Back up Staffing Guidelines

The Back-Up Staffing Plan is designed to assure the health and safety of Members receiving Innovations services.  Failure to provide back-up staffing is a Level I Incident and must be reported to the Partners. Partners has chosen Alpha MCS as the reporting method to be used by providers. If you do not have an AlphaMCS log-in, contact the Partners IT Service Desk at 704-842-6431 for access.

The NC Department of Health and Human Services (NC DHHS) communicated via Joint Communication Bulletin 256 (#J256) on July 3, 2017 that “It is the expectation that if a provider agency or Employer of Record (EOR) staff member is unable to provide back-up staff, the provider or EOR is required to report this lack of staffing to the LME-Managed Care Organization.” This is a requirement and back-up staffing reports should be submitted bi-weekly.

In relation to back-up staffing, there are two types of service interruptions: Failure to Provide Back-Up Staffing and Service Breaks.

When to Submit a Failure to Provide Back-Up Staffing Report

1)  Regularly scheduled staff is unable to provide service(s) AND a back-up staff is not available.

2) Regularly scheduled staff is unable to provide service(s) and back-up staff is available BUT is declined by the member/legally responsible person.

The purpose of the back-up staffing report is to document the reason that back-up staff was not provided, NOT why the primary staff was unable to provide the service. The Back-Up Staffing Report is NOT used to report service breaks.

Service Breaks

Per Clinical Coverage Policy 8P https://files.nc.gov/ncdma/documents/files/8-P.pdf , and also communicated via Joint Communication Bulletin #J266 on September 21, 2017, service breaks do not require Back-Up Staffing reporting to the Partners.  Service breaks are defined as holidays, vacations, weather conditions, illnesses, and scheduling conflicts.  Services breaks should be documented in the Member’s record.

The following table contains scenarios regarding when to complete a Failure to Provide Back-Up Staffing Report versus documenting a service break in the Member’s record. The scenarios are based on information provided by Division of Health Benefits (DHB) in response to questions they have received from providers regarding completion and submission of Failure to Provide Back-Up Staffing Incident Reports.

Scenario

Type of Incident

Provider Action Step

Submit via ALPHA PORTAL BUS MODULE

Member had doctor’s appointment and services were not provided Service Break Document the service break in the member’s record

 

 

No
Member went on vacation and did not receive services Service Break Document the service break in the member’s record No
Regularly scheduled staff out due to illness. Back-up staff was offered but Member/family did not want another staff person or back-up staff was unavailable Failure to Provide Back-Up Complete Failure to Provide Back-up Staffing Incident Report Yes
Regularly scheduled staff quit. Back-up staff was offered but Member/family did not want another staff person or back-up staff was unavailable Failure to Provide Back-up Complete Failure to Provide Back-up Staffing Incident Report Yes
Member/family not utilizing all authorized service units available Service Break Document the service break in the member’s record No
Member/family did not notify the supervisor that regularly scheduled staff did not show up for work until several days after the fact Failure to Provide Back-up Complete Failure to Provide Back- up Staffing Incident Report Yes
New regularly scheduled staff in the process of being hired. Back-up staff offered during interim but declined or back-up staff was unavailable Failure to Provide Back-up Complete Failure to Provide Back- up Staffing Incident Report Yes
Member did not have services over a Christmas Holiday per member/family request Service Break Document the service break in the member’s record No
Member/parent/guardian requested no staff to come to give member a break Service Break Document the service break in the member’s record No
Member/family requested no services due to inclement weather Service Break Document the service break in the member’s record No
Member is sick and unable to participate in services Service Break Document the service break in the member’s record No
Member is in the hospital Service Break Document the service break in the member’s record No
Member/family had a scheduling conflict and requested cancellation of services Service Break Document the service break in the member’s record No
Provider is closed for a holiday Service Break Document the service break in the member’s record No
Provider is closed or closes early due to inclement weather Service Break Document the service break in the member’s record No

Submitting the Failure to Provide Back-Up Staffing Report is a requirement by Division of Health Service Regulation. Information from reports submitted by providers is used in a quarterly report required to be submitted to the State by each LME-MCO. Partners also shares quarterly reporting to our Human Rights Committee and a monthly snapshot of details to our Quality of Care Committee.

Entering the Failure to Provide Back-up Staffing Reports in the AlphaMCS Portal

Instructions for using the Back-up Staffing Module may be found upon logging into the AlphaMCS portal and locating “Alpha University” in the menu,   http://www.alphacm.net/mcsuniversity/. You will look for the Quality Management section and click on Backup Staffing V2 to bring up the instruction document. You may save but should also print to have when you enter the reports until you are familiar with the process.

Below are some highlights of the instructions:

  • To begin, go back to the menu in AlphaMCS, click on Quality Management > Backup Staffing > Create
  • When you create, AlphaMCS will assign a unique BUS ID#. Fields with “asterisks” are required fields.
  • A report must be submitted for each date of incident, as the form does not allow for multiple dates.
  • To enter the member information, click on the “search” button, type in the last and first name and click “search” again and it should bring up the Member. If it brings up more than one member with that name, look at the DOB and SSN before selecting.
  • Complete the provider details and contact information.
  • You will either check the box stating that back-up staffing was not available, or that back-up staffing was offered but declined. When either box is checked it will open additional fields, specific to the reason chosen, to be completed.
  • Service Details—begin typing the service code such as T2013TF or H2015 as this will cause the predictive text to pop up and you can click on it to populate the field.
  • Indicate the time of service and the hours without staff.
  • Choose the reason the back-up staff was unavailable (not the primary staff) in the drop down. If “Other” is chosen as the reason, there must be an explanation of what “other” means in the field to the right of the reason field.

Do not submit a report for a date of incident prior to the actual date of incident.

At the bottom of the report, you have the option of clicking on the “Save” button then returning to the form to complete. When you are ready to complete and submit the report to the Partners, click on the “Submit” box on the left of the form, then click on the “Save” button on the right of the form to send the report to the Partners.

Back up Staffing Tutorial

If you have questions, please contact Renae Cheek, QM Analyst via phone 336-527-3208 or email rcheek@partnersbhm.org