Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING
Subchapter E - ELIGIBILITY, ENROLLMENT AND REVIEW
Section 261.241 - Level of Need Criteria

Current through Reg. 49, No. 38; September 20, 2024

(a) The department will assign one of five LONs as follows:

(1) An intermittent LON (LON 1) will be assigned if the person's ICAP service level score equals 7, 8, or 9;

(2) A limited LON (LON 5) will be assigned if the person's ICAP service level score equals 4, 5, or 6, or an LON 1 is increased in accordance with subsection (b) or (d) of this section;

(3) An extensive LON (LON 8) will be assigned if the person's ICAP service level score equals 2 or 3, or an LON 5 is increased in accordance with subsection (b) or (d) of this section;

(4) A pervasive LON (LON 6) will be assigned if the person's ICAP service level score equals 1, or an LON 8 is increased in accordance with subsection (b) or (d) of this section; and

(5) Regardless of a person's ICAP service level score, a pervasive plus LON (LON 9) will be assigned if the person meets the criteria set forth in subsection (c) of this section.

(b) An LON 1, LON 5, or LON 8 will be increased to the next LON by the department, due to a person's dangerous behavior, if the supporting documentation described in § 261.242 (1) of this chapter (relating to Supporting Documentation for Level of Need) is submitted to the department proving that:

(1) the person exhibits dangerous behavior that could cause serious physical injury to the person or others;

(2) a written behavior intervention plan has been implemented for the person;

(3) more staff members are needed and available than would be needed if the person did not exhibit dangerous behavior;

(4) management of the individual's behavior requires that staff members are constantly prepared to physically prevent the dangerous behavior or intervene when the behavior occurs; and

(5) the person's MR/RC Assessment is correctly scored with a "1" in the "Behavior" section.

(c) An LON 9 will be assigned by the department, due to the person's extremely dangerous behavior, if the supporting documentation described in § 261.242(2) of this chapter (relating to Supporting Documentation for Level of Need) is submitted to the department proving that:

(1) the person exhibits extremely dangerous behavior that is life threatening to the person or to others such that specified staff must be at arm's length during waking hours;

(2) a written behavior intervention plan has been implemented for the person;

(3) management of the person's behavior requires a staff member to exclusively and constantly supervise the person during the person's waking hours, which must be at least 16 hours per day;

(4) the staff member assigned to supervise the person has no other duties during such assignment; and

(5) the person's MR/RC Assessment is correctly scored with a "2" in the "Behavior" section.

(d) An LON 1, LON 5, or LON 8 will be increased to the next LON by the department, due to a person's extraordinary medical needs, if the supporting documentation described in § 261.242(3) of this chapter (relating to Supporting Documentation for Level of Need) is submitted to the department proving that:

(1) the person's extraordinary medical needs require direct nursing treatment in excess of 180 minutes per week;

(2) the provision of nursing treatment is documented by a nurse in the person's medical record to include the amount of time spent for treatment; and

(3) the person's MR/RC Assessment is correctly scored with a "6" in the "Nursing" section.

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