- The Intellectual Disability/Related Condition (ID/RC) Purpose Code 3 can be electronically submitted up to 60 days before the Level of Care/Level of Need (LOC/LON) expiration date. To maintain the same renewal cycle, the requested begin date must be the day after expiration of the current ID/RC.
- If there is an increase in LON based on the Inventory for Client and Agency Planning (ICAP), a behavior or medical increase, or an LON 9, an LON increase packet supporting the requested change must be submitted to IDD Utilization Review. This can be submitted via IDD Operations Portal, fax, or mail.
P.O. Box 149030 MC: W-551
Austin, TX 78714-9030
- When requesting an increased LON, a packet must be received by HHSC within seven calendar days of electronic transmittal of the ID/RC into Texas Medicaid & Healthcare Partnership (TMHP). If no supporting documentation is received within this time, IDD UR will reconcile the ID/RC to the previously authorized LON.
- Once HHS receives the complete packet, IDD UR has 21 calendar days to complete the LON review. If IDD authorizes the requested LON, the LON will be authorized in TMHP.
- If IDD UR denies the requested LON, the provider will be notified via letter available in TMHP. The provider has 10 calendar days from receipt of the notice to submit additional documentation for reconsideration.
- If the LON is denied upon reconsideration, the provider will be notified by letter uploaded into TMHP. The provider has 15 calendar days from the receipt of this second notice to request an administrative hearing.
- The provider cannot request an administrative hearing unless the LON was denied upon reconsideration.