GRACE STEPS – a Texas Off Site ISS

No. The off-site ISS model utilizes existing HCS and CLASS waiver authorization hours already approved and funded under current Medicaid allocations. By moving services off-site and employing a caregiver-employee framework, we keep services cost-neutral to the state match while avoiding the heavy capital expenditures of traditional facility construction.

In counties like Bowie, Red River, Titus, and Morris, there are over 7,000 waiver-eligible adults but zero facility-based day services. Currently, families are forced to drive up to 330 miles round-trip to urban centers (costing $300+ weekly). This service eliminates that travel burden, divert cost-sink, and brings direct care directly to their local community spaces, enhancing constituent quality of life and dignity.

Our Caregiver-Employee model recruits and employs local Host Home/Companion Care providers as paid part-time socialization guides. This structure creates local administrative and support jobs in rural areas, channeling state and federal Medicaid funds directly back into the county economy.

100% of direct service delivery occurs in community-integrated settings chosen by the individual (libraries, parks, volunteer sites) rather than the provider's office or the client's home. We maintain a Designated Place of Business (DPOB) for administrative records as required, but do not host services there. Delivers off-site ISS in natural community settings to prevent isolation.

We run a proprietary real-time geolocation safety system. Caregivers check-in using a GPS-tracked application. If they return to the home or cross a geofence into a prohibited setting, the billing timer immediately pauses. Additionally, our automated billing checks cross-reference HCS Host Home billing hours with ISS service hours to completely prevent double-dipping, ensuring audit readiness.

Our human resource database performs daily automated API checks of the HHSC Employee Misconduct Registry (EMR), the Nurse Aide Registry, and the Texas DPS Criminal History Registry. If any employee is flagged, their scheduling is immediately suspended, eliminating the risk of human oversight in compliance auditing.

Since our model is 100% off-site, there is no centralized day facility to cause parking or zoning conflicts. Activities are distributed across standard public community locations like libraries and parks in compliance with the Fair Housing Act and local ordinances.

Every coordinator is trained in CPR/First Aid, ANE (Abuse, Neglect, Exploitation) prevention, and PMAB/SAMA crisis de-escalation. Staff carry client Dossiers with safety/medical protocols, NWS real-time heat/weather triggers, and a mandatory first-aid pack. All outings require a pre-outing safety checklist to ensure ADA compliance and shelter availability.

Traditional agencies struggle to recruit staff to travel to isolated rural areas for part-time hours. By employing the primary Host Home provider (who already lives with the individual) as a part-time ISS employee, we solve the staffing shortage, leverage existing trust/behavioral familiarity, and establish a continuous residential-community habilitation loop.

We establish a strict Collaborative Inter-Agency Protocol. Before service begins, we secure the individual's Person-Directed Plan (PDP), Individual Plan of Care (IPC), and Behavior Support Plan (BSP). We translate PDP outcomes directly into custom Habilitation Lesson Plans and compile monthly progress reports shared directly with the Service Coordinators.