5100, Intellectual Disability/Related Condition Assessment Process

Revision 22-2; Effective May 1, 2022

The HCS program provider must annually renew an individual's LOC and LON by completing Form 8578, Intellectual Disability/Related Condition (ID/RC) Assessment, and entering the information into the HHSC data system. Instructions for renewing an LOC/LON may be found in Title 40, Texas Administrative Code, Chapter 9, Subchapter D, Home and Community-based Services (HCS) Program, and the instructions for completing Form 8578.

  • Form 8578 must be signed by one of the following people – RN, LVN, qualified intellectual disability professional (QIDP), qualified developmental disability professional (QDDP), case manager, LIDDA service coordinator (SC) or HCS provider representative. 
  • The program provider must enter the ID/RC assessment information into the HHSC data system.
  • The program provider must ensure that the SC receives a copy of the signed Form 8578 within three days after data entry.

Once the program provider has entered the information into the HHSC data system, the SC will have seven days to review the LOC/LON information and enter an agreement or disagreement with what was entered.

LIDDAs are expected to review each ID/RC.

The information entered by the program provider will be displayed in the HHSC data system for the SC to enter an agreement or disagreement and any comments.

  • If the SC believes the program provider made an error when entering data, the SC may return the ID/RC to the program provider for error correction. The SC will contact the program provider the same day that they return an ID/RC.
  • If the SC returns an ID/RC assessment to a provider, the SC must enter a comment in the HHSC data system as to why it is being returned.

After reviewing the ID/RC information, if the SC disagrees with the ID/RC assessment, the SC must notify HHSC Program Eligibility Support (PES) and the program provider by completing Form 8579, Notification of SC Disagreement, and faxing it to HHSC PES and sending a copy to the program provider. This notification should be done the same day of the data entry. 

Program providers will not be prevented from entering billing because an SC does not review the ID/RC assessment in a timely manner. If the SC does not review an ID/RC assessment within seven days of data entry, the HHSC data system will automatically send the ID/RC assessment to HHSC for approval. Reports will be available for state office and LIDDA management staff noting those ID/RC assessments not reviewed by the SC. This will also be noted in the form history in the HHSC data system. 

HHSC PES will continue to approve or deny an individual's LOC. For an LON review, HHSC PES will complete reviews for Purpose Code 2 and HHSC Utilization Review (UR) will complete reviews for Purpose Codes 3 and 4. The SC's agreement or disagreement does not ensure any action will be taken or not taken by HHSC PES or HHSC UR. HHSC UR may contact the SC to provide additional information if an LON review is necessary.

Review of the ID/RC

Information from the ICAP is entered on the ID/RC (Form 8578) to request an LON for an individual. In some cases, it may be necessary for the SC to request a copy of the individual's current ICAP booklet in order to ensure that the appropriate LON has been requested by the program provider.

The ID/RC assessment notes the ICAP service level (Item No. 33). The service level translates to the LON as follows:

  • LON 1 – ICAP service level 7, 8, 9
  • LON 5 – ICAP service level 4, 5, 6
  • LON 8 – ICAP service level 2, 3
  • LON 6 – ICAP service level 1

The ICAP consists of two parts: the adaptive skills section and the problem behavior section. Generally, the higher the service level, the more adaptive skills the individual possesses. Exceptions exist for individuals who have more cognitive skills and limited physical abilities. The person acting as the respondent for the ICAP should be familiar with the individual's abilities.

The adaptive section of the ICAP is reflected on the ID/RC assessment under "Broad Independence" (Item No. 31), and the problem behavior section score is noted as "General Maladaptive" (Item No. 32) and is scored as a negative number. A score lower than -25 (as in temperatures, -26 is lower than -25) generally indicates that the individual's behaviors are serious enough to have a formal program in place.

The section rating an individual's adaptive skills is divided into four categories:

  • Motor skills (Can they pick up an object, pull themselves into a standing position, print their name, etc.?)
  • Social and communication skills (Are they able to communicate basic needs, understand simple commands, etc.?)
  • Personal living skills (Can they assist with dressing, use the toilet, help with household chores, etc.?)
  • Community living skills (Do they understand the concept of purchasing an item from a vending machine, know how to navigate in the home/neighborhood, etc.?)

These items are scored 0 - 3, with 0 meaning the individual is not capable of completing the task and 3 meaning the individual is able to perform the task independently.

The problem behavior section consists of eight categories of behaviors. If a behavior occurs in any of these categories, the frequency and severity is scored:

  • Hurtful to self
  • Hurtful to others
  • Destructive to property
  • Disruptive behavior
  • Unusual or repetitive habits
  • Socially offensive behavior
  • Withdrawal or inattentive behavior
  • Uncooperative behavior

A program provider must have a method of addressing behaviors if they feel the behavior is severe enough to be rated more than slightly serious. A formal behavior support plan must be in place targeting any behavior noted to be very or extremely serious, and a training objective is required to address any behavior rated as moderately serious.

A program provider may request an increase in LON for an individual for medical or behavioral reasons. This is one level higher than the LON assessed by the ICAP tool.