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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER DHOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM
RULE §9.163LON Assignment

(a) An MRA must request an LON for an applicant from DADS at the time an applicant is enrolled into the HCS Program. The LON is requested by electronically transmitting to DADS a completed MR/RC, indicating the recommended LON, is signed and dated by the service coordinator. The electronically transmitted MR/RC Assessment must contain information identical to the information on the signed and dated MR/RC.

(b) A program provider must request an LON for an individual from DADS in accordance with this subsection.

  (1) Before the expiration of an MR/RC Assessment, the program provider must electronically transmit to DADS a completed MR/RC Assessment, indicating the recommended LON, that is signed and dated by the program provider.

  (2) The program provider must ensure the electronically transmitted MR/RC Assessment contains information that is identical to the information on the signed and dated MR/RC Assessment.

  (3) The program provider must, within three calendar days after submission, provide the service coordinator with a paper copy of the signed and dated MR/RC Assessment.

  (4) If applicable, the program provider must submit supporting documentation to DADS as required by §9.164(c) of this subchapter (relating to DADS' Review of LON).

(c) For an LON requested in accordance with subsection (b) of this section, within seven calendar days after the MR/RC Assessment is electronically transmitted by the program provider, the service coordinator must review the MR/RC Assessment in CARE and:

  (1) enter the service coordinator's name and date in CARE;

  (2) enter in CARE whether the service coordinator agrees or disagrees with the MR/RC Assessment; and

  (3) if the service coordinator disagrees with the MR/RC Assessment, notify the individual, LAR, DADS, and the program provider of the service coordinator's disagreement in accordance with DADS instructions.

(d) The service coordinator's agreement or disagreement is considered in DADS' review of an MR/RC Assessment transmitted in accordance with subsection (b) of this section.

(e) The program provider must maintain documentation supporting the recommended LON in the individual's record.

(f) DADS assigns an LON to an individual based on the individual's ICAP service level score, information reported on the individual's MR/RC Assessment, and required supporting documentation. Documentation supporting a recommended LON must be submitted to DADS in accordance with DADS' guidelines.

(g) DADS assigns one of five LONs as follows:

  (1) an intermittent LON (LON 1) is assigned if the individual's ICAP service level score equals 7, 8, or 9;

  (2) a limited LON (LON 5) is assigned if the individual's ICAP service level score equals 4, 5, or 6;

  (3) an extensive LON (LON 8) is assigned if the individual's ICAP service level score equals 2 or 3;

  (4) a pervasive LON (LON 6) is assigned if the individual's ICAP service level score equals 1; and

  (5) regardless of an individual's ICAP service level score, a pervasive plus LON (LON 9) is assigned if the individual meets the criteria set forth in subsection (i) of this section.

(h) An LON 1, 5, or 8, determined in accordance with subsection (g) of this section, is increased to the next LON by DADS, due to an individual's dangerous behavior, if supporting documentation submitted to DADS proves that:

  (1) the individual exhibits dangerous behavior that could cause serious physical injury to the individual or others;

  (2) a written behavior support plan has been implemented that meets DADS guidelines and is based on ongoing written data, targets the dangerous behavior with individualized objectives, and specifies intervention procedures to be followed when the behavior occurs;

  (3) more service providers are needed and available than would be needed if the individual did not exhibit dangerous behavior;

  (4) service providers are constantly prepared to physically prevent the dangerous behavior or intervene when the behavior occurs; and

  (5) the individual's MR/RC Assessment is correctly scored with a "1" in the "Behavior" section.

(i) DADS assigns an LON 9 if supporting documentation submitted to DADS proves that:

  (1) the individual exhibits extremely dangerous behavior that could be life threatening to the individual or to others;

  (2) a written behavior support plan has been implemented that meets DADS guidelines and is based on ongoing written data, targets the extremely dangerous behavior with individualized objectives, and specifies intervention procedures to be followed when the behavior occurs;

  (3) management of the individual's behavior requires a service provider to exclusively and constantly supervise the individual during the individual's waking hours, which must be at least 16 hours per day;

  (4) the service provider assigned to supervise the individual has no other duties during such assignment; and

  (5) the individual's MR/RC Assessment is correctly scored with a "2" in the "Behavior" section.

(j) The program provider must re-administer the ICAP to an individual under a circumstance described in paragraphs (1) - (3) of this subsection and must submit a completed MR/RC Assessment to DADS recommending a revision of the individual's LON assignment if the ICAP results and the MR/RC Assessment indicate a revision of the individual's LON assignment may be appropriate. The ICAP must be re-administered:

  (1) within three years after the individual's enrollment and every third year thereafter;

  (2) if changes in the individual's functional skills or behavior occur that are not expected to be of short duration or cyclical in nature; or

  (3) if the individual's skills and behavior are inconsistent with the individual's assigned LON.


Source Note: The provisions of this §9.163 adopted to be effective June 1, 2010, 35 TexReg 4441

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