Criteria and requirements for an increased LON due to behavioral challenges
In both the Home and Community-based Services (HCS) and Intermediate Care Facilities for Persons with an Intellectual Disability (ICF/ID) programs, individuals with a Level of Need (LON) of 1, 5 or 8 may be assigned to the next higher LON category if they have dangerous behaviors that require a behavior support plan (BSP) that includes preventive actions by additional provider staff. This document provides further clarification regarding the criteria for dangerousness and the required components of the BSP.
The definition of dangerous behavior, as it applies to the need for additional staff resources is as follows:
- Behavior that in frequency and/or severity could cause serious physical injury to the individual or someone else.
This definition includes the major categories of
- self-injurious behavior (such as self-inflicted tissue damage, pica and access to food for individuals with Prader-Willi syndrome);
- serious disruptive behavior (such as threatening strangers, running into traffic and public disrobing);
- aggressive behavior (includes physical attacks against others); and
- sexually aggressive behaviors (such as assault, pedophilia and public masturbation).
Certain very serious behaviors may be of low frequency, but still require additional staff to prevent their reoccurrence.
Additional staff are needed to deal with the problem behavior while other staff supervise the other individuals. There is not a requirement that the behavior be such that two staff are necessary to directly intervene with the individual. However, it should be noted that if verbal redirection is effective, the behavior would not meet this criterion.
Please refer to the rules governing each program for specific criteria for LON increases due to dangerous behavior:
However, if the behavior is extremely dangerous and life threatening — and constant one-to-one supervision is to be required — those individuals may be assigned a LON 9. Supporting documentation must be submitted to the Texas Department of Aging and Disability Services proving all program requirements are met.
Please refer to the rules governing each program (see above) for specific criteria. In addition, refer to LON documentation requirements in the left navigation.
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September 5, 2012