Per LME-MCO Communication Bulletin #J256, “It is the expectation that if a provider or Employer of Record (EOR) staff member is unable to provide a service and the provider agency or EOR is unable to provide back-up staff, the provider or EOR is required to report this lack of staffing to the LME-MCO. This should be sent by the provider agency to the LME-MCO on a bi-weekly basis on a spreadsheet provided by the LME-MCO.”
The intent of the back-up staffing report is to document the reason that BACK-UP STAFF was not provided, NOT why regularly scheduled (primary) staff was unable to provide the service.
Back-up staffing reports SHOULD be submitted when:
- Regularly scheduled (primary) staff is unable to provide service(s) AND a back-up staff is not available
- Regularly scheduled (primary) staff is unable to provide service and back-up staff is available BUT declined by the individual/legally responsible person.
Back-up staffing reports SHOULD NOT be submitted to:
- Report the lack of regularly scheduled (primary) staff (back-up staffing reports should not be submitted for cases that are not fully staffed). General staffing concerns should be communicated to the provider’s assigned Provider Network Development Specialist.
- Record the difference between authorized hours and unused hours, unless unused hours are due to a lack of back-up staff. Concerns related to deviations in service should be communicated to the UM I/DD Supervisor.
- Record reasons why a service date is not billable.
- Document breaks in service. These are defined as holidays, vacations (consumer), weather conditions, illnesses (consumer), and scheduling conflicts. Service breaks should be documented by the provider and communicated to the consumer’s Care Coordinator however, they should not be documented on the back-up staffing report.
Completing the Form
Access the bi-weekly spreadsheet on the Innovations Reporting for Failure to Provide Back-Up Staffing. Reports for the 1st through the 15th of the month should be submitted to Alliance by the last day of the same month. Reports for the 16th through the last date of the month should be submitted to Alliance by the 15th of the following month. Reports should be submitted via email to backupstaffing@AllianceHealthPlan.org.
- Enter the date of the back-up staffing event.
- Enter the consumer’s name and date of birth.
- Select the service that the consumer missed from the drop-down.
- Enter the number of service hours the consumer missed. Note, service hours are specific to the date and service entered. This should be per date, per service, not the sum of multiple services or multiple dates of missed services.
- Select the reason that BACK-UP staff was not provided from the drop-down.
- By selecting “Individual/LRP declined back-up staff”, you are saying that the individual/LRP declined the back-up staff that was offered.
- By selecting “Staff out sick”, you are saying that the BACK-UP staff was not available because they were out sick.
- By selecting “Staff out due to extended leave”, you are saying that BACK-UP staff was not available because they were out due to extended leave.
- By selecting “Staff had an appointment”, you are saying that BACK-UP staff was not available because they had an appointment.
- By selecting “Staff on vacation”, you are saying that BACK-UP staff was not available because they were on vacation.
- By selecting “Staff resigned”, you are saying that BACK-UP staff was not available because they resigned.
- By selecting “Staff terminated”, you are saying that BACK-UP staff was not available because they were terminated.
- By selecting “Staff did not show to work”, you are saying that BACK-UP staff did not show to work.
- If back-up staffing was unavailable for reasons not indicated in the drop-down, select Other.
- If Other is selected from the Reason drop-down, please enter an explanation for why back-up staffing was not available in the Comment column. Explanations should include specific information about why back-up staff was not available.