LON Documentation — Medical 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 increased 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 whose medical conditions require nursing interventions of 181 or more minutes per week. The level of need may be increased to the next higher level of need if supported by the documents.

Submission Requirements

  • Form 8603, Level of Need (LON) Review/Increase Cover Sheet.
  • Cover letter describing the person’s medical or nursing issues and needed nursing interventions (optional)
  • Complete copy of the current ICAP response booklet and computer scoring sheet
  • Complete copy of the previous ICAP response booklet and computer scoring sheet
  • Latest annual staffing and individual program plan for the ICF/IID program or the person-directed plan and implementation plan for the HCS program
  • Any of the following that’s relevant and current within the past year:
    • Team or interim meetings relating to medical and behavioral issues
    • Any professional assessments that discuss changes in the person’s medical condition or changes in needed medical and behavioral intervention
    • Staff or progress notes supporting the adaptive and problem behavior ratings on the ICAP
    • Other documents that show the nursing services needed and validate the LON increase, such as:
      • Nursing narrative notes
      • Nursing assessments
      • Physician assessments
      • Physician orders
      • Current medication sheets
      • Current treatment sheets
  • A nursing flowchart or daily schedule, indicating nursing that adresses:
    • Ongoing and chronic medical condition which require direct nursing services of 181 or more minutes weekly
    • Treatments and other direct nursing service requirements for the person
    • Explanation of how the amount of time required to complete the nursing task was determined
    • Address the frequency, time required and extenuating factors relating to services that may appear to require excessive nursing involvement, if applicable

HHSC does not require supporting documentation to renewal of 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 submission can be made by mail or fax.

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.

Submit purpose code 3 or 4 Intellectual Disability/Related Condition assessments and the required supporting documents to HHSC IDD Waivers Utilization Review.

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.