Criteria & Requirements for an Increased LON Due to Behavior Challenges

In the Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions program or the Home and Community-based Services program, people assigned a level of need 1, 5 or 8 may be assigned to the next higher LON if they show dangerous behavior and need a behavior support plan including preventive actions by additional program provider staff. This page clarifies the criteria for dangerous behavior and the required parts of the BSP.

The definition of dangerous behavior, as it applies to the need for more staff, is:

  • Behavior that in frequency or severity could cause serious physical injury to the individual or someone else.

This definition includes the major categories of

  • Self-injurious behavior, such as self-inflicted tissue damage, pica and access to food for people with Prader-Willi syndrome.
  • Serious disruptive behavior, such as threatening strangers, running into traffic and public disrobing.
  • Aggressive behavior, including physical attacks against others.
  • Sexually aggressive behaviors, such as assault, pedophilia and public masturbation.

Very serious behaviors that happen infrequently may still meet criterion for an increase.

Additional staff are needed to deal with the problem behavior while other staff supervise the other individuals. There is not a requirement that the behavior be such that two staff are necessary to directly intervene with the individual. However, it should be noted that if verbal redirection is effective, the behavior would not meet this criterion.

Additional staff are needed to supervise a person and constantly prepared to physically prevent the dangerous behavior or intervene when the behavior occurs. A staff member must be exclusively assigned to supervise the person during the person’s waking hours and have no other duties during such assignment. If verbal redirection is effective, the behavior does not meet the criterion. 

Refer to the rules of each program for specifics on LON increases due to dangerous behavior:

If the person’s behavior is extremely dangerous, life-threatening or requires constant one-to-one supervision, they may be assigned a LON 9. Supporting documentation must be sent to the Health and Human Services Commission to prove all program requirements are met. Refer to the LON 9 Documentation resource page for LON 9 document requirements.

HHSC prefers to receive documents through the IDD Operations Portal but submissions can be made by mail or fax.

At enrollment, submit a purpose code 2 Intellectual Disability/Related Condition Assessment and required supporting documents to HHSC Intellectual and Developmental Disability Program Eligibility and Support.

Contact Us

IDD Program Eligibility and Support 
Mailing Address: 

Texas Health and Human Services Commission
IDD Program Eligibility and Support 
Mail Code: W254
P.O. Box 149030
Austin, TX 78714-9030

Physical Address:
Texas Health and Human Services Commission
IDD Program Eligibility and Support 
Mail Code: W254
701 W. 51st St.
Austin, TX 78751

Fax: 512-438-4249 
Do not fax more than 20 pages without prior approval from IDD PES. For questions, call 512-438-2484.

After enrollment, submit a purpose code 3 (renewal) or 4 (revision) ID/RC Assessment and required supporting documents to HHSC IDD Waivers Utilization Review.

IDD Waivers Utilization Review
Mailing Address:

Texas Health and Human Services Commission 
IDD Waivers Utilization Review
Mail Code: W551
P.O. Box 149030
Austin, TX 78714-9030

Physical Address:
Texas Health and Human Services Commission 
IDD Waivers Utilization Review
Mail Code: W551
701 W. 51st St.
Austin, TX 78751

Fax: 512-438-4249 
Do not fax more than 20 pages without prior approval from IDD UR. For questions, call 512-438-5055.