Current through Reg. 49, No. 38; September 20, 2024
(a) A LIDDA must
request that HHSC assign an LON for an applicant or individual by entering the
information from the completed ID/RC Assessment in the HHSC data system and
electronically submitting the information to HHSC that includes the recommended
LON and, as appropriate, submitting supporting documentation in accordance with
§
262.106(b) of
this subchapter (relating to HHSC Review of LON). The electronically submitted
ID/RC Assessment must contain information identical to the information on the
signed and dated ID/RC Assessment.
(b) A LIDDA must, in accordance with §
262.106(a) of
this subchapter, submit supporting documentation to HHSC as requested by HHSC
for a review of a recommended or assigned LON.
(c) A LIDDA must maintain the applicant's or
individual's ICAP assessment booklet supporting the recommended LON in the
applicant's or individual's record and other documentation supporting the
requested LON, including:
(1) the individual's
PDP, including the deliberations and conclusions of the applicant's or
individual's service planning team;
(2) assessments and interventions by
qualified professionals; and
(3)
behavior support plans.
(d) If a pervasive plus LON (LON 9) is
recommended, a LIDDA must maintain documentation that proves:
(1) the applicant or individual exhibits
extremely dangerous behavior that could be life threatening to the applicant or
individual or to others;
(2) a
written behavior support plan has been implemented that meets HHSC guidelines
and is based on ongoing written data, targets the extremely dangerous behavior
with individualized objectives, and specifies intervention procedures to be
followed when the extremely dangerous behavior occurs;
(3) management of the applicant's or
individual's behavior requires a person to exclusively and constantly supervise
the individual during the individual's waking hours, which must be at least 16
hours per day;
(4) the person
supervising the individual has no other duties or activities during the period
of supervision; and
(5) the
individual's ID/RC Assessment is correctly scored with a "2" in the "Behavior"
section.
(e) HHSC assigns
an LON for an individual based on the individual's ICAP service level score,
information reported on the individual's ID/RC Assessment, and required
supporting documentation.
(f) A
LIDDA must submit documentation supporting a recommended LON to HHSC in
accordance with HHSC instructions regarding LON packet submission available on
the HHSC website.
(g) HHSC assigns
one of five LONs as follows:
(1) an
intermittent LON (LON 1) is assigned if the individual's ICAP service level
score equals 7, 8, or 9;
(2) a
limited LON (LON 5) is assigned if the individual's ICAP service level score
equals 4, 5, or 6;
(3) an extensive
LON (LON 8) is assigned if the individual's ICAP service level score equals 2
or 3;
(4) a pervasive LON (LON 6)
is assigned if the individual's ICAP service level score equals 1;
and
(5) regardless of an
individual's ICAP service level score, an LON 9 is assigned if the individual
meets the criteria set forth in subsection (i) of this
section.
(h) An LON 1, 5,
or 8, determined in accordance with subsection (g) of this section, is
increased to the next LON by HHSC, due to an individual's dangerous behavior,
if supporting documentation submitted to HHSC proves that:
(1) the individual exhibits dangerous
behavior that could cause serious physical injury to the individual or
others;
(2) a written behavior
support plan has been implemented that meets HHSC guidelines and is based on
ongoing written data, targets the dangerous behavior with individualized
objectives, and specifies intervention procedures to be followed when the
behavior occurs;
(3) more service
providers are needed and available than would be needed if the individual did
not exhibit dangerous behavior;
(4)
service providers are constantly prepared to physically prevent the dangerous
behavior or intervene when the behavior occurs; and
(5) the individual's ID/RC Assessment is
correctly scored with a "1" in the "Behavior" section.
(i) HHSC assigns an LON 9 if supporting
documentation submitted to HHSC proves that:
(1) the individual exhibits extremely
dangerous behavior that could be life threatening to the individual or to
others;
(2) a written behavior
support plan has been implemented that meets HHSC guidelines and is based on
ongoing written data, targets the extremely dangerous behavior with
individualized objectives, and specifies intervention procedures to be followed
when the behavior occurs;
(3)
management of the individual's behavior requires a service provider to
exclusively and constantly supervise the individual during the individual's
waking hours, which must be at least 16 hours per day;
(4) the service provider assigned to
supervise the individual has no other duties during such assignment;
and
(5) the individual's ID/RC
Assessment is correctly scored with a "2" in the "Behavior" section.
(j) A service coordinator must
conduct an ICAP assessment in accordance with this subsection.
(1) A service coordinator must conduct an
ICAP assessment of an individual:
(A) within
three years after the individual's enrollment and every third year
thereafter;
(B) if changes in the
individual's functional skills or behavior occur that are not expected to be of
short duration or cyclical in nature; or
(C) if the individual's skills and behavior
are inconsistent with the individual's assigned LON.
(2) If the results of an ICAP assessment
demonstrate that the individual's LON assignment may not be accurate, the
service coordinator must submit a completed ID/RC Assessment to HHSC
recommending a revision of the individual's LON assignment.
(k) A LIDDA must retain in the individual's
record results and recommendations of individualized assessments and other
pertinent records documenting the recommended LON assignment.
