• If the LOC/LON is near expiration, the ID/RC assessment needs to be entered into the CARE system in order to avoid creating a gap in the LOC/LON.
  • A Purpose Code 3 for an LOC/LON renewal can be entered in the CARE database up to 60 days before the current ID/RC expiration date and maintain the same ID/RC cycle. (Note: An ID/RC assessment is good for 364 days after the effective/begin date [365 days total]. Therefore, every four years [each leap year] the cycle changes by one day.)

To keep the same ID/RC cycle, the header screen for CARE Screen C23, Purpose Code 3 — Renewal, must specify the day after the current ID/RC end date as the requested begin date. This may only be done during the 60-day window before expiration of the current ID/RC. The CARE system requires a requested begin date to be entered when renewing the ID/RC. During the 60-day window, any date from the date of data entry to the day after the current ID/RC end date may be requested as the begin date for the ID/RC renewal. A renewal (Purpose Code 3) at any other time must use the date of data entry as the requested begin date.

  • Ask, "Is the LON an initial behavioral increase or LON 9?" not "Is the LON the same as last year?" Anytime the LON score does not directly correlate to the Inventory for Client and Agency Planning (ICAP) service level (i.e., a "1" or "2" in any of the behavior status items) or if there is an LON increase based on a change in ICAP information, an initial LON increase packet of supporting documentation must be sent to the Texas Department of Aging and Disability Services (DADS) Program Enrollment/Utilization Review (PE/UR).

  • When the ID/RC assessment data is entered into the CARE system, the initial LON documentation packet should be concurrently mailed to PE/UR, as the packet needs to be received in the PE/UR office within seven calendar days of the entry date. Do not send a packet to PE/UR unless a pending ID/RC assessment has been entered in CARE.

  • If the ID/RC assessment has more than one type of initial increase request, do not send two separate packets. Send the information for all types of increases in one packet and note all the increases being requested on Form 8603, Level of Need (LON) Review/Increase Cover Sheet. §For Home and Community-based Services (HCS), a one level LON behavior Increase from the verified ICAP LON of 1, 5 or 8 may be authorized based on documentation supporting the occurrence of problem behaviors with the potential for serious physical injury that require additional staff resources.§ For ICF/IID only, a medical or behavior increase may be authorized based on the submitted documentation, but not both. Per the Texas Administrative Code, a LON 9 can be authorized regardless of ICAP LON.

  • Use Form 8603, Level of Need (LON) Review/Increase Cover Sheet, for all packets submitted for review. Be sure to complete all sections including the provider's component code, the individual's CARE ID and Medicaid number, contact name, fax number, telephone number and legally authorized representative (LAR) information, as applicable.

  • If PE/UR approves the requested LON increase, the approval will be entered in the CARE system by the PE/UR reviewer and transmitted electronically to the provider. A notification letter will not be sent.

  • If the requested LON increase is denied, a denial letter will faxed to the provider. The individual or LAR will be notified of denial by regular mail. The pending ID/RC assessment will not be processed in the CARE system until the reconsideration packet is processed by PE/UR or the reconsideration request time period of 10 days has expired, except as noted below.

    • If the provider is not seeking reconsideration, the provider may mail or fax this decision to the PE/UR reviewer. This notification must include the individual's name, the staff person's name and title, and it must instruct the PE/UR reviewer that reconsideration is not being sought. The PE/UR reviewer will place this notification in the LON packet and authorize the LON verified during the initial review.

    • If the provider chooses to seek reconsideration, the reconsideration packet must include the completed reconsideration form that was sent to the provider with the LON denial letter. Do not submit the reconsideration form with a packet if the packet is not a reconsideration packet.

    • If there is a pending ID/RC assessment in the CARE database with a behavior increase or LON 9, and no packet is received within seven calendar days, PE/UR will process that pending assessment with the increase information removed. The LON will be approved at the previously approved LON. If the increase is due to a new ICAP, which resulted in a higher LON, the LON will be lowered to the previously approved ICAP LON.