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.