• 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. (Specify on CARE Header Screen to accomplish this.)

  • If there is an increase in Inventory for Client and Agency Planning (ICAP) LON, an initial behavior increase is being requested, or an initial LON 9 is being requested on the ID/RC, an LON increase packet supporting the requested change must be submitted to Texas Department of Aging and Disability Services (DADS) Program Enrollment/Utilization Review (PE/UR). Current requirements for "initial" and "renewal" packets are specified on LON resources page.

  • If the provider is requesting an initial LON increase, an initial behavior increase, or an initial LON 9 on a Purpose Code 3 ID/RC, the packet supporting the requested change should be submitted with sufficient time to allow DADS PE/UR to review it before the ID/RC begin date.

  • When requesting a increased LON, a packet must be received within seven calendar days of electronic transmittal of the ID/RC (CARE system entry). If no supporting documentation is received within this time, DADS PE/UR will electronically notify the provider that the LON request will not be processed.

  • Once DADS receives the complete packet, PE/UR has 21 calendar days to complete the LON review. If DADS PE/UR approves the requested LON, the LON will be authorized in CARE.

  • If DADS PE/UR denies the requested LON, the provider will be notified by fax. The provider has 10 calendar days from receipt of the letter to submit documentation for reconsideration. The individual or his or her legally authorized representative will be informed of this action by regular mail.

  • If the LON is denied upon reconsideration, the provider has 15 calendar days from the receipt of the denial letter to request an administrative hearing.

  • The provider cannot request an administrative hearing unless the LON was denied upon reconsideration.