of chemical dependency counseling (one hour per month of which shall be individual counseling); and
- three hours of additional counseling, chemical dependency education, life skills training, and relapse prevention education.
Personal Social Adjustment Training, Vocational Adjustment Training, Job Skills Training and Job Placement services can be provided simultaneously by VR if the facility has an Employment Services contract with TWC or if partnering with another approved service provider. All requirements outlined in the Standards for Providers chapters related to the service must be met by either party.
The ratio of direct care staff-to-customer ratio must be at least 1:20 when customers are awake and 1:50 during sleeping hours, as specified in 25 TAC §448.903 (h).
VR may purchase up to 90 days of residential treatment, in 30-day increments, when the customer demonstrates progress towards established goals and objectives as outlined in the treatment plan and the VR3384, Supportive Residential Progress Report.
The customer must participate in a recovery program, abide by residential rules, and be actively working towards mastering work readiness skills or obtaining competitive integrated employment for additional time to be approved.
If there is a need for VR sponsored residential services for more than 90 days:
- VR supervisor review and approval is required in 30 day increments for continued sponsorship to ensure that the customer is continuing to make measurable, predefined progress towards established goals and objectives, and
- VR3472, Contracted Service Modification Request must be submitted and approved prior to services being authorized.
For additional information about Contract Service Modifications, refer to Vocational Rehabilitation Services Manual D-200: Purchasing.
11.4.2 Process and Procedure
11.4.2.1 Referral
The provider receives a VR3383, Supportive Residential Referral Form and any documentation that will prepare the provider to better work with the customer, such as medical or psychological reports or case notes and service authorization for up to 30 days.
11.4.2.2 Treatment Plan
The provider and customer develop a treatment plan as outlined in 25 TAC §448.804 identifying:
- goals based on the customer's needs, strengths, and preferences;
- objectives that are individualized, realistic, measurable, time specific, appropriate to the level of treatment and stated in behavioral terms;
- strategies to be used describing the type and frequency, to help the customer achieve the identified goals; and
- discharge criteria, including initial discharge plan.
The discharge plan must identify:
- where the customer will live and work after completion Supportive Residential Services; and
- specific supports that will be necessary for maintaining the progress made in Supportive Residential Services.
11.4.2.3 Reporting Progress
The provider provides services in accordance with 25 TAC §448.903 and completes the VR3384, Supportive Residential Services Progress Report. The treatment plan and VR3384 is reviewed monthly (every 30 days) to:
- evaluate the customer's progress toward their goals;
- determine if the treatment plan needs to be updated prior to a service authorization being issued to approve additional days; or
- determine if the customer's Supportive Residential Services are complete.
The provider must complete the VR3384, Supportive Residential Supportive Residential Services Progress Report and update the treatment plan at least monthly and submit with an accurate invoice.
11.4.3 Discharge Notice
The facility is required to provide advance notice to the customer, the customer's care giver (when applicable), and VR office before discharging the customer. When notifying a caregiver, the facility uses the current address/phone number/email address of record provided by the customer/caregiver for purposes of notice. When notifying the VR office, the notification must be made by phone during regular business hours.
The only exception to the advance notice requirement is when there is a documented concern about the customer's safety or wellbeing or the safety or wellbeing of other individuals at the facility. These concerns must be communicated to VR immediately and efforts must be made to ensure that the customer's care giver is present at the time of discharge.
11.4.4 Outcomes Required for Payment
The provider documents, in descriptive terms, all the information required by the Service Description on the VR3384, Supportive Residential Services Progress Report, including evidence that:
- services were provided in accordance with 25 TAC §448.903;
- the customer's attendance at the facility without elopement or unauthorized weekend passes outside the scope of recovery was recorded;
- the customer's attendance in at least the six hours of required treatment services each week was recorded;
- the customer is abstaining from any controlled substances and maintaining medication as prescribed;
- the customer is maintaining adherence to residential rules;
- goals and objectives identified in the treatment plan were addressed and progress documented on the VR3384, Supportive Residential Services Progress Report; and
- customer satisfaction was verified through either a signature on VR3384, Supportive Residential Services Progress Report or by VR staff members' contact with the customer.
VR will not pay any fees related to excused or unexcused absences or holidays.
Payment for Supportive Residential Services for Persons in Recovery is made when the VR counselor approves a complete, accurate, signed, and dated:
- treatment plan;
- VR3384, Supportive Residential Services Progress Report; and
- invoice.
11.4.5 Supportive Residential Services Fees
| Service Name | Unit Rate | Comments |
|---|---|---|
| Supportive Living for Recovery | $35.00 per day |
|
