| (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.
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