Where can more information be found about the Intellectual Disability and Related Condition (ID/RC) Assessment?
Form 8578, Intellectual Disability/Related Condition Assessment, and instructions can be found in the Texas Department of Aging and Disability Services (DADS) forms website.
Where can I check on an individual's Level of Need (LON) status?
After registering an individual in the CARE system, check the following for any Level of Care (LOC)/LON history:
- CARE Screen C68 — Home and Community-based Services (HCS) and Texas Home Living (TxHmL) ID/RC Assessments — Summary HCS; or
- CARE Screen 1168 — Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) ID/RC Assessment Summary Inquiry
What do some of the various items in the ID/RC mean?
Item #13 — Purpose Code
- Purpose Code 2: Initial/new enrollment means that there is no current ID/RC, or for ICF/IID, the individual has been out of an ICF/IID for more than 180 days.
- Purpose Code 3: Renewal of LOC/LON (may be the same LON or changed). A LON change submitted on a Purpose Code 3 may affect the provider's ability to bill until the LON review is completed. A Purpose Code 3 is valid for 365 days, once approved.
- Purpose Code 4: Change LON. The date of the data entry of the Purpose Code 4 is the effective date of the requested LON change. The expiration date will remain the same as the current Purpose Code 3 expiration date.
- Purpose Code E: Covers a gap in LOC/LON. Check the 1168 (ICF/IID) or C68 (HCS, TxHmL) screen to see the gap dates. A LON increase will not be authorized on a Purpose Code E.
Item #17 — Level of Care
- The LOC is a determination of eligibility for an individual in either the Medicaid waiver or ICF/IID programs. The LOC for individuals with a primary diagnosis of intellectual disability will be LOC 1. The LOC for individuals with a primary diagnosis of a related condition will be either LOC 1 or LOC 8.
|IQ||—75||N / A|
|ABL||I, II, III, IV||II, III, or IV|
Item #19 — Primary Diagnosis
- Always use the diagnosis of intellectual disability (ID) or the appropriate related condition diagnosis for the individual's "Primary Diagnosis."
- ID diagnoses are as follows:
- F70 Mild ID
- F71 Moderate ID
- F72 Severe ID
- F73 Profound ID
- F79 ID, severity unspecified
- For a related condition, the individual must have an acceptable diagnosis listed on the International Classification of Diseases (ICD-10-CM) that has been approved by DADS (PDF format).
Item #33 — Inventory for Client and Agency Planning (ICAP) Service Level
- The ICAP Service Level, Item #33, must match the requested LON, Item #18, unless a request for a LON increase is made. Use the chart below to calculate the LON.
|LON||Service Level||Service Score|
|5||4, 5, 6||40-69|
|1||7, 8, 9||> 70|
Items #35 - #40 — Level of Need
- All initial LON increases require that supporting documentation be submitted to Program Enrollment/Utilization Review (PE/UR) for review. When sending supporting documentation to PE/UR you must use Form 8603, Level of Need (LON) Review/Increase Cover Sheet.
- For LOC/LON Annual Renewals: Anytime the LON is different from the straight calculated LON from the ICAP score due to behavioral status (ID/RC Assessment item numbers 35—38 are scored with at least one 1 or one 2, then supporting documentation must be submitted.) There are no medical increases in the HCS waiver program.
- Any time Item #s 35—38 on the ID/RC have a one, and a behavior increase has not been authorized for the previous ID/RC, a behavior increase LON packet containing the appropriate documentation must be submitted unless the individual has been previously authorized by ICAP as a LON 6 for the preceding year.
- If the requested LON is a 9 (any of Item #s 35-38 have a 2), and a LON 9 was not authorized on the previous ID/RC, then supporting documentation (LON 9 packet) must be submitted.
- The supporting documentation must be received by DADS PE/UR within seven calendar days of electronic submission of the ID/RC assessment (per the Texas Administrative Code). If no supporting documentation is received within this time period, DADS will electronically notify the provider that the LON request will not be processed and the LON assigned will be derived from the previously authorized ICAP Service Level. This will be communicated to the provider electronically in the CARE system.
- Transfers do not require that a new ID/RC assessment be submitted unless the LON changes or the LOC has expired.
Item #48-55 — Physician Evaluation and Recommendation
- A physician's evaluation is not required for the HCS and TxHmL waiver programs.
- A physician evaluation and recommendation is required for all ICF/IID and ID/RCs, except for Purpose Code 4.
- The physician's license number must be verifiable through the Texas Medical Board website (http://www.tmb.state.tx.us/).
- The physician's signature date for Purpose Code 3 must be not more than 60 days before the requested effective date.