(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.

Source Note: The provisions of this §262.105 adopted to be effective March 1, 2023, 48 TexReg 1055