Section 5000, Level of Care and Level of Need


Revision 11-5; Effective September 1, 2011

The following sections provide information related to Form 8578, Intellectual Disability/Related Condition Assessment.


5100 Intellectual Disability/Related Condition Assessment Process

Revision 10-0; Effective June 1, 2010

The Home and Community-based Services (HCS) program provider must annually renew an individual's level of care (LOC) and level of need (LON) by completing and signing Form 8578, Intellectual Disability/Related Condition Assessment, and entering the information into CARE. 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.

Providers may use the C65 screen (displayed below) to determine when an individual's LOC/LON will expire.

The C65 screen is used to determine when an individual's level or care or level of need will expire.<p><img  data-cke-saved-src=

The detail screen (displayed below) includes the name of each individual with an LOC/LON expiring by the date requested, and date range of their current LOC/LON.

This screen includes the name of each individual with a level of care or level or need expiring by the date requested, as well as date range of the current level of care or level of need.<p><img alt=

  • Form 8578 only requires a program provider's signature.
  • The Local Authority (LA) service coordinator (SC) is no longer required to sign Form 8578.
  • The program provider must enter the ID/RC assessment information into CARE.
  • 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 CARE, the SC will have seven days to review the LOC/LON information and enter an agreement or disagreement with what was entered.

CARE screen L82 has been developed to assist an LA with tracking ID/RCs that need to be reviewed by the SC. LAs are expected to review each ID/RC and must determine how frequently they will need to produce the list in order to meet this expectation.

The new screen L82 will look something like the following examples.

This screen assists Local Authorities track assessments that need to be reviewed by the service coordinator.

All ID/RCs waiting for the SC review will be displayed.

This screen assists Local Authorities track assessments that need to be reviewed by the service coordinator.

The SC will access screen L32 (displayed below) to view the ID/RC and enter an agreement or disagreement and any comments.


The service coordinator accesses this screen to view the assessment and enter an agreement or disagreement and comments.

The information that was entered by the program provider will be displayed followed by a screen for the SC to enter an agreement, 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.
    • The program provider may also use the C82 screen and select status code "X -RETURNED TO PROVIDER FOR MORE INFORMATION" to see if any ID/RC assessments have been returned by the LA.
  • If the SC returns an ID/RC assessment to a provider, the SC must enter a comment as to why it is being returned on the final screen.

After viewing the ID/RC assessment information, the final L32 screen for the SC data entry will be displayed, as shown below.

This is an example of the final L32 screen for the service coordination data entry.

If an SC does not agree that the information is accurate, the SC will indicate a disagreement by answering the question "Local Authority agrees with information on this ID/RC?" with "N" for no. Any time a disagreement is noted, the SC must notify DADS Program Enrollment (PE) and the program provider by completing Form 8579, Notification of SC Disagreement, and faxing it to DADS PE and sending a copy to the program provider. This notification should be done the same day of the data entry. Errors made on the SC review screen may only be corrected during the LA review time period (within seven days 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, CARE will automatically send the ID/RC assessment to DADS for approval. Reports will be available for state office and LA management staff noting those ID/RC assessments not reviewed by the SC.

DADS PE will continue to approve or deny an individual's LOC/LON. The SC's agreement or disagreement does not ensure any action will be taken or not taken by DADS PE. The SC may be used as an informant if DADS PE determines an LON review is necessary.

ID/RC and LON Resources

Additional information regarding ID/RC assessments and requesting a LON from DADS PE may be found at:


5200 Service Coordinator Review of Intellectual Disability/Related Condition

Revision 11-5; Effective September 1, 2011

The HCS program provider is responsible for completing Form 8578, Intellectual Disability/Related Condition Assessment, and transmitting it to DADS. This document consists of the individual's LOC and LON. The SC does not approve or deny an individual's LOC or LON, but is responsible for reviewing the document in CARE, entering their name and date of review, and entering whether or not they agree with the information. In order to review the ID/RC assessment, the SC must have a basic understanding of the ID/RC assessment and the Inventory for Client and Agency Planning (ICAP) assessment.

Level of Care

The LOC determines the individual's programmatic eligibility for the HCS program. Individuals enrolling into HCS must have a LOC 1, which requires either a diagnosis of intellectual disability or diagnosis of a related condition (RC). Along with the diagnosis of an RC, the individual's IQ score must be below 76. There is a small group of individuals initially enrolled under the HCS-Omnibus Budget Reconciliation Act program with a LOC 8. An individual's LOC is established at the time of enrollment and does not typically change.

Level of Need

An individual's LON is used to determine the reimbursement rate a provider will receive for some of the HCS program services. The LON is obtained by completing and scoring an ICAP assessment for each individual.

A brief overview of the ICAP is provided in this document, but is not intended to be comprehensive. More extensive ICAP training is provided by DADS PE staff at the applicable waiver conferences.

Review of the ID/RC

Information from the ICAP is entered on the ID/RC (Form 8578) to request a 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 provider.

The ID/RC assessment notes the ICAP service level (Item #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 someone familiar with the individual's abilities.

The adaptive section of the ICAP is reflected on the ID/RC assessment under "Broad Independence" (Item #31), and the problem behavior section score is noted as "General Maladaptive" (Item #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.

Individuals may be "bumped" to a higher LON if they display behaviors severe enough to warrant additional staffing resources to address the behavior, and the program provider is providing these additional resources. The provider requests this bump by noting on the ID/RC that the individual has a behavior support plan and notes a "1" in one of the behavioral status questions (Items #35-38). If a LON 9 is requested the provider will enter a "2" in the appropriate field.

If the LON changes, the SC should be aware of the reason for the change. The individual's LOC/LON history can be viewed by using the C68 screen in CARE, and the entire ID/RC assessment is displayed on the C83 screen.

In order to assist in reviewing the accuracy of the individual's ICAP levels of need, the following profiles were developed. These general descriptions are intended to give a basic overview of the skill level/behavioral severity of an individual in that LON range, and are not an absolute requirement for an individual with that LON. The SC should not make the assumption that a LON should be bumped up if the individual seems to meet one or two items in a different LON category. To secure an initial behavior increase to another level, the provider must submit documentation that supports that increase.

Individual Profiles


Varied skill levels are noted here. This is less than one percent of the population. Individuals require staff supervision 16 hours a day during waking hours to assure this individual's safety or the safety of others due to the individual's life-threatening behavior. Due to the threatening nature of this behavior, most individuals in this LON category live in shift pattern residential homes. Significant documentation supporting this LON assignment must be submitted by the provider in order to be approved. DADS PE staff must review all initial LON 9 requests.


This individual may have limited self-help skills or some independent basic self-help skills, but may demonstrate challenging behavior as well. Usually an individual in this category will have a behavioral program or intervention strategies in place regardless of the absence of self-help skills. (The author of the ICAP, Brad Hill, used this analogy: a newborn infant requires extensive care throughout the day but a child in his/her "terrible twos" requires a more intense level of supervision to assure this child's safety due to his ambulation and adventuresome behavior.) Individuals in this LON may even require 1:1 supervision or care, though not 16 hours a day for safety reasons. Other individuals with more skills may bump from the extensive category to this category due to behavioral intervention. All living environments are noted with this LON.


This individual has skills ranging from no self-help skills (due to physical limitations) to demonstrating some basic self-help skills. Staff intervention includes personal care assistance utilizing hands-on techniques. Other individuals with more skills may bump from the limited category to this category due to behavioral intervention (all programs) or medical issues (intermediate care facility for persons with intellectual disability (ICF/ID) only). This individual typically lives in all possible living arrangements.


This is probably the largest number of individuals served who have the most varied skill levels within the same level of need. This individual has skills ranging from fairly independent to some personal care reminders/guidance required. Behavior intervention may be required or hands-on personal care assistance. Individuals may have psychiatric disorders but are fairly controlled with medications. Staff intervention varies from reminders to 24-hour guidance and support. This individual may possibly be living in an apartment with support, with natural or foster care families or in a shift pattern residence setting.


This individual does not need 24-hour care and demonstrates very independent living skills, with no significant maladaptive behavior noted. Staff intervention is typically reminders with some guidance required. This individual may live in an apartment with support, at home with family, in a foster/companion residence or receive Supervised Living in a group home. They generally do not require the level of supervision or assistance provided in Residential Support.