All providers must comply with this chapter of the VR Standards for Providers manual.

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3.1 Overview of the Basic Standards

The VR Standards for Providers (VR-SFP) manual focuses on the business practices, processes, and policies that must be followed for the Texas Workforce Commission (TWC) and the contracted provider to comply with federal and state laws and TWC rules and requirements.

TWC must ensure that taxpayer funds are spent wisely and provide the best value to the taxpayer. The standards that providers must meet ensure that Vocational Rehabilitation (VR) customers receive quality services to help them achieve their vocational rehabilitation goals.

Each provider is expected to be familiar with and comply with the most recently published standards and use the most recently published forms applicable to their contract. Each provider must maintain an updated VR3443, TWC VR Standards for Providers Certification form on file with their regional program specialist and contract manager.

Terms Used in the Manual

Contractor—An entity or individual awarded a contract with TWC to provide goods and services. Sometimes used interchangeably with provider or service provider.

Employment services provider—A provider that has a contract with TWC to provide employment-related services to eligible customers. An employment services provider was previously referred to as a community rehabilitation program.

Provider—Any individual or business from which a VR contractor can obtain goods and services for customers. Providers are also referred to as vendors.

Service provider—Entities or individuals approved to provide services to individuals with disabilities who receive VR or Independent Living Services for Older Individuals Who Are Blind (ILS-OIB). Sometimes used interchangeably with provider or contractor.

Refer to the VR Glossary to ensure familiarity with the key terms used in this manual.

3.1.1 Contractor's Primary Contacts

The contractor's primary TWC contacts include the following:

  • Contract manager—the assigned VR contact for assisting with contract-related issues
  • OIB worker—the primary contact for customer-related issues and for directing the independent living skills contractor in the provision of services to ILS-OIB customers. The OIB worker coordinates cases, provides counseling and guidance, determines a customer's eligibility, and develops and manages comprehensive independent living plans for ILS-OIB customers.
  • Liaison—the VR contact for answering the routine questions posed by contractors and their staff about VR programs and the standards required for providers
  • Regional Quality Assurance Specialist or Regional Program Support Specialist (referred to as Regional Program Specialist within this chapter)—the VR contact for answering routine questions about the VR program and the standards for providers, when the liaison is unavailable to help the contractor or when no liaison is assigned
  • VR counselor—The primary contact for customer-related issues. The VR counselor provides counseling and guidance, determines a customer's eligibility, and develops and manages comprehensive individual rehabilitation plans for VR customers.

3.1.2 Contract Types

Service Contracts

Service contracts are used when a provider completes tasks or provides services described in the VR-SFP manual, such as when:

  • assessing assistive technology designed for the blind and visually impaired;
  • providing diabetes education;
  • providing employment-related services;
  • assessing a customer's work environment;
  • providing services for older individuals who are blind;
  • providing Orientation and Mobility services;
  • providing Post-Acute Brain Injury services;
  • providing Pre-Employment Transition Services;
  • providing Project Search services;
  • providing Supportive Residential Services for Persons in Recovery; and
  • developing Wellness Recovery Action Plans.

Goods or Equipment Contracts

Goods or equipment contracts are used when a provider provides a product for the customer, as described in the VR-SFP manual, such as when providing:

  • durable medical equipment;
  • hearing aids; or
  • vehicle modification.

3.1.3 Headquarters

Each provider must have a designated headquarters where customer records are securely stored and where administrative responsibilities are performed, as required by the contract. The provider must maintain the following forms up-to-date and on file with the regional program specialist and contract manager:

3.1.4 Legally Authorized Representative

Each contractor must have a legally authorized representative to sign contracts, official documents, and verification statements.

3.1.5 Director

Service contracts must designate a director as the primary contact. Goods or equipment contracts do not require UNTWISE Director Credentials to maintain compliance with the contract.

The designated director in each service contract:

  • handles routine communication;
  • addresses compliance issues;
  • ensures that staff qualifications are documented and up-to-date;
  • supervises staff and subcontractors, if any; and
  • ensures that the contractor meets the requirements explained in the contract, in the VR-SFP manual, and in-service authorizations.

The director is not required to have the job title of director.

The director may be the legally authorized representative. The legally authorized representative may assign a staff member to be the contractor's designated director.

As of September 1, 2017, all designated directors must hold the UNTWISE Director Credential and maintain its effectiveness throughout the contract term. There is no grandfather clause for this requirement. The director credential must be maintained without lapsing. Exception: Contracts for Employment Supports for Brain Injury services and Supported Residential Services for Persons in Recovery.

For more information, see UNTWISE.

The contractor must keep a completed VR3455, Provider Staff Information Form, for the director on file at the contractor's headquarters, and must provide copies on request to the TWC contract manager and the VR or OIB regional program specialist. The VR3455 must fully document that the required qualifications of the director are met.

A director's qualifications must be reviewed by TWC staff during contract monitoring reviews. TWC staff may request verification of the director's qualifications at any time. Payment made for services provided during periods without an approved credentialed director may be subject to recoupment or other penalties under the contract. Failure to maintain the qualifications is not in compliance with the terms of the contract and may result in the contract being suspended or terminated.

3.1.6 Staff of the Contracted Provider

A contractor may hire employees or use independent subcontractors. If the contractor uses subcontractors, refer to the contract for the subcontracting requirements.

A contractor's employees and subcontractors who are under contract to provide VR and/or ILS-OIB services are not TWC employees, are not eligible for TWC employee benefits, and must not represent themselves as state employees. The contractor must provide all legally required unemployment insurance and workers' compensation insurance.

3.1.6.1 Subcontractors

The contractor accepts liability and retains responsibility for the performance of subcontractors that provide services under the terms of the contract. Subcontractors providing services under the contract must meet the requirements and qualifications required in the standards.

No subcontract may relieve the contractor of the responsibility of ensuring that the contracted services are provided according to the standards. The provider accepts responsibility for compensating any party with which the provider enters a subcontract relationship.

3.1.6.2 Staff Credentialing

TWC has partnered with UNTWISE and the Center for Social Capital to ensure that providers are fully equipped to offer the highest quality services to Texans with disabilities.

UNTWISE has developed:

  • a director credential for all standards-related service contracts, excluding services related to post-acute brain injury and supported residential services for individuals in recovery;
  • credentialing and training processes for the staff of providers' that offer employment services such as job coaching, job placement, supported employment services, and Vocational Adjustment Training; and
  • endorsements for areas of specialization to work with various disability groups, such as groups for individuals with autism or with blind and visual impairments.

For additional information about the UNTWISE credentialing and endorsement processes, see Texas Credential Training.

The Center for Social Capital has developed credentialing and training processes for contractors' staff that provide self-employment services.

For information on the qualifications required of contractors' staff and the premiums TWC pays for services, see the chapters in the VR-SFP manual that are related to each service.

3.1.6.3 Staff Required Documentation

Each service provider (contractor)—excluding providers of post-acute brain injury or supportive residential services for individuals in recovery—must keep the following information on file for all directors, employees, and subcontractors:

  • A VR3455, Provider Staff Information Form
  • Supporting evidence that the staff providing services or the appointed director meets all required qualifications under the contract, such as:
    • professional credentials;
    • credentials from UNTWISE or the Center for Social Capital;
    • copies of college transcripts, a high school diploma, or a General Educational Development test;
    • certificates of specialized training; or
    • statements from former employers
  • A completed US Department of Justice Form I-9 Employment Eligibility Verification, as applicable (see United States Citizenship and Immigration Services)
  • A signed W-4 form from the IRS, unless the staff member is a subcontractor

Each service provider must submit the VR3455 form and the supporting evidence that the staff member meets the required qualifications to both the regional program specialist and the assigned contract manager within 30 days of:

  • hiring new staff;
  • making a significant change to a staff member's job duties;
  • changing staff qualifications; or
  • terminating a staff member.

3.1.6.4 Temporary Waiver of Staff Qualifications

When a contractor no longer has qualified or credentialed staff, including directors, a VR3490, Temporary Waiver of Credentials, must be completed and approved by the VR director before services are provided.

The waiver is specific to the contractor and staff members named on the VR3490 and is valid for the period specified on the approved waiver.

The VR director may approve a VR3490 waiver after consideration of:

  • the availability of another qualified or credentialed director;
  • the availability of a qualified or credentialed staff member who meets the qualifications required by the standards for the contracted service;
  • the necessity of the waiver to avoid a break in the essential services being provided to a VR or ILS-OIB customer receiving services from that provider; and
  • whether approval of a waiver is in the best interest of VR or ILS-OIB customers and the state.

After a VR3490 is processed, regardless of whether approved or denied, a copy is sent to the contractor and must be kept on file by the:

  • contractor;
  • assigned VR regional program specialist; and
  • assigned TWC contract manager.

A copy of the approved VR3490 must accompany any invoice for services provided by a non-credentialed employee or subcontractor to a VR or ILS-OIB customer.

3.1.6.5 Staff-to-Customer Ratios

Each services-related chapter in the VR-SFP manual describes the required staff-to-customer ratio.

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3.2 Insurance Requirements

All contractors subject to the VR Standards for Providers (VR-SFP) must provide proof of insurance, as required, to the assigned Texas Workforce Commission (TWC) contract manager and regional program specialist.

TWC VR requires the following kinds of insurance:

  • Garage liability insurance for vehicle modification providers, as required per contract;
  • Auto liability insurance for providers who choose to transport customers in motorized vehicles. Transportation of VR customers is not required, but if done, contractors must meet the minimum liability requirements of the Texas Department of Insurance, and keep records of staff who transport customers in vehicles.

When insurance is required, the contractor submits the form VR3445, Provider Insurance Verification, with evidence of coverage at the time of execution of a contract, and resubmits it any time that insurance coverage, terms and conditions, or other information is changed or updated. Insurance requirements can be found in the contractor's contract and VR-SFP chapters for specific services.

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3.3 Contractors Standards–All Contract Types

3.3.1 Employment of Qualified Individuals with Disabilities

Each contractor must demonstrate the meaningful efforts made to employ and advance in employment qualified individuals with disabilities.

Contractors must maintain and implement written standards of conduct for the contractor's employees and subcontractors. These standards of conduct must incorporate all professional standards of conduct and ethics required by the licensing or credentialing entity for licensed individuals in positions held by the contractor's employees and subcontractors.

3.3.2 Professionalism

Contractors, their employees, and any subcontractors must perform in a professional manner and dress in business casual attire that is appropriate for the work activity and workplace:

  • when interacting with VR customers and staff; and
  • when providing services and visiting VR offices.

A professional manner is defined as:

  • maintaining the confidentiality of all customer information in full compliance with state and federal regulations;
  • obtaining a written confidentiality release when sharing information with others who are not VR staff or are not the customer's legal guardian;
  • not misrepresenting oneself as a state of Texas employee;
  • not misrepresenting the contractor as a state agency;
  • reporting in a timely manner and to appropriate authorities the abuse or neglect of any customer or customer's family member;
  • considering the negative impacts of action or inaction on the part of the individual or contractor to the health, safety, or welfare of any customer or customer's family member;
  • avoiding relationships with customers or VR staff that would impair the contractor's objectivity in performing his or her duties or that would endanger confidentiality;
  • not engaging in activities or relationships with customers that might be misconstrued by the customer; or
  • not allowing a third party to be present when meeting with a customer at the customer's home or business, unless the customer has signed a release allowing the third party to be present or unless the third party is a potential employer.

3.3.3 Conflict of Interest

Contractors and potential contractors must not offer, give, or agree to give TWC staff anything of value.

Anything of value includes prepared foods, gift baskets, promotional items, awards, gift cards, meals, or promises of future employment.

If a violation occurs, corrective action is required and may include contract termination or disqualification from receiving a future contract with TWC.

Real or apparent conflicts of interest might occur when a former VR employee becomes an employee or a subcontractor of a TWC contractor.

A contractor must not:

  • hire, contract with, or accept as a volunteer any current employees of TWC, VR, or ILS-OIB;
  • hire, contract with, or accept as a volunteer any former employees of TWC, VR, or ILS-OIB earlier than 12 months after the separation date, if the former employee will provide contracted services as defined in the VR-SFP manual and/or Texas Government Code §572.069; or
  • knowingly request or obtain confidential information from a state employee for the benefit of the contractor, personally or professionally.

The scenarios above do not make up a complete list of real or apparent conflicts of interest. Failure to disclose a conflict of interest can result in contract termination, disqualification from receiving a future contract, and/or recoupment of payments.

Each contractor must have a current VR3444, Conflict of Interest Certification, on file with their contract manager and regional program specialist.

3.3.3.1 Texas Workforce Solutions–VR Customer Providing Services to other Texas Workforce Solutions–VR Customers

A customer is acting in a dual role when the Texas Workforce Solutions–VR (TWS-VR) customer’s IPE supports the customer:

  • obtaining employment from an existing contractor to provide services to other TWS-VR customers; or
  • becoming a TWC-VR contractor to provide services to TWS-VR customers.

When the TWS-VR customer is in a dual role, for a period of 12 months following the closure of his or her case, the customer:

  • is prohibited from providing services to any customer who is assigned to the customer’s same TWS-VR counselor; and/or
  • may not receive service authorizations from the office to which the customer’s VR counselor is assigned.

An exception may be granted when a VR3472, Contracted Service Modification Request, is approved for any of the following reasons:

  • The customer lives in a rural or other area where no other providers are available to serve the customer(s);
  • The contractor has a skill or capability that no other available and accessible provider has. For example, in situations where a customer is not proficient in English, the contractor speaks the customer's language as well as English.

3.3.4 Confidentiality

All contractors, contractor employees, and subcontractors must keep customer and employee information confidential.

The contractor must provide physical safeguards for confidential records, such as locked cabinets or encrypted file storage, and ensure that the records are available only to authorized staff members as needed to provide goods or services. Customer case records must be stored in a secured location where there is maximum protection against fire, water damage, theft, and other hazards.

If a breach of confidentiality is discovered, the contractor must report it immediately to the:

  • assigned VR counselor or OIB worker; or
  • TWC contract manager.

3.3.5 Data Encryption

VR policy and federal law requires that all email messages that contain confidential information must be sent using the level of encryption required by publication 140-2 of the Federal Information Processing Standard (FIPS).

If a contractor is not equipped to use the FIPS 140-2 level of encryption, the contractor must ask a VR staff member who is equipped to send the email message. The same message can then be used to send encrypted information back to VR, when the directions are followed accurately.

If the contractor fails to use the FIPS 140-2 level of encryption, the contractor must report a breach of confidentiality to the assigned regional program specialist and TWC contract manager.

3.3.6 Sound Fiscal and Business Practices

Contractors must demonstrate business procedures and internal controls that prevent the following practices:

  • Abuse—practices that are inconsistent with sound fiscal or business practices and that result in unnecessary costs, such as intentional destruction, diversion, manipulation, misapplication, or misuse of public resources in both financial or nonfinancial settings
  • Fraud—any intentional conduct designed to deceive others, resulting in a loss to the victim and/or a gain or benefit to the actor
  • Misconduct—intentional wrongdoing or improper behavior or activity
  • Waste—the thoughtless or careless expenditure, consumption, mismanagement, misuse, or squander of public resources, such as incurring unnecessary costs because of inefficient or ineffective practices, systems, or controls

Contractors for VR and the contractor's employees and subcontractors must:

  • implement and maintain business controls that prevent fraud, waste, or abuse;
  • implement, maintain, and strengthen controls over the costs of services; and
  • obtain high-quality goods and services that are cost effective for customers.

3.3.6.1 Reporting Abuse, Fraud, Misconduct, and Waste

A contractor is responsible for any abuse, fraud, misconduct, or waste that is committed by the contractor's staff or subcontractors.

If abuse, fraud, misconduct, or waste is reported, the contractor must provide the assigned TWC contract manager or regional program specialist with:

  • the name of the individual providing the information;
  • the name of the individual submitting the information (if different from the individual providing the information);
  • the name of an additional contact person;
  • details about whether and when law enforcement was notified;
  • the names of witnesses;
  • the name of the individual or facility being reported; and
  • detailed information about the abuse, fraud, misconduct, or waste.

Contractors must report all allegations of fraud, misconduct, and waste to TWC Fraud Reporting.

3.3.7 Reporting Substance Abuse by Customers

If a customer is observed using alcohol or drugs, or any other evidence of substance abuse by the customer exists, the provider must:

  • report the information immediately to the VR counselor or OIB worker; and
  • document that the VR counselor or OIB worker was informed of the observations and other evidence.

3.3.8 Referrals to VR by a Provider

A provider may refer an individual with a disability to VR for services.

The provider must inform the individual that:

  • the VR counselor or OIB worker determines eligibility for VR services; and
  • the VR counselor or OIB worker works with eligible customers to do the following and provide them with the information required to make an informed choice:
    • Develop an individualized plan for employment for VR or an independent living plan
    • Choose the services necessary to meet the individual's goals and objectives
    • Choose the providers of any planned goods or services

Referrals from a provider are not a guarantee that the provider will be selected to work with the referred, eligible customer.

3.3.9 Contract Adherence

TWC contracts only with providers who are in full compliance with all chapters in the VR-SFP manual that relate to the contract. Each contractor is required to undergo a review and comply with periodic monitoring activities to ensure continued compliance with the standards.

Contracted service providers must be in full compliance with:

Revisions to the VR-SFP manual are published at least 30 days before the effective date of the revisions.

It is the responsibility of the contractor to maintain awareness of revisions to the standards and to implement the changes as prescribed.

Failure to follow applicable standards and contract requirements could result in adverse consequences, such as denial of payments, recoupment of payments, suspension as a provider of VR services, or loss of an awarded contract.

If a provider is unwilling or unable to change in a timely manner the provision of services as prescribed, the provider must contact the assigned contract manager and the regional program specialist.

3.3.10 Contractor Required Policy and Procedures

The contractor must develop and adhere to policies and procedures to protect customers, customer interests, visitors, and the contractor's staff.

Contractors must have policies and procedures in place before providing services to customers and must review and update their policies to ensure continued compliance with the standards. Contractors must ensure that their policies and procedures do not conflict with the standards or the requirements of their contract. Contractors must develop a written plan and maintain documentation that staff and customers, as appropriate, have been educated on policies and procedures.

At a minimum, contractors must have written policy and procedures on the following:

3.3.11 Safe and Secure Environments

Contractors must provide a safe and secure environment for their employees, VR or ILS-OIB customers, and visitors.

The contractor must report all incidents in accordance with:

  • the contractor's policies and procedures;
  • the contractor's contract; and
  • state and/or federal regulations and laws, as required by the standards.

An incident is an unusual or unexpected event that compromises or may compromise the health or safety of individuals or the security of property.

The contractor must report incidents that involve VR customers, the contractor's employees, or subcontractors.

Examples of incidents include, but are not limited to:

  • violence, including domestic violence;
  • automobile accidents;
  • physical or sexual assault;
  • terrorist threats;
  • serious medical emergencies, deaths, or suicides;
  • breaches of confidential information (refer to 3.3.4 Confidentiality);
  • theft or loss of property or mischievous or malicious destruction of property on loan from or purchased by VR;
  • negative behaviors displayed by VR customers;
  • fires or accidents involving hazardous materials;
  • interruption of service that is due to an emergency or disaster;
  • threat of harm to oneself or others by personal contact, letter, phone, or email; and
  • abuse, neglect, or exploitation of an individual with a disability.

All incidents must be reported within one business day to the:

  • VR counselor or OIB worker;
  • assigned regional program specialist; and
  • TWC contract manager.

VR and ILS-OIB policies and procedures require VR employees to report incidents in writing, as required by Texas law, the appropriate licensure and investigating agencies, the standards, and the provider's contract. See 3.6.6 Allegations or Incidents of Abuse, Neglect, or Exploitation.

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3.4 Contractor Standards for Service Contracts Only

3.4.1 Customer Satisfaction Surveys

Each contractor must have an ongoing self-evaluation system designed to assess the customer's satisfaction and the effectiveness of the services provided to customers.

At the minimum, each customer must be offered the opportunity to complete a customer satisfaction survey after the service has been completed.

If a customer declines when asked to complete a customer satisfaction survey, proof must be documented that the survey was offered, for example, by noting on a blank survey that the customer declined and specifying the date declined.

Each contractor's survey, at a minimum, must use a 1–5-point Likert scale to rate each of the four statements below:

  • I was treated in a friendly, caring, and respectful manner by the staff of [insert provider name].
  • Services were provided in a timely manner.
  • The services met my needs.
  • I was satisfied with the services provided.

The contractor must tally the data quarterly, in September–November, December–February, March–May, and June–August, and summarize the data in a final report.

When the data indicates that improvements are needed, the contractor creates an action plan and monitors the plan, updating it when necessary, until the improvements are achieved. TWC's VR staff may request the survey results and the summary of the data at any time.

3.4.2 Service Delivery Achievements

Each contractor must develop a self-evaluation system designed to measure the effectiveness of services provided to customers. The system must measure achievements against preestablished goals. Results of the self-evaluation that indicate successful achievements by customers may be useful to communicate the results to both potential customers and VR staff or ILS-OIB staff. Contractors must demonstrate the validity of materials and data used in marketing when requested by a TWC employee.

Use of a VR customer's photographs or statements for any purpose is prohibited.

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3.5 Contractor Standards for Physical Locations

Physical location is defined as a location the contractor owns, leases, or uses as dedicated space to provide services to customers and/or attend meetings with customers. The contractor must complete the VR3442A, Provider Physical Location Information Part A - Certification Statement and the VR3442B, Provider Physical Location Information Part B forms for each facility it owns, leases, or uses as dedicated space to provide service to customers.

The contractor must maintain the following records and ensure that a current copy is on file with the assigned TWC contract manager and regional program specialist:

  • Occupation permit or building permit
  • Fire inspection report from an inspection by the fire marshal with local jurisdiction (if the contractor's local fire department does not conduct inspections, the contractor may request an inspection from the Texas Department of Insurance, State Fire Marshal's Inspection Services Division, 333 Guadalupe Street, Austin, Texas 78701, (512) 305-7900)

The contractor must keep a copy of the Americans with Disabilities Act (ADA) Checklist for Existing Facilities on file and make it available upon request.

The permits, fire inspection reports, and ADA checklist may be obtained from the landlord, if they are not in the possession of the contractor.

Each physical location must have:

  • working smoke detectors with visible (flashing) and audible fire warning signals within the facilities where customers receive services;
  • fire extinguishers in accessible locations, ensuring that they are up-to-date with annual inspections;
  • diagrams posted that show accessible fire escape routes that are free and clear of obstructions and develop a plan to evacuate customers who are in the facility and require physical assistance;
  • accessible aisles and work safety zones; and
  • secure, safe storage and identification of hazardous or flammable materials.

In addition to providing safety equipment within physical locations, the contractor must have safety procedures and plans on the following, to ensure the safety and health of staff, customers, and visiting public:

  • The use of safety equipment and machinery with moving parts
  • Fire drills and emergency evacuation drills, which must be held quarterly and with proof of employee and customer participation, when applicable
  • How to obtain emergency medical services from a doctor, hospital, or emergency medical service unit
  • The availability of assistance for individuals with disabilities to ensure successful engagement in services
  • The recording and reporting of incidents, which must include:
    • the date, time, and place of incident;
    • the nature of the incident;
    • the names of VR or ILS-OIB customers, witnesses, or others involved;
    • the name of the individual making the report;
    • a description of the incident; and
    • the actions taken and planned by the contractor as a result of the incident, including reporting the incident to the assigned VR counselor or OIB worker, TWC contract manager, and regional program specialist.

The following incidents must be reported to the customer's VR counselor or OIB worker, TWC contract manager, and regional program specialist by the close of business on the next working day:

  • Emergency evacuations
  • Emergency medical services
  • Emergency room treatment
  • Hospitalization
  • Death

Exemptions to Physical Locations

Physical locations do not include community sites that are not owned, leased, or used as dedicated space by the contractor, such as state, federal, city, county, or other public meeting spaces.

Headquarters are exempt from this section of policy, unless customers receive services or attend meetings at the headquarter location. Contactors that provide all services at community sites that are not owned or leased by the contractor are not required to maintain a physical location.

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3.6 Customer Safeguards

3.6.1 Customer Orientation

Any customer referred to a contractor by VR must receive orientation to the services, roles, responsibilities, expectations, policy, and procedures, as applicable. Contractors must document in writing the topics included in the orientation and must obtain the customer's signature to verify that the customer received the orientation.

Orientation and handouts, if applicable, must address at a minimum:

  • information about the contractor and the purpose of the referral;
  • appropriate rules and regulations;
  • the customer's responsibilities and the contractor's expectations;
  • safety information; and
  • how to report complaints about a contractor (a provider of services) to VR at 1-800-628-5115.

3.6.2 Communication Needs

Each contractor must coordinate with the customer's VR counselor or OIB worker to ensure that all verbal and written communications between the contractor and the customer are conducted in the customer's preferred language.

If interpreter services are needed, the contractor is responsible for scheduling the needed services in a timely manner through the customer's VR counselor or OIB worker.

3.6.3 Training Materials

The contractor implements services using instructional approaches that meet each customer's educational and disability needs, such as:

  • discussions;
  • PowerPoint presentations;
  • Inquiry-based instructions;
  • hands-on experiments or activities;
  • project- and problem-based learning;
  • computer-aided instructions;
  • handouts; or
  • exercises.

All training materials must be available in a format that is appropriate to the customer's needs, including regular print, large print, braille, recorded audio and/or video files on flash memory, and must be provided in the customer's preferred language. TWC staff can ask to review training materials at any time.

3.6.4 Evaluation of Service Delivery

Service delivery includes meetings and delivery of services prescribed in the VR-SFP Manual. All staff qualifications and requirements outlined in the services description, process and procedures, and outcomes for payment must be followed in the delivery of services for VR or ILS-OIB customers. Each chapter will indicate how the service can be conducted. When the service chapter allows for remote service delivery, requirements in 3.6.4.1 Remote Service Delivery must be followed.

When services need to be provided and guidelines cannot be followed in the service delivery as prescribed in the VR-SFP, the VR director must approve a VR3472, Contracted Service Modification Request before the service is provided. 

When the Centers for Disease Control and Prevention (CDC), federal, state, and/or local governments issue health and safety protocols, such as social distancing, providers must provide services to VR or ILS-OIB customers following these guidelines. 

For in person services, when social distancing protocols are in place, a VR3472 must be approved justifying the need for the service and how the customer's and provider staff health and safety will be maintained.

For more information refer to 3.6.4.2 Evaluation of Service Delivery.

3.6.4.1 Remote Service Delivery

Telerehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet and includes vocational rehabilitation.

Not all customers will benefit from participating in telerehabilitation for meeting attendance and remote service delivery. VR counselor or OIB worker must evaluate each customer's case to determine when telerehabilitation is in the best interest of the customer and whether the customer has access to required resources and has the skills necessary for effective use.

When the VR-SFP service chapters allow or when indicated on the TWC-VR referral form, a provider may:

  • implement accessible training activities using a computer-based training platform that allows for face-to-face and/or real time interaction; and
  • use video telecommunication services and software such as Video Relay Services or FaceTime, as training tools.

The service provider must ensure all requirements in the TWC-VR SFP, including confidentiality and the customer's literacy and disability needs are met in the delivery of the services.

For some services, the VR counselor or OIB worker will indicate on the service's TWC-VR referral form when remote delivery of service is allowed for a customer.

The service provider must evaluate the customer's ability to actively participate in the computer-based training, including identifying whether the customer's computer resources are adequate.  When a service provider identifies customer's needs are not being met, they must notify the VR counselor or OIB worker.

Meetings can be held remotely between the VR counselor or OIB worker, customer, provider and, as appropriate, the customer's circle of supports (including the customer's representative).

Appropriate Online Platform

The U.S Department of Health and Human Services issued guidance on utilizing HIPPA compliant platforms: HHS's Notification of Enforcement Discretion for Telehealth During COVID-19.

The following are listed as HIPPA-compliant applications by HHS:

  • Skype for Business / Microsoft Teams for government;
  • Updox;
  • VSee;
  • Zoom for Healthcare;
  • Doxy.me;
  • Google G Suite Hangouts Meet;
  • Cisco Webex Meetings / Webex Teams;
  • Amazon Chime; and
  • GoToMeeting.

The contractor should visit the link above to ensure continued compliance with HIPPA complaint platforms and to identify when platforms have been added or removed.

3.6.4.2 Evaluation of Service Delivery

The contractor monitors and discusses the effectiveness of the services with the customer's VR counselor or OIB worker on a continuing basis. When necessary, the services being delivered to the customer may need to be changed or an alternate plan established to better meet the customer's goal.

When the service definition, process and procedures, or outcomes required for payment for a service are changed from their description in the VR-SFP to meet a customer's individual needs a VR3472, Contracted Service Modification Request must be completed. The service may not be provided until the VR counselor or OIB worker completes the VR3472 and VR's director approves it.

The VR3472 must justify:

  • the need for the change in the service,
  • outline how the service will be delivered, and
  • indicate the customer's agreement to participate in the service delivery as described.

The VR director may delegate signature authority for approval of the VR3472.

3.6.5 Termination of Service Delivery

If a customer's behavior is a concern, contractors must address the behavior before terminating a contractor-provided service because of the behavior. If behaviors are harmful to the customer or others, appropriate actions must be made to ensure that all parties remain safe.

Reasons for terminating services based on behavior may include:

  • behaviors dangerous to oneself or others;
  • serious infraction of the provider's rules;
  • frequent unexcused absenteeism;
  • frequent unexcused tardiness; or
  • lack of cooperation on assigned tasks.

Every effort must be made to inform the VR counselor or OIB worker before termination of a customer's services. When the VR counselor or OIB worker cannot be informed before termination, the VR counselor or OIB worker must be informed in writing within one work day after termination. The contractor must maintain documentation that the VR counselor or OIB worker was informed of termination.

3.6.6 Allegations or Incidents of Abuse, Neglect, or Exploitation

Texas Family Code §261.101 requires a professional person who has cause to believe that a child's physical or mental health or welfare has been adversely affected by abuse or neglect by any individual to immediately (within 48 hours) report the suspected abuse.

Texas Human Resources Code §48.051 requires a professional (such as any TWC contractor) individual to make a report if there is cause to believe that an individual age 65 or older or an individual with a disability is being abused, neglected, or exploited.

Any TWC contractor is a professional and is required to report any allegations or incidents of abuse, neglect, or exploitation.

3.6.6.1 Reporting and Documenting Allegations of Abuse, Neglect, or Exploitation

To report allegations of abuse, neglect, or exploitation, the individual who has cause to believe that abuse, neglect, or exploitation has occurred:

  1. immediately contacts law enforcement, if the incident is a threat to health or safety;
  2. secures the individual's safety;
  3. immediately reports the incident to the appropriate investigatory agency, as listed in 3.6.6.2 Reporting to Investigatory Agencies;
  4. documents in the customer's case file which investigatory agency was contacted, including the reference number provided by the investigatory agency; and
  5. notifies the VR counselor or OIB worker, program specialist, and/or appropriate contract manager about the allegation.

If a licensed professional is involved as an alleged perpetrator, the information must also be reported to the appropriate professional licensing agency.

If injuries are sustained during an alleged incident, appropriate medical personnel must be contacted.

3.6.6.2 Reporting to Investigatory Agencies

Any contractor or contractor's employee or subcontractor that has cause to believe that a child who is a minor, an adult with a disability, or an individual 65 years of age or older is at risk of or in a state of harm due to abuse, neglect, or exploitation must immediately report the information to the appropriate investigatory agency (see the table below). If the incident is a threat to health or safety, the local law enforcement agency must also be notified.

Reporting suspected abuse, neglect, or exploitation directly to the appropriate investigatory agency is required, regardless of the circumstances.

Reporting Process

If the alleged abuse, neglect, or exploitation occurs in… …then the contractor that has cause to believe abuse, neglect, or exploitation has occurred, reports the information to the following:
  • a child care operation licensed by the Texas Department of Family and Protective Services, including a residential child care operation;
  • a state-licensed facility or community center that provides services for mental health, intellectual disabilities, or related conditions;
  • an adult foster home that has three or fewer customers and is not licensed by the Texas Department of Aging and Disability Services (DADS);
  • an unlicensed room and board facility;
  • a school; or
  • an individual's own home

Texas Department of Family and Protective Services
Statewide Intake Program
P.O. Box 149030
Austin, Texas 78714-9030

Voice 1-800-252-5400
Fax (512) 832-2090

Texas Abuse Hotline
  • an assisted-living care facility licensed by DADS;
  • a nursing home, adult day care;
  • a private intermediate care facility for individuals with intellectual disabilities; or
  • an adult foster care facility

Texas Department of Aging and Disability Services
Complaints Management and Investigations
P.O. Box 149030, Mail Code E-340
Austin, Texas 78714-9030

1-800-458-9858

a Texas Department of State Health Services licensed substance abuse facility or program

Texas Department of State Health Services
Substance Abuse Compliance Group Investigations
1100 W. 49th Street
Austin, Texas 78756
Mail Code 2823

1-800-832-9623

the Criss Cole Rehabilitation Center at:

Texas Workforce Commission
4800 N. Lamar Blvd.
Austin, Texas 78756

Report incident to the incident report mailbox for TWC Risk and Security Management at IncidentReports.RSM@twc.state.tx.us

The Criss Cole Rehabilitation Center Policy Manual has additional reporting requirements.

a hospital licensed by the Texas Department of State Health Services

Texas Department of State Health Services
Facility Licensing Group
1100 W. 49th Street
Austin, TX 78756

Complaint Hotline 1-888-973-0022

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3.7 Services, Goods, and/or Equipment and Premium Fees

Contractors agree to accept TWC authorized rates as payment in full for services provided. Contractors may not collect money from a VR or ILS-OIB customer or the customer's family for any service that costs more than the authorized rate.

When VR and another resource pay for a customer service, the total payment may not exceed the authorized rate.

Premium fees are available to contractors as incentive payments for providing certain services. Premium fees are established to compensate contractors' staff that have specialized skills or work with customers who meet specific criteria.

For details about the criteria and the fees for services, refer to Chapter 20: Premiums.

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3.8 Goods and Services Purchased

3.8.1 Overview

VR purchases contracted services, goods, and equipment that are deemed necessary for the customer to obtain and maintain successful competitive integrated employment or achieve independent living goals.

3.8.2 Service Authorization

A service authorization is a request for a contractor to provide identified goods or services based on the terms and conditions specified in the authorization. A service authorization is the only valid authorization by which purchases are made. No services or goods can be provided to a customer without a valid, signed service authorization for the specific services or goods.

If a contractor is issued service authorizations for a good or service that has prerequisites or requirements and the prerequisites or requirements have not been met, the contractor must inform the VR counselor that the contractor cannot accept the issued service authorization to prevent being in noncompliance with the standards. Authorized services must be provided within the dates prescribed in the service authorization.

Each service authorization contains:

  • a start date and end date during which the services or goods are to be provided;
  • a description of the services or goods to be provided;
  • an authorized quantity, if applicable; and
  • a unit cost.

A service authorization may include comments in the comment section that define basic terms and provide supplemental information related to the services or goods. Actions required of the contractor by the service authorization instructions must be completed before the contractor submits the invoice for payment.

If a service authorization is changed by VR in any manner, a copy of the new, signed service authorization must be given to the contractor when the change is made. If VR fails to give the contractor an updated service authorization, the contractor must contact the customer's VR counselor or OIB worker, assigned regional program specialist, or contract manager.

The contractor must keep a copy of all service authorizations in the contractor's customer records.

3.8.3 Invoices

3.8.3.1 Timely Submission of Invoices for Payment

By accepting the service authorization, the vendor agrees to send an invoice to TWC for payment.

All invoices must contain all required elements, as listed in 3.8.2 Service Authorization.

Billings for medically related purchases (e.g., durable medical equipment-DME, hearing aids, services included in Chapter 21: Employment Supports for Brain Injury) may be supported by ReHabWorks system-generated billing cover sheet for the relevant service authorization.

Non-medical billings must be invoiced on the vendor/contractor’s paperwork and may not use the ReHabWorks system-generated billing cover sheet.

Provider electronic signatures will be accepted on forms required for invoicing. For more information, refer to 3.11.1 Documentation and Signatures.

3.8.3.2 Required Elements of an Invoice Submitted to TWC-VR

Invoices must include at a minimum:

  • the vendor's complete name and remittance address including city, state, and ZIP code;
  • the vendor's 14-digit Texas vendor identification number;
  • the vendor's contact name and telephone number, email address, or fax number;
  • the service authorization number;
  • the VR office's name and address, or delivery address, as applicable;
  • the contract number;
  • a description of the goods or services provided, including the dates of service;
  • the quantity and unit cost being billed, as documented on the current service authorization;
  • other relevant information supporting and explaining the payment requested or identifying a successor organization to an original vendor, if necessary; and
  • any other information required by applicable state and federal laws, rules, and regulations governing the provision of services under the contract and the policies and standards.

For examples of invoices that include all required elements, see the invoice templates posted on the UNTWISE website.

3.8.3.3 Inaccurate Invoice

TWC-VR does not accept invoices that are incorrect or that do not include all the required items listed in 3.8.3.2 Required Elements of an Invoice Submitted to TWC-VR.

TWC-VR returns incomplete or incorrect invoices and any associated reports to the contractor, asks the vendor to make the necessary corrections, and asks the contractor to complete a VR3460, Vendor Invoice Additional Data Request form.

The contractor resubmits the correct invoice and required documentation for review and payment.

3.8.3.4 Recoupment of Funds Paid

A contractor must promptly settle overpayments discovered by TWC.

If a contractor discovers the overpayment, the contractor must immediately self-report it to the assigned regional program specialist, other TWC staff, or the contract manager and arrange for reimbursement.

3.8.3.5 Payments Due

TWC is obligated to pay only for goods and services that lead to the results required for payment, as explained in the VR-SFP manual and on the service authorization.

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3.9 State Payee Payment Resources

The application Search State Payments Issued allows contractors and other payees to view their detailed payment information.

TWC recommends that contractors register at TX Comptroller E-Systems.

For resources, see CPA Texas.

For more information, see FAQs from Comptroller, State Payee Payment Resource, and Search State Payments Issued Tutorials.

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3.10 Reading Warrants (Paper Checks)

A warrant is a traditional paper check with a stub attached.

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3.11 Documentation and Record Keeping

Upon request, the contractor must make available to VR or ILS-OIB staff (such as assigned monitors, regional program specialists, and contract managers) any documents, papers, and records that are directly pertinent to the goods or services provided to VR customers.

Examples include:

  • invoices;
  • service authorizations;
  • any documentation (such as forms, training materials, or attendance records) that is required in the chapter of the VR-SFP manual that relates to the services referred to in the contract;
  • company financials;
  • insurance certificates;
  • staff information sheets; and
  • any documentation required under the contract.

A contractor must not share with a customer documents received from TWC-VR. When a customer requests such documents, the contractor must refer the customer to the customer's VR counselor.

A contractor may share with a customer documents that relate to the services provided by the contractor and that have been signed by the customer or legal guardian.

3.11.1 Documentation and Signatures

When completing forms and/or documentation related to the delivery of services or goods to customers, the contractor must do the following:

  • Answer all questions related to the services or goods provided. If a question or section does not apply, enter "Not Applicable" or "N/A" and explain why.
  • Write summaries in paragraph form in clear English with adequate details, for questions requiring a narrative response.
  • Review the form carefully, leaving no blanks.
  • Write the goal in clear, measurable terms, when goals are required.
  • Collect required signatures from VR or OIB staff, customers, provider’s staff, and circle of supports (including customer representatives, if any), using encryption when required, through one of the following methods:
    • obtaining handwritten signatures;
    • obtaining digital signature(s) ensuring customer confidentiality on approved software options.

      Examples of approved software to collect digital signatures include:

      • Adobe and
      • DocuSign (when it is an option for a TWC-VR form)

      Signatures can be collected on smart devices (i.e. tablets and phones).

    • sending a copy of the document to the customer when the customer has the equipment necessary to print, sign and return an electronic copy of the signed form (such as a photo or scanned copy).
  • Make certain that all standards have been met before submitting any form and/or report with an invoice for payment.

When the provider has attempted to obtain signatures, and has recorded such attempts on the submitted documentation, VR or OIB staff can verify the customer's satisfaction and service delivery as described in the VR-SFP by contacting the customer.

When forms are completed by a provider, the forms must be submitted by either US mail, hand delivery, fax, or encrypted email, unless otherwise noted.

Information must be accurate and complete. All instructions on the form and in the VR-SFP manual must be followed.

3.11.2 Record Storage

Contractors must keep their financial and supporting documents, statistical records, and any other records that are pertinent to the services for which a claim or report was submitted to the Texas Workforce Commission (TWC):

  • safe;
  • confidential; and
  • available to TWC staff on request.

The records and documents must be kept as follows, whichever is later:

  • For three years after the date that the final bill was submitted
  • Until all billing-related questions are resolved

Contractors must report lost data within one business day to the:

  • assigned contract manager and regional quality assurance specialist; or
  • regional program support specialist.

Paper Record Storage

Paper is the preferred method for storing records.

Stored paper documents must be protected:

  • as required in 3.3.4 Confidentiality; and
  • in a retrievable and organized manner that prevents the documents from being stolen, tampered with, or damaged.

The contractor assumes all business risk associated with lost records. Lost records could result in adverse action against the contractor.

Electronic Storage (Not Cloud-Based or on a Third-Party Server)

Records stored on desktop computers or on portable devices (for example, on laptops, USB flash drives, hard drives, CDs, and DVDs) must be protected as required in 3.3.4 Confidentiality and 3.3.5 Data Encryption.

Portable devices must be protected from theft, tampering, or damage. The contractor is responsible for all data collection and assumes all business risk associated with lost data. Lost data could result in adverse action against the contractor.

Cloud-Based Storage

Records that are stored entirely or partially in the cloud must be stored in compliance with the Federal Risk and Authorization Management Program (FedRAMP), or must be able to be made compliant in a short, defined period of time, as independently verified and validated by a FedRAMP-accredited third-party assessment organization (3PAO).

The contractor must comply with TWC's requirement that all data remain in the United States and meet TWC's stringent privacy and security requirements.

TWC's privacy and security requirements include the following:

  • Protecting confidential TWC information, including personally identifiable information, from—at a minimum—unauthorized disclosure, unauthorized access, and misuse in accordance with the National Institute of Standards and Technology's (NIST) Special Publication 800-122, Guide to Protecting the Confidentiality of Personally Identifiable Information (PII), by establishing controls such as role-based access, encryption at rest, and encryption in transit
  • Disposing of data in a manner that complies with NIST Special Publication 800-88, Guidelines for Media Sanitization.
  • Complying with TWC's minimum encryption standards, that is, with the Federal Information Processing Standard (FIPS) 140-2, validated 256 bit, Advanced Encryption Standard (AES), and SHA-256 Cryptographic Hash Algorithm
  • Complying with TWC's minimum cryptographic protocol Transport Layer Security (TLS) 1.1 (TLS 1.2 preferred) for protecting the security and privacy of communications over a computer network, including over the internet
  • Maintaining continuous process improvement and vigilance to assess risks, monitor and test security protection, and implement changes needed to protect TWC data
  • Cooperating fully with TWC's chief information security officer to detect and remediate vulnerability of the hosting infrastructure and/or the application
  • Giving TWC access to the contractor's facilities, installations, technical capabilities, operations, documentation, records, and databases, to the extent required to carry out FedRAMP assessments and FedRAMP continuous monitoring, to safeguard against threats and hazards to the security, integrity, and confidentiality of the nonpublic TWC data that are collected and stored by the contractor

    The contractor must notify TWC about new or unanticipated threats or hazards or about safeguards that cease to function, as the issues are discovered.

  • Complying with any additional FedRAMP privacy requirements
  • Understanding that TWC has the right to perform manual or automated audits, scans, reviews, or other inspections of the IT environment being used to provide or facilitate services for TWC

In accordance with Federal Acquisition Regulation 52.239-1, the contractor must do as follows:

  • Obtain the contract officer's written consent before publishing or disclosing the details of safeguards that the contractor designs, develops, or otherwise provides to TWC under contract (exception: disclosures to a consumer agency for the purposes of certifying or verifying authorization)
  • Give TWC access within 72 hours to the contractor's facilities, installations, technical capabilities, operations, documentation, records, and databases, to the extent required to conduct an inspection to safeguard against threats and hazards to the security, integrity, and confidentiality of TWC data

    Inspections include vulnerability scans of authenticated and unauthenticated:

    • operating systems and networks;
    • web applications; and
    • database applications.

    Automated scans can be performed by TWC personnel (or agents acting on behalf of TWC) using equipment operated or authorized by TWC and using TWC-specified tools.

  • Notify TWC immediately, if new or unanticipated threats or hazards are discovered, or if safeguards cease to function

If the contractor chooses to run its own automated scans or audits, results from the scans or audits may, at TWC's discretion, be accepted in lieu of vulnerability scans performed by TWC; however:

  • the scanning tools and their configurations must be approved by TWC; and
  • the complete results must be provided to TWC.

3.11.3 Record Retention

The contractor retains financial and supporting documents, statistical records, and any other records pertinent to the services provided under the contract for which a claim or report was submitted to TWC-VR.

Records and documents must be kept for three years after the final bill is submitted or until all billing-related questions are resolved, whichever is later.

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3.12 Monitoring

The contractor agrees to permit on-site monitoring visits and desk reviews, as needed by TWC, to review all financial or other records and management control systems relevant to providing goods and services under the contract.

3.12.1 Ongoing Monitoring

TWC staff members, including field, regional, and support staff, continuously monitor services provided to VR customers. Each provider may have formal liaisons assigned to answer questions about the standards and to perform routine monitoring reviews to ensure compliance with standards. Monitoring may include ongoing dialogue, observation, on-site visits, and reviews of case files.

TWC maintains negative and positive performance records on providers and may use the reviews to determine the risk of requiring formal monitoring and/or to determine whether a contract will be renewed or terminated.

3.12.2 Compliance Monitoring

All contractors are subject to periodic monitoring of programmatic and financial compliance by TWC staff. Risk assessment tools are used at the state and regional level each fiscal year to identify VR contractors that will be monitored on-site during a 12-month period. Contractors not identified on the risk assessment may be monitored at the discretion of TWC.

3.12.3 Unscheduled or Unannounced Compliance Monitoring

TWC staff members may conduct an unscheduled monitoring review when VR management determines that such a review is necessary.

3.12.4 Monitoring Team

A monitoring team comprises representatives from the Regulatory Integrity Division-VR Contract Oversight, the Business Operations-VR Contract Administration, and VR staff.

When a contractor is selected for an announced monitoring review, the lead monitor sends a letter announcing the review. The letter explains the scope of the review and how to prepare for the review.

3.12.5 Monitoring Review

A monitoring review typically consists of:

  • the entrance conference;
  • the records review; and
  • the exit conference.

At the entrance conference, the lead monitor:

  • introduces the monitoring team members;
  • briefly explains the monitoring process, purpose, and scope of the review;
  • requests that the contractor assign an individual to be accessible to and work with the monitoring team; and
  • ensures that the team has an acceptable work area to use while conducting the review, if conducted at the contractor's facility.

During the records review, the monitoring team:

  • completes the customer records review;
  • reviews the contractor's files;
  • may compare information in the contractor's files with information in the VR files; and
  • may conduct customer interviews or observations.

The exit conference is held after the review. At the exit conference, the lead monitor verbally provides the contractor with:

  • the results of the records review information about potential overpayments identified during the records review that are subject to possible recoupment;
  • notice that TWC will send the contractor a finding report, if applicable; and
  • information on the time frames and process for the contractor's response and the importance of meeting deadlines.

3.12.6 Report of the Monitoring Results

For routine monitoring reviews, the lead monitor sends the results of the monitoring review to the contractor in writing through either a monitoring review closeout letter or through a findings report, if instances of noncompliance were noted. The findings report includes findings of noncompliance with program or financial standards. The lead monitor asks the contractor to offer a corrective action plan or provide further documentation to help resolve the findings.

3.12.7 Corrective Action Plan

If TWC has asked the contractor to submit a corrective action plan, the contractor must, by the date requested in the report of findings:

  • submit a corrective action plan, including financial restitution, if required; or
  • rebut a finding and submit documentation that substantiates the rebuttal.

TWC reviews the corrective action plan and may accept the corrective action plan or recommend changes.

If the contractor does not submit an acceptable corrective action plan or make financial restitution when required, TWC may take adverse action against the contractor, which can include termination of the contract.

3.12.8 Monitoring Closeout

The monitoring review is closed if there are no findings, or when the monitoring team accepts the corrective action plan. TWC sends the contractor a letter to close the monitoring review.

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3.13 Contract Noncompliance and Performance Deficiencies

TWC may suspend a contractor from providing services, goods, and equipment on a temporary basis for reasons such as:

  • suspected fraud;
  • suspected customer abuse;
  • failure to meet contract specifications; or
  • failure to perform according to the terms and conditions of the contract.

Depending on the type and severity of the noncompliance, TWC may require the contractor to take corrective action to return to compliance, before the contractor can resume providing services.

TWC may impose adverse actions along with, or instead of, requesting a corrective action plan. For example, TWC may recoup overpayments from a contractor as part of a corrective action plan. Some situations may require TWC to impose more serious adverse action, such as contract termination and debarment, without allowing the contractor to take corrective action.

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Last Verified: September 23, 2020

Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request to individuals with disabilities.
Deaf, hard-of-hearing or speech-impaired customers may contact TWC through the relay service provider of their choice. Equal opportunity is the law.

For questions, compliments or complaints, call 800-628-5115

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