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.”
Per the Samantha R. Consent Order:
“To determine the extent to which authorized hours (or units) for CLS are different than actually, utilized hours (or units) as a result of provider or DSP unavailability, DHHS will collect data showing the reason(s) for non-utilization. The categories to be collected will isolate provider or staffing availability as a basis for underutilization and DHHS will amend or revise its LME/MCO contracts to collect data that at a minimum indicates the hours (or units) of services not provided due to provider or staffing availability. DHHS will regularly publish this data as specified in Section IV, below.”
Reporting Requirements
Back up staffing
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 member/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).
- Record the difference between authorized hours and unused hours, unless unused hours are due to a lack of backup staff.
- Record reasons why a service date is not billable.
- Document breaks in service. These are defined as holidays, vacations (member), weather conditions, illnesses (member), and scheduling conflicts. Service breaks should be documented by the provider and communicated to the member’s Care Manager however, they should not be documented on the backup staffing report.
CLS Utilization
CLS utilization reports should be submitted when:
- When a member’s CLS services are not fully utilized as reflected in the approved Individual Support Plan (ISP).
- Non utilization of CLS services should be reported in all instances regardless if the member has primary staff or not.
CLS utilization reports should not be submitted when:
- Innovations Waiver services other than CLS
Completing the Alliance Claims System (ACS) Module
Back up Staffing and CLS Utilization 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. Both reports should be submitted via the ACS Back Up Staffing Module. Guidance documents for using the module are below.
All questions and technical assistance requests should be sent to the following email address: ACSBUSCLSReports@alliancehealthplan.org
