Body
Revision 25-2, Effective Sept. 24, 2025
E.1 IL Skills Training for Blindness and Low Vision
Overview
Independent living skills training is designed to accommodate for the person’s vision loss in daily living activities.
Qualifications
Vendors who provide independent living skills training must have earned a bachelor's degree from an accredited college or university in rehabilitation, education, psychology, sociology or a related field and:
- have one year of work experience in rehabilitation teaching, rehabilitation or education of people with disabilities, or have two years of work experience in general education or a related field; or
- have been included on the list of independent living skills trainers who previously held contracts with the Department of Assistive and Rehabilitative Services to provide this service.
Scope of Services
Independent living skills vendors provide the following services in the person’s home or local community at the discretion of the person. The vendor may provide one or more of the following services as authorized by the service provider.
The needs assessment is for people who are blind and is completed with the person to identify the barriers that prevent them from functioning independently. Vendor staff or a subcontractor completes this process face-to-face with the person. This should occur after the person is determined eligible for services. The service provider uses the needs assessment to develop the ILP.
Independent living skills training teaches a person techniques to enable them to perform the skills of daily living in alternative ways.
These skills are divided into the following categories:
- Personal management includes grooming, eating, maintaining health, staying safe, identifying and coordinating clothing, and managing medication
- Home management includes sewing, cleaning clothes, keeping house, preparing meals safely in the kitchen, planning for grocery shopping and performing minor home repair
- Communication includes telling and managing time, using the phone, managing money, writing, organizing and using adaptive devices
- Information access and technology includes using magnifiers, video magnification systems including closed circuit televisions and other low-vision devices, and adapting computers and other types of technology for the person’s use
Service Provider Responsibilities
The service provider:
- sends referrals to the vendor;
- determines the person’s eligibility for independent living services;
- refers eligible people to the vendor for the needs assessment if this service is subcontracted;
- develops the ILP with the person and enters it into the Independent Living Electronic Data Reporting System;
- authorizes independent living skills training hours;
- manages case records;
- reviews documentation of services provided by the vendor;
- authorizes the purchase of recommended equipment and services;
- documents the purchase of equipment and services in the person’s ILP; and
- arranges for or provides more complex services, including braille instruction, orientation and mobility training within the person’s community, and diabetes education.
Vendor Responsibilities
The vendor:
- conducts a needs assessment if subcontracted by the service provider;
- provides services as directed by the service provider and as described under Scope of Services;
- submits the appropriate documents for each type of service to the service provider for review and approval;
- provides training in basic independent living skills as described in the needs assessment and ILP;
- periodically assesses the person’s progress toward goals and timelines with the service provider;
- submits appropriate recommendations for purchasing products and services for the person to the service provider; and
- provides the service provider with a written report of each contact that includes details of the assessment, or the service provided and the outcome.
Needs Assessment
The vendor must contact a person who is referred for a needs assessment within 30 calendar days of the referral.
The vendor must document the needs assessment on the form provided by the service provider. The recommendations section of the form must contain a summary of the independent living skills training and services the vendor has identified for inclusion in the ILP.
Independent Living Skills Training
After the service provider has developed the ILP, the vendor provides monthly training services as authorized by the service provider. The services are documented monthly using a progress report developed by the service provider.
The monthly report must:
- detail the services provided to the person;
- document the outcome of each service; and
- include any recommendations for changes to the ILP.
E.2 Orientation and Mobility Services
Revision 25-2, Effective Sept. 24, 2025
Function of Orientation and Mobility Vendors
Orientation and Mobility (O&M) vendors offer complex, interrelated services designed to promote independent travel skills for people who are blind or visually impaired.
O&M training prepares people to travel independently with competence and confidence. Orientation is the process of using the available senses to establish one's position and relationship within the environment. Mobility is the ability to travel in the environment with the help of an established tool. Tools include white canes, dog guide and electronic travel aids.
Qualifications and Requirements
The O&M service provider must make sure each person approved to provide O&M services to independent living people meets one of the following requirements:
- The vendor is certified by either the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) or the National Blindness Professional Certification Board (NBPCB).
- The vendor is not certified at the start of the contract, but they:
- have a degree in O&M from an accredited college or university with an established O&M training curriculum and will be certified by ACVREP or NBPCB within one year of the contract date; or
- have at least two years of full-time work experience teaching O&M skills for an entity the service provider recognizes, such as a rehabilitation center, Veterans Affairs (VA) hospital or educational system;
- have three professional references indicating the person's ability to teach O&M skills to blind or visually impaired people; and
- will be certified by ACVREP or NBPCB within one year of the contract date.
To continue contracting for independent living services, all O&M vendors under the contract must maintain ACVREP or NBPCB certification.
Training
In addition to meeting the education, training and experience requirements, all prospective O&M vendors must participate in required training developed by HHSC. Each vendor is responsible for all costs related to attending the training.
Internship Requirements
O&M vendors who use interns to serve people receiving ILS services must:
- observe a minimum of 12 lessons during the internship;
- document the observations; and
- make the observations available for monitoring review by the service provider who may request them in any format for HHSC monitoring.
O&M interns must:
- attend confidence builders training or its equivalent – interns are responsible for all training-related expenses;
- be supervised by a certified O&M vendor for the duration of the internship;
- be observed by the certified O&M vendor for a minimum of 12 lessons during the internship;
- follow all standards for O&M services in this document; and
- sign and forward reports to the supervising O&M vendor for their approval.
Scope of Services
O&M services include:
- an initial assessment of any of the person’s O&M skills including strengths, challenges and existing competency levels;
- a review of the assessment results and training recommendations with the person; and
- O&M skills training as agreed on by the person, the service provider and the O&M vendor.
Vendor Objectivity
The O&M vendor must remain impartial and objective.
Referral Information
Before contacting the person, the O&M vendor receives referral information from the service provider.
Initial Assessment
Assessments may be conducted using the person’s functional vision, which is an opportunity for them to recognize that their vision may not meet all their travel needs.
The initial assessment includes an evaluation of the person’s O&M skills in multiple situations, which may include:
- the person’s home and immediate surrounding area;
- public areas, such as a church, park or college campus;
- commercial areas, such as a bank, store or mall;
- transit systems, such as paratransit or taxis, if available;
- local buses and similar public transportation, if available;
- rural areas, if applicable;
- residential areas are those with light vehicle and foot traffic and some stop signs;
- small business areas are those with heavier traffic and simple traffic lights;
- downtown areas are those with heavy vehicle and foot traffic and complex traffic lights;
- commercial transportation systems, such as buses, trains and airplanes, if applicable; and
- travel using low-vision devices, if applicable.
Post-Assessment Discussion
Following the initial assessment, the O&M vendor reviews the results with the person and answers any questions they may have about the recommended training. A meeting with the person, service provider and O&M vendor is strongly recommended so all parties can agree on the overall O&M training plan.
Documenting the Initial Assessment
Initial assessment reports must be documented and submitted to the service provider per the service provider’s requirements.
The assessment report includes the:
- O&M vendor's observations and comments;
- the person’s current skill level and recommendations for O&M skills training in each of the areas included in the initial assessment;
- number of recommended training hours for each area;
- the person’s goals for O&M training;
- total number of recommended training hours;
- anticipated period that lists the begin and end dates for recommended training;
- person’s signature on their acceptance or rejection of the training recommendations;
- height of the rigid cane that is most appropriate for the person using the measurement between the person’s chin and nose when standing up; and
- description of all the travel aids the person uses or would benefit from using.
Training Authorization
After submitting an assessment report, the O&M vendor must contact the service provider to discuss the initial assessment and get authorization to provide training services.
The topics covered during the discussion include:
- the vendor's recommendations for training, if any, including recommendations on the:
- O&M skills needed;
- proposed completion date of the training; and
- number of training hours authorized by the person’s service provider;
- anticipated delays in services, if any;
- special considerations or extended dates for direct training, if any;
- the person’s readiness to begin nonvisual O&M skills training; and
- the person’s understanding of O&M skills training and its potential benefits.
Monthly Progress Reports
After receiving authorization to provide training services, the O&M vendor must document each person’s monthly training progress.
Monthly progress reports must be submitted within 30 days of the end of each calendar month until the person’s O&M services are completed or services are no longer recommended by the person’s service provider.
Each person’s monthly progress report must include:
- the number of training hours provided in each training area; and
- a detailed narrative of each skill area addressed during the reporting period and the training location for each lesson.
Training locations include:
- home, both indoors and outdoors;
- public areas including bank, church and doctor's office;
- commercial areas such as grocery store and mall;
- transit systems including public transportation, paratransit and taxi;
- rural areas;
- residential areas such as light traffic and stop signs;
- small business areas are those with heavier traffic and simple traffic lights;
- downtown areas are those with heavy traffic and complex lights;
- commercial travel including trains and planes;
- a detailed explanation of anticipated training for the upcoming month;
- an explanation of deviations from assessment recommendations, if any; and
- a detailed narrative of cumulative progress, if training is complete.
Expectations of Training
It is expected that O&M training services for independent living people be conducted using nonvisual, blindfold techniques and a rigid, non-folding cane. All exceptions must be discussed with the service provider before training services begin and must be fully documented in the O&M vendor’s required reports.
O&M vendors will discuss the benefits of nonvisual training with each person. Role modeling and peer support for nonvisual training are encouraged.
Travel Aids
The service provider provides one rigid, long, white cane for each person for O&M assessment and training, to be distributed by the O&M vendor. The O&M vendor conveys to the service provider the appropriate length for the person using the person’s height and other information.
If a person has a dog guide, they are assessed by the O&M vendor to make sure they have proficient cane skills. O&M training can occur with either a cane or a dog guide.
The O&M vendor must include observations and recommendations of cane skills in the initial assessment. Recommended hours for training must include the person’s travel needs, regardless of the mobility tool, dog or cane. More hours are not requested for training with a dog guide.
O&M vendors also give information about cane purchasing to each person. People are responsible for acquiring all replacement canes, cane tips and back-up canes.
O&M vendors may recommend other travel aids or other items to the person’s service provider. But the decision to purchase more items rests solely with the service provider.
O&M vendors are not reimbursed for items provided to a person by the service provider.
Providing Services
The O&M training may not exceed the extent of services such as type of training and total number of hours authorized by the person’s service provider.
O&M vendors cannot provide more than six hours of training on any given day, even if multiple people are served in that day. Lessons are approximately two hours long. Without prior authorization from a service provider, a person must not receive more than four hours of O&M instruction on any given day.
Consistent and frequent scheduling is recommended to maximize learning.
For people receiving independent living services, the service provider authorizes two to three hours for the initial assessment. The vendor’s initial assessment report should determine if training is necessary, the total number of hours needed to complete the training, and a breakdown of how the hours will be completed. This includes the number, length and frequency of training sessions.
The service provider will review the initial assessment report and determine if the vendor’s recommendations align with:
- the person’s goals
- the complexity of the environment the person will be navigating such as distance, number of obstacles, amount of traffic, if public transit is involved, and the person’s current familiarity with the area
- the person’s stamina and ability to walk, focus and learn for the recommended length of a session which is based on conversations with the person and understanding of their disabilities
- prior O&M training completed under similar circumstances
Transporting people does not count toward training time. O&M vendors are not reimbursed for time spent in the car, even when a person is present.
The O&M vendor must notify the service provider within 24 hours about all:
- no-shows, cancellations or rescheduled appointments;
- issues, concerns or circumstances that might impact or delay planned services; and
- issues that might delay the completion of services.
O&M vendors must get written approval from the service provider before deviating from any of these standards during training, even when based on a person’s needs.
If Services Are Interrupted
If training cannot be completed as planned or if services are postponed indefinitely because of unexpected circumstances, the O&M vendor must notify the service provider within 24 hours. The service provider will then document the postponed services.
E.3 Services for People Who Are Deafblind
Revision 25-2, Effective Sept. 24, 2025
Vendor Qualifications
A vendor must meet the following qualifications:
- Hold a bachelor's degree in education or a related field.
- Have a working knowledge of the following:
- The medical, psychological, social and independent living issues faced by people who are deafblind, are visually impaired or hard of hearing, or are otherwise disabled
- Assessment techniques and tools
- American Sign Language, augmentative communication, manual signs and other communication systems
- Knowledge of agencies, people and facilities that serve those who are deafblind, with or without other disabilities, and serve the culture and adaptive needs of people who are deafblind
- Can do the following:
- Adapt teaching methods to the needs of people who are elderly and either deafblind or deafblind and multiply disabled
- Help people adapt or modify common items in the home to make the items accessible
- Assess, formulate, organize and implement a personalized program of instruction with people
- Teach people to read and write all aspects of uncontracted braille
- Communicate using American Sign Language, including using tactile sign language
- Teach assistive technology, as needed, to enable a person who is deafblind to access independent living skills
- Deliver, install and setup adaptive aids or devices
Vendor Authorization
Services must not begin until the service provider has been notified of approval.
Deafblind Services Vendor Responsibilities
The deafblind services vendor:
- completes an assessment of needs;
- submits the right documents for each type of service to the service provider for review and approval;
- submits proper recommendations to the service provider to purchase products and services for each person;
- trains people who are deafblind to use adaptive equipment, including visual alarms and vibrating alerting systems; and
- provides a written report of each contact to the service provider including details of the assessment or service provided and the outcome.
Initial Contact
The deafblind services vendor must make the initial contact with a person who is referred for deafblind services training within 15 working days of the referral.
E.4 Eyeglasses and Contact Lenses
Revision 25-2, Effective Sept. 24, 2025
Required Qualifications
An ophthalmologist must be licensed by the Texas Medical Board.
An optometrist must be licensed by the Texas Optometry Board.
Purchasing Procedures
Eyeglasses and contact lenses may only be purchased for a person who is significantly visually impaired with best correction. Eyeglasses and contacts lenses that restore vision to better than 20/70 are not purchased with funds from this contract. Once a recommendation and a prescription from a licensed optometrist or ophthalmologist has been received, purchase lenses and frames per the following procedures:
- Single vision, bifocal and trifocal glasses or contact lenses may be purchased using available funds.
- Lenses may have tint and be impact-resistant, if prescribed.
- Frames must be the least expensive serviceable type available. The person may supplement the additional cost for frames, if the cost of the person’s choice exceeds the minimum cost for a functional frame.
- Compare the cost of contact lenses with the cost of glasses before purchasing contact lenses to determine the most cost-effective way to meet the required need for the person.
Low Vision Services
Low vision services may be provided to eligible people whose visual acuity cannot be improved by conventional prescription eyeglasses. Low vision evaluations should be provided by an optometrist or ophthalmologist who has received specialized low vision training.
Optical Low Vision Devices
Optical low vision devices are complex optical aids designed by a specialist for a specific person, based on the person’s functional vision and optical prescription.
Examples of optical low vision devices include highly sophisticated bioptic, telemicroscopic and reversed telescopic optical systems, as well as other single or compound optic systems.
Non-Optical Low Vision Devices
People with low vision may benefit from low-tech adaptations, such as modifications in lighting or the use of contrasting colors, including using a place mat that contrasts in color with the plate, as well as non-optical low vision devices.
Non-optical low vision devices include the following:
- Readily available independent living aids such as 20/20 pens and bold line paper
- Video magnification devices, including closed circuit television (CCTV)
- Non-prescription optical devices, such as hand-held magnifiers and telescopes
A technology evaluation or a low vision specialist recommendation is required for technology purchases of $2,500 or more such as some CCTV video magnification systems and stand-alone scanners.
To purchase a non-optical low vision device:
- get the price for each item;
- consider the needs for accessibility, training and installation;
- document the specific information about the item, such as the:
- manufacturer;
- model number or version;
- monitor size; and
- purchase as needed.