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

(Revised 3/1/17 ML#3497)

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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 business days. A face-to-face visit (if applicable) must be completed within 15 business days of the referral.
  2. Requests for LCA services can only be received from a nursing facility through a centralized intake system established by Aging Services Division. Requests will be forwarded to the respective RASPA for follow-up with the nursing facility social worker or designated staff.
  1. The nursing facility social worker or designated staff shall submit the Local Contact Agency (LCA) Referral (SFN 584) form to centralized intake by either of the following formats: fax to 701.328.8744 or scan and email to carechoice@nd.gov.
  1. Upon receipt of the LCA referral from centralized intake, LCA staff shall:

  1. Within three business days contact the nursing facility social worker or designated staff to discuss the 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. (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 business days of the referral. LCA staff 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 LCA staff provides information on options that are available based on the resident’s preferences).
  3. Complete all information on the Local Contact Agency (LCA) Transition Plan (SFN 585). Distribute the completed form 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. 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 service is needed after discharge. LCA services end when the resident is discharged to the community.

  1. SAMS Documentation must be completed as follows:

    1. 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, follow-up activities, and next steps.

    2. 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.

    3. Documentation and posting of Service Delivery must be completed by the 25th of the month following service delivery as outlined in LCA Service Delivery Procedures 650-25-26-11.

  1. A signed release of information document must be on file before information is shared or released.
  2. 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.