ICAP and level of need: how Texas HCS assigns a LON

What is the ICAP assessment?

The Inventory for Client and Agency Planning (ICAP) is, in HHSC's words, "a comprehensive and structured instrument designed to assess the status, adaptive functioning, and service needs" of a person. In Texas it is required to determine the level of need (LON) in HCS, Texas Home Living (TxHmL), and ICF/IID.

The ICAP has two parts. The adaptive skills part scores motor, social and communication, personal living, and community living skills from 0 (cannot do the task) to 3 (does it independently). The problem behavior part scores the frequency and severity of eight kinds of behavior, such as hurting self or others and destroying property.

The adaptive score goes on the ID/RC as Broad Independence (Item 31), the behavior score as General Maladaptive (Item 32), and the result as the ICAP Service Level (Item 33). HHSC says the University of Minnesota now owns the ICAP.

How does the ICAP set the HCS level of need?

The ICAP service level converts straight to a LON. Service levels 7, 8, and 9 are LON 1. Levels 4, 5, and 6 are LON 5. Levels 2 and 3 are LON 8. Level 1 is LON 6. LON 9 can come from any service level.

This is the Calculating Level of Need chart in the Form 8578 instructions. Item 33 must match the LON requested on Item 18 unless the provider asks for a behavior or medical increase. The LON numbers are codes, not a ranking, so they run 1, 5, 8, 6, 9 from least to most support.

• LON 1, Intermittent: ICAP service level 7, 8, or 9; service score 70 or higher
• LON 5, Limited: service level 4, 5, or 6; service score 40 to 69
• LON 8, Extensive: service level 2 or 3; service score 20 to 39
• LON 6, Pervasive: service level 1; service score 1 to 19
• LON 9, Pervasive Plus: any service level, with a code of 2 on at least one behavior item (Items 35 to 38)

What do intermittent, limited, extensive, pervasive, and pervasive plus mean?

They describe how much support a person typically needs. HHSC's Definition of LON Terminology gives common traits for each level, from very independent living skills at LON 1 to one-to-one supervision for at least 16 hours a day at LON 9.

These are HHSC's "common characteristics," not rules.

• Intermittent (LON 1): no 24-hour care needed, very independent living skills; staff mostly give reminders
• Limited (LON 5): fairly independent to needing personal care reminders; may need behavior help or hands-on care
• Extensive (LON 8): few or some basic self-help skills; staff give hands-on personal care
• Pervasive (LON 6): may have challenging behavior, usually with a behavior program; may need 1:1 care, though not 16 hours a day
• Pervasive Plus (LON 9): 1:1 supervision at least 16 hours a day because of dangerous behavior; under one percent of people, per HHSC

Who completes the ICAP and the ID/RC, and how often?

The ICAP is answered by someone who knows the person well. The ICAP results go on Form 8578, and the HCS program provider must renew the individual's level of care and level of need at least once a year by sending a new ID/RC to HHSC.

HHSC's ICAP guidelines say any parent, teacher, or care person who knows the person well can answer. As a guide, that means someone who has seen the person day to day for at least three months. Scores generally reflect the last three months.

Form 8578 must be signed by an RN, LVN, QIDP, QDDP, case manager, LIDDA service coordinator, or HCS provider representative. For renewals and mid-cycle LON requests, the HCS provider completes it and enters it in the state system.

The provider then gives the service coordinator a signed copy within three days, and the coordinator has seven days to agree or disagree (Form 8579). An approved renewal is valid for 365 days. If the ID/RC lapses, the provider must also send one covering the lapsed period.

How does the level of need affect HCS reimbursement?

The LON sets the rate the provider is paid for residential support, supervised living, host home/companion care, and individualized skills and socialization (ISS). Under HHSC's HCS Program Billing Requirements, a claim for these services must be based on the LON authorized by the ID/RC assessment.

The gap is large. On HHSC's HCS rate table effective Sept. 1, 2025, residential support is $164.46 per day at LON 1 and $341.83 at LON 9. Rates change, so check the current HHSC Provider Finance Department table.

Most other services, such as nursing and therapies, are priced by level of care (LOC 1 or LOC 8) instead. Employment readiness is also listed by LON.

How does the level of need affect the IPC cost limit?

The LON also sets the yearly HCS individual cost limit on the IPC. HHSC Information Letter 2025-21 set these limits, effective Sept. 1, 2025: $169,182 for LON 1, 5, and 8; $211,822 for LON 6; and $392,318 for LON 9.

Each limit is 210 percent of an annualized ICF/IID cost of care, based on the LON 8, LON 6, or LON 9 daily rate. The IPC (Form 3608) total has to stay within it.

One special case: if an individual at LON 8 receives 181 or more minutes of RN or LVN nursing a week, the Form 8578 instructions raise their cost cap to the LON 6 cap.

How do you request a LON increase or a LON change?

The provider enters the ID/RC with the new LON, then sends Form 8603 and a packet of supporting documents to HHSC Utilization Review. The packet must arrive within seven calendar days of the effective date, or HHSC will not process the LON request.

Behavior increase: raises LON 1, 5, or 8 one level when a behavior item (Items 35 to 38) is coded 1. HHSC requires dangerous behavior, a behavior support plan, and staff exclusively assigned during waking hours. If verbal redirection works, it does not qualify.

Medical increase: raises LON 1, 5, or 8 one level when the person gets 181 or more minutes of RN or LVN nursing a week. LON 9 is requested by coding a behavior item 2, meaning constant one-to-one supervision while awake. HHSC reviews every initial LON 9, and a LON 6 is never raised to LON 9 this way.

ICAP increase: send the current and previous ICAP booklets, a cover letter, the past year's records such as incident reports and progress notes, and the latest plans. A mid-cycle change takes effect on the date it is entered. If HHSC denies a LON, it mails a certified letter to the individual or legally authorized representative.

How does Sereniq help with the ID/RC and LON?

Sereniq keeps Form 8578 as a fillable record on each HCS individual, including the ICAP Broad Independence, General Maladaptive, and Service Level items. It records the LON you requested and the LON the state assigned, and it reminds your team 60, 30, and 7 days before the ID/RC expires.

The ICAP booklet and signed ID/RC are stored in the Individual Binder next to the IPC, and Sereniq prints Form 8578 as a four-page facsimile.

Sereniq does not score the ICAP, assign a LON, or submit anything to HHSC. Your team still does the assessment and enters the ID/RC in the state portal.