7 C.F.R. § 1944.257 – Service coordinator.

(a) Each grantee must have at least one service coordinator who shall perform the responsibilities listed in section 802(d)(4).
(b) The service coordinator shall comply with the qualifications and standards required by the Secretary concerned. The service coordinator shall be trained in the subject areas set forth in section 802(d)(4), and in any other areas required by the Secretary concerned.
(c) The service coordinator may be employed directly by the grantee, or employed under a contract with a case management agency on a fee-for-service basis, and may serve less than full-time. The service coordinator or the case management agency providing service coordination shall not provide supportive services under a CHSP grant or have a financial interest in a service provider agency which intends to provide services to the grantee for CHSP.
(d) The service coordinator shall:
1. (1) Provide general case management and referral services to all potential participants in CHSP. This involves intake screening, upon referral from the grantee of potential program participants, and preliminary assessment of frailty or disability, using a commonly accepted assessment tool. The service coordinator then will refer to the professional assessment committee (PAC) those individuals who appear eligible for CHSP;
2. (2) Establish professional relationships with all agencies and service providers in the community, and develop a directory of providers for use by program staff and program participants;
3. (3) Refer proposed participants to service providers in the community, or those of the grantee;
4. (4) Serve as staff to the PAC;
5. (5) Complete, for the PAC, all paperwork necessary for the assessment, referral, case monitoring and reassessment processes;
6. (6) Implement any case plan developed by the PAC and agreed to by the program participant;
7. (7) Maintain necessary case files on each program participant, containing such information and kept in such form as HUD and RHS shall require;
8. (8) Provide the necessary case files to PAC members upon request, in connection with PAC duties;
9. (9) Monitor the ongoing provision of services from community agencies and keep the PAC and the agency providing the supportive service informed of the progress of the participant;
10. (10) Educate grant recipient's program participants on such issues as benefits application procedures (e.g. SSI, food stamps, Medicaid), service availability, and program participant options and responsibilities;
11. (11) Establish volunteer support programs with service organizations in the community;
12. (12) Assist the grant recipient in building informal support networks with neighbors, friends and family; and
13. (13) Educate other project management staff on issues related to “aging-in-place” and services coordination, to help them to work with and assist other persons receiving housing assistance through the grantee.
(e) The service coordinator shall tailor each participant's case plan to the individual's particular needs. The service coordinator shall work with community agencies, the grantee and third party service providers to ensure that the services are provided on a regular, ongoing, and satisfactory basis, in accordance with the case plan approved by the PAC and the participant.
(f) Service coordinators shall not serve as members of the PAC.