LCA Service Delivery Procedures 650-25-26-11

(Revised 1/1/14 ML#3396)

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The following service delivery procedures must be used for reimbursement through the contract:

1. LCA Community Transition – 8 Units of Service

Upon receipt of the LCA Referral Form, the options counselor shall:

1. Contact nursing facility social worker or designated staff to discuss referral and other pertinent information. Determine a date/time for an on-site visit (to be conducted within 15 days of the referral) with the resident, other identified individuals, and the nursing facility social worker/designee. (Note: The nursing facility social worker/designee is responsible for handling logistics, setting up the visit with the resident and other identified individuals, etc.).
2. Conduct an on-site visit within 15 days of the referral. The options counselor must attempt to obtain necessary data to determine the resident’s needs, preferences, values, and individual circumstances using person-centered planning strategies. (Note: The nursing facility social worker/designee is responsible for the discharge plan; the options counselor provides information on options that are available based on the resident’s preferences).
3. Complete LCA Service Activity Summary form. Documentation must include, at a minimum:

• Summary of the interaction and options discussed;
• Determination as to whether or not the resident’s needs can be met in a community setting;
• Potential referrals to MFP program or Medicaid (county social services), if applicable;
• Potential referrals to community-based services; and
• Next steps.

4. Follow-up to determine if/when discharge will take place. The nursing facility social worker/designee is responsible for developing the discharge plan that includes a referral to ADRL Options Counseling, if the options counseling service is needed after discharge.
5. Fax a copy of the LCA Referral Form and the LCA Service Activity Summary form to the MFP administrator. If the resident is eligible for MFP services, the MFP administrator will contact the applicable Center for Independent Living (CIL).
6. LCA Services end when the resident is discharged to the community (if indicated in discharge plan, ADRL Options Counseling will contact consumer to schedule options counseling visit).
7. Enter information obtained from the LCA Referral Form and the LCA Summary Activity form in SAMS ADRL Options Counseling assessment form; in the narrative section, document referral information, summary of the on-site visit including interactions and options discussed, needs determination, referrals, and next steps.
8. Documentation and posting of Service Delivery must be completed by the 15th of the month following service delivery.

2. LCA Telephone Contact, E-mail, Written Correspondence, or Brief Face-to Face Visit – 1 Unit of Service

1. If needed to complete the LCA Community Transition process, a referral entity, resident, or family member may be contacted via telephone, e-mail, written correspondence, or through a brief face-to-face visit regarding a needed service or receipt of services.
2. Document in the Narrative section of the SAMS ADRL Options Counseling assessment form the specific purpose of the contact and a brief descriptive statement of the interaction and outcome(s).
3. Documentation and posting of Service Delivery must be completed by the 15th of the month following service delivery.

3. LCA Follow-Up Contact – 2 Units of Service

1. A follow-up contact (telephone, e-mail, written correspondence, or face-to-face visit) with the nursing facility may be needed to determine if discharge will take place or to complete the LCA Community Transition process.
2. All follow-up contacts must be documented in the narrative section of the SAMS ADRL Options Counseling assessment form. Documentation of each contact shall include:

• The specific purpose of the contact;
• A brief descriptive statement of the interaction; and
• Outcome of the follow-up contact.

3. Documentation and posting of Service Delivery must be completed by the 15th of the month following service delivery.

4. LCA Community Transition Inactivity – 1 Unit of Service

1. If a referral is made to the MFP program or county social services, the narrative section of the SAMS ADRL Options Counseling assessment form must be updated to reflect referral information and service delivery posted to reflect ‘inactive’.
2. LCA Services end when the resident is discharged to the community (if indicated in discharge plan, ADRL Options Counseling will contact consumer to schedule options counseling visit). The Narrative section of the ADRL Options Counseling assessment form must be updated to reflect that the resident transitioned to the community.
3. Documentation and posting of Service Delivery must be completed by the 15th of the month following service delivery.