LCA Service Delivery Procedures 650-25-26-11

(Revised 3/1/17 ML#3497)

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The following service delivery procedures must be used to record service delivery in the individual consumer record:

1. LCA Community Transition – 8 Units of Service

Upon receipt of the LCA Referral form (SFN 584), the options counselor shall:

1. Within three business days 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 business days of the referral) with the resident, other identified individuals, and the nursing facility social worker/designee.
2. Conduct an on-site visit within 15 business days of the referral. The LCA staff must attempt to obtain necessary data to determine the resident’s needs, preferences, values, and individual circumstances using person-centered planning strategies.
3. Complete all information on the LCA Transition Plan. Distribute the plan as indicated.
4. Fax or scan and email a copy of the LCA Referral form (SFN 584) and the LCA Transition Plan (SFN 585) to the LCA Coordinator/Money Follows the Person (MFP) administrator at Medical Services. If the resident is eligible for MFP services, the LCA Coordinator/MFP administrator will contact the applicable Center for Independent Living (CIL).

5. Enter information obtained from the LCA Referral form and the LCA Transition Plan in the SAMS ADRL Options Counseling assessment form. At a minimum, Sections I through IV must be completed. In the narrative section, document referral information, summary of the on-site visit including, follow-up activities, and next steps.
6. If a referral is made to the MFP program or county social services, the narrative section must reflect the referral information. If the client is not receiving other services, their file should be updated to reflect ‘inactive’ and the care enrollment end-dated.
7. Documentation and posting of Service Delivery must be completed by the 25th 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 25th 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 25th of the month following service delivery.