LCA Service Delivery Characteristics/Activities 650-25-26-01-16

(Revised 1/1/14 ML#3396)

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LCA Services must be delivered throughout the service area.

1. All requests for LCA Services must be responded to within three working days. A face-to-face visit (if applicable) must be completed within 15 working days.
2. Provide LCA Services: Requests for LCA Services can only be received from a nursing facility. Determine if the request requires only information and assistance or if LCA Community Transition is needed.

1. If it is determined that only information and assistance is needed, requested information should be given or assistance/consultation provided. Time spent on the call shall be billed to LCA Operating.
2. If it is determined that LCA Community Transition is needed, the nursing facility social worker or designated staff shall fax the LCA Referral Form to the options counselor.

3. If it is determined that LCA Community Transition is needed, 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 the 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 the 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 Service Activity Summary form in the SAMS ADRL Options Counseling assessment form; in the narrative section, document referral information, summary of the on-site visit, follow-up activities, and next steps in SAMS data system.
8. Documentation and posting of Service Delivery must be completed by the 15th of the month following service delivery.

4. 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’.
5. A signed release of information document must be on file before information is shared or released.
6. Each case record must be maintained in an individualized file and secured in a locked file cabinet, a locked area, or an access coded computer program. At a minimum, the record should include the initial contact information, the SAMS ADRL Options Counseling assessment form, all documentation, and the release of information form(s) as applicable.