The backup staffing plan is designed to assure the health and safety of members receiving Innovations services. Failure to provide backup staffing is a Level I Incident and must be reported to the MCO. Partners uses Alpha+ as the reporting method to be used by providers. If you do not have an Alpha log-in, contact the Partners IT Service Desk at 704-842-6431 to be given 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 backup staff, the provider or EOR is required to report this lack of staffing to the LME-MCO.” This is a requirement and backup staffing reports should be submitted bi-weekly.
In relation to backup staffing, there are two types of service interruptions: Failure to Provide Backup Staffing and Service Breaks.
When to Submit a Failure to Provide Backup Staffing Report
- Regularly scheduled staff is unable to provide service(s) and a backup staff is not available.
- Regularly scheduled staff is unable to provide service(s) and backup staff is available but is declined by the member/legally responsible person.
The purpose of the backup staffing report is to document the reason that backup staffing was not provided, not why the primary staff was unable to provide the service. The backup staffing report is not used to report service breaks.
Per Clinical Coverage Policy 8P 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 Backup Staffing reporting to the MCO. Service breaks are defined as holidays, vacations, weather conditions, illnesses, and scheduling conflicts. Service breaks should be documented in the member’s record.
Service Breaks v/s Failure to Provide Backup Staffing
Service Breaks are member-driven in that the service was not provided due to the member canceling the service.
Failure to provide Backup Staffing is provider-driven in that the service is not provided because the provider is unable to provide staffing.
The following table contains scenarios regarding when to complete a Failure to Provide Backup Staffing Report versus document a service break in the member’s record. The scenarios are based on information provided by DMA in response to questions they have received from providers regarding the completion and submission of Failure to Provide Backup Staffing Incident Reports.
|Scenario||Type of Incident||Provider Action Step||Submit via ALPHA PORTAL BUS MODULE|
|Member had a doctor’s appointment and services were not provided.||Service Break||Document the service break in the member record.||No|
|Member went on vacation and did not receive services.||Service Break||Document the service break in the member record.||No|
|Regularly scheduled staff out due to illness. Backup staff was offered but members/families did not want another staff person or backup staff was unavailable.||Failure to Provide Backup||Complete Failure to Provide Backup Staffing Incident Report.||Yes|
|Regularly scheduled staff quit. Backup staff was offered but members/families did not want another staff person or backup staff was unavailable.||Failure to Provide Backup||Complete Failure to Provide Backup Staffing Incident Report.||Yes|
|Member/family not utilizing all authorized service units available.||Service Break||Document the service break in the member 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 Backup||Complete Failure to Provide Backup Staffing Incident Report.||Yes|
|New regularly scheduled staff in the process of being hired. Backup staff was offered during the interim but declined or backup staff was unavailable.||Failure to Provide Back-up||Complete Failure to Provide Backup Staffing Incident Report.||Yes|
|Member did not have services over a holiday per member/family request.||Service Break||Document the service break in the member record.||No|
|Member/parent/guardian requested no staff to come to give the member a break.||Service Break||Document the service break in the member record.||No|
|Member/family requested no services due to inclement weather.||Service Break||Document the service break in the member record.||No|
|Member is sick and unable to participate in services.||Service Break||Document the service break in the member record.||No|
|Member is in the hospital.||Service Break||Document the service break in the member record.||No|
|Member/family had a scheduling conflict and requested cancellation of services.||Service Break||Document the service break in the member record.||No|
|The provider is closed for a holiday.||Service Break||Document the service break in the member record.||No|
|The provider is closed or closes early due to inclement weather.||Service Break||Document the service break in the member record.||No|
Submitting the Failure to Provide Backup Staffing Report is a requirement by DHSR. Information from the reports submitted by providers is used in a quarterly report required to be submitted to the Division by the MCOs. Partners provides quarterly reporting to our Human Rights Committee (HRC) and a monthly snapshot of details to our Quality of Care Committee.
COVID FLEXIBILITIES – FAILURE TO PROVIDE BACKUP STAFFING
Effective July 1, 2022, Partners is requiring providers to submit the failure to provide backup staffing reports at least bi-weekly. The COVID flexibilities allowed by Partners will end on June 30, 2022.
ENTERING THE FAILURE TO PROVIDE BACKUP STAFFING REPORTS IN THE ALPHA PORTAL
Instructions for using the Backup Staffing Module may be found upon logging into the Alpha+ portal and locating “Alpha University” in the menu, 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 Alpha, and click on Quality Management/Backup Staffing/Create.
When you create, Alpha will assign a unique BUS ID#. Fields with “asterisks” are required fields.
A report must be submitted for each date of the 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 Backup Staffing was not available, or that backup 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 backup staff was unavailable (not the primary staff) from 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 the incident prior to the actual date of the incident.
At the bottom of the report, you have the option of clicking on the “Save” button and then you can return to the form to complete it. When you are ready to complete and submit the report to the MCO, 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 MCO.
If you have questions, please contact: Renae Cheek, QM Analyst email@example.com