LON Documentation — Behavior Increase

The following documents must be submitted to the Health and Human Services Commission to support the Inventory for Client and Agency Planning ratings and increase in services and supports for a person in the Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions program or the Home and Community-based Services program that warrants an increased level of need due to dangerous behavior.

Submission Requirements

  • Form 8603, Level of Need (LON) Review/Increase Cover Sheet
  • A cover letter addressing the following:
    • Description of the behavior that requires additional staff coverage
    • Historical information, including the frequency and severity of the behavior
    • Negative outcomes directly related to the behavior
    • Work schedule for the added staff for the person
    • General staffing pattern in the residence
  • Complete copy of the current ICAP response booklet and computer scoring sheet
  • Complete copy of the previous ICAP response booklet and computer scoring sheet
  • Behavior support plan that meets HHSC criteria and addresses the dangerous behavior, including:
    • Baseline of frequency and severity of the behavior
    • Functional assessment of the targeted behavior
    • Specific objective to decrease or eliminate the targeted behavior
    • Progress notes based on data
    • History of previous interventions
    • Preventive measures
    • Detailed procedures to address the behavior
    • Appropriate approvals of the behavior support plan
    • Appropriate consents for restrictive and intrusive BSP —  Click here to review BSP requirements and expectations.
  • Any of the following that’s relevant and current within past year:
    • Progress notes or quarterly monitoring reports monitoring the BSP by appropriate staff including data on the effectiveness of the program and plans for addressing problems in implementation or effectiveness
    • Behavior tracking logs
    • Incident, injury and restraint reports documenting serious occurrences or attempts to exhibit targeted behavior that support the frequency and severity ratings of the identified problem behavior and reflect staff interventions
    • Observation notes, progress notes, data sheets or service summary logs from home, residential or day programs
    • Psychological and psychiatric evaluations or updates
    • Any team or interim meetings along with any professional assessments that discuss the dangerous behavior, interventions or changes in treatment due to the targeted behavior
    • Other documents that would validate the frequency and severity of the dangerous behavior, such as:
      • Police reports
      • Hospital reports related to the behavioral issues
  • The latest annual staffing and individual program plan for the ICF/IID Program or the person-directed plan and implementation plan for the HCS or TxHmL programs

HHSC does not require supporting documentation to renew a previously authorized initial LON increase, but a renewal request is required through electronic submission of the ID/RC Assessment. The supporting documents for the LON increase must be maintained in the person’s record. These records are subject to review during HHSC on-site reviews or upon HHSC request, as described in Information Letter 14-10 (PDF).

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

At enrollment, submit purpose code 2 Intellectual Disability/Related Condition assessments and the 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 Commission 
IDD Program Eligibility and Support 
Mail Code: W254
P.O. Box 149030
Austin, TX 78714-9030

Physical Address:
Texas Health and Human 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 purpose code 3 or 4 Intellectual Disability/Related Condition assessments and the required supporting documentation to HHSC IDD Waivers Utilization Review

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

Physical Address:
Texas Health and Human 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.