Alliance has two Incident Report Managers who review the incident reporting system daily. Incident report managers may contact providers on behalf of these committees to request additional information.
Incident Report Managers review IRIS entries for the following:
- Timeliness of incident reporting and submission (i.e. immediate verbal/electronic notification of Level 3s, IRIS submission within 72 hours for all incidents) and of provider responsiveness to LME/MCO requests for additional information in IRIS (i.e. by end of the next business day).
- Appropriate leveling and categorization of the incident.
- Notification of guardian, relevant agencies and others (DSS, HCPR, Police, DHSR, etc.).
- Sufficient narrative regarding incident cause (including triggers) and effective prevention.
Late Submissions: Incident reports that are not submitted in IRIS within three days of the incident (or of learning of the incident) are considered late. To promptly address the late submission of Level II and Level III incident reports, the following steps will be taken:
- An email notification or certified letter will be issued to executive leadership/management of any provider who submits a Level II or Level III Incident Report late.
- A Plan of Correction will be issued to any provider who:
a. Receives two written notifications in the same quarter
b. Receives two written notifications in two consecutive quarters in the current fiscal year
c. Receives three written notifications within the current fiscal year
Quarterly Reporting: Alliance has received a waiver from the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services for Level 1 incident reporting. Providers are not required to submit QM11 forms until further notice. Providers still are required to track Level 1 incidents as noted below.
Incident reporting reminders:
- For Level 3 incidents, providers are responsible for contacting the LME/MCO as soon as possible (or no later than 24 hours of the incident occurrence). Verbal notification is strongly encouraged by contacting the appropriate Incident Report Manager or calling Alliance BHC Access and Information Line 1-800-510-9132. Email notification is also acceptable.
- All Level 2 and 3 incidents must be entered into IRIS within three days of learning of the incident. (If IRIS cannot be accessed within that timeframe, providers may email or fax QM02 DHHS Incident and Death Report form. The provider is still responsible for entering the incident in IRIS as soon as the system is available.) Failure to submit the incident via IRIS may result in a plan of correction.
- All Level 1 incidents should be maintained by providers, separate from clinical records, at the provider’s site. They may be reviewed by during provider monitoring.
Helpful resources for incident reporting:
IRIS Reporting Manual (refer to pp. 20- 25, Appendix B for detail on incident categories)
Death certificates: obtained by contacting the Dept. of Vital Statistics of the county where the person died. (A copy of the death certificate should be attached to incident report in IRIS. Certified copy of death certificate is not necessary, a copy is fine.)
Division of Health Services Regulation (DHSR) Complaint Line: (800) 624-3004
DHSR/Health Care Personnel Registry (HCPR) Reporting Allegations: (919) 855-3968/fax (919) 733-3207
Incident Reporting Contact Information
|NC SNAPS||Diane Sofia||(919) 651-8481||(919) 651-8687|
First Responder Test Calling
As part of the contract between the North Carolina Department of Health and Human Services (DHHS) and Alliance Health, Alliance is responsible for ensuring that appropriate services are provided, including ensuring calls to providers are returned within one hour. Alliance has elected to monitor this requirement through routine testing of our network providers’ first responder capacity and quality throughout its coverage area. Provider First Responder capacities remain a key function of enhanced service providers within Alliance’s provider network.
There are three purposes for the following information. First is to provide the definitions of first responder and the first responder requirements. Second is to provide first responder recommendations and to encourage agencies to review their policies related to first responder. Finally, we want to ensure that providers are aware of the process by which Alliance will test first responder lines across its coverage area. If you or anyone at your agency has any questions after receiving this communication or at any point during the first responder testing processes, please contact the point of contact whose information can be found at the end of this webpage.
First Responder Definitions and Requirements
First Responder is defined as the provider designated in the PCP to provide crisis response on a 24/7/365 basis. Typically, the first responder is the provider who has the most sustained contact and familiarity with the clinical dynamics of the individual being served.
First Responder Requirements by Service Type (from DMA Enhanced Service Definitions).
The services listed below are not intended to be a comprehensive list of all providers with first responder requirements. However, they represent the majority of service types contracted with Alliance that will be part of the first responder testing process.
Multisystemic Therapy (MST) – Organizations that provide MST must provide “first responder” crisis response on a 24/7/365 basis to individuals who are receiving this service.
Assertive Community Treatment Team (ACTT) – Organizations that provide ACTT services must ensure service availability 24 hours per day, 7 days per week, 365 days per year and be capable of providing a full range of treatment functions including crisis response wherever and whenever needed to recipients who are receiving ACTT services.
Substance Abuse Intensive Outpatient Program (SAIOP) – Organizations that provide SAIOP must provide “first responder” crisis response on a 24/7/365 basis to recipients receiving this service.
Substance Abuse Comprehensive Outpatient Treatment (SACOT) – Organizations that provide SACOT must provide “first responder” crisis response on a 24/7/365 basis to recipients receiving this service.
Intensive In-Home (IIH) – This team service includes a variety of interventions that are available 24 hours a day, 7 days a week, 365 days a year and are delivered by the IIH staff, who maintain contact and intervene as one organizational unit. The IIH Team shall provide “first responder” crisis response, as indicated in the Person Centered Plan, 24 hours a day, 7 days a week, 365 days a year to recipients of this service.
Community Support Team (CST) – This team service includes a variety of interventions that are available 24 hours a day, 7 days a week, 365 days a year and are delivered by the CST staff who maintain contact and intervene as one organizational unit.
Child and Adolescent Day Treatment (MH/SA) – As part of the crisis plan of the Person Centered Plan, the Day Treatment provider shall coordinate with the Local Management Entity and recipient to assign and ensure “first responder” coverage and crisis response, as indicated in the Person Centered Plan, 24 hours a day, 7 days a week, 365 days a year to recipients of this service.
First Responder Recommendations
Below are some common recommendations generated after several first responder testing events:
- Keep Alliance informed with up-to-date contact information.
- Check Alliance’s website under Provider Search for your agency’s contact information and website, if applicable. If there are errors, notify Alliance’s Provider Network Department at [email protected] to ensure all information is up-to-date and accurate.
- Implement a 15 minute time limit for returning crisis calls and include that time in all phone messages enrollees may call during a crisis.
- Have a voicemail message that states the agency’s name and informs callers what to do if they do not receive a response within 15 minutes
- Identify yourself with agency name, name of person answering call, and title when answering the crisis line. Many during checks answer by simply saying “hello” with no other identification.
- Be able to respond face-to-face and/or schedule follow up appointments over the phone if necessary.
- Have access to crisis plans for all individuals receiving services that require first responders.
- Periodically review individual crisis plans to ensure that the First Responder numbers listed are accurate and relevant.
- Routinely conduct internal checks of your own system to make sure it is working. Internal checks should ensure covering staff follow agency first responder expectations and that voice messages are working properly and are loud and clear enough. Voice messages should repeat any phone numbers referenced a second time.
- Providers using an answering service will be evaluated by the same standards and should ensure that calls are directed to appropriate staff.
First Responder Evaluation Process
Performance in first responder tests conducted by Alliance is broadly measured as satisfactory and unsatisfactory.
- Satisfactory responses include live responses by agency staff to test calls and voicemails that are returned in less than one hour.
- Unsatisfactory responses include, but are not limited to: voicemail that are not returned, voicemails returned after more than 1 hour, not participating in the test calls, being unable to leave a voicemail, crisis lines not accepting calls from blocked numbers
Requirements for First Responder including timeliness of response can be found in the Alliance Provider Operations Manual, in the paragraph entitled “After Hours Coverage.”
To ensure tests calls are made using the correct contact information, provider crisis numbers will be gathered from individual crisis plans submitted for authorizations. These crisis plans will be randomly selected from any authorizations for services listed above.
Following the completion of the first responder test calls, Alliance staff will email results to provider contacts (main contact, Quality Management/Training Director, Clinical Director, and CEO/owner, as applicable), along with contact information for additional technical assistance.
Providers with multiple unsatisfactory performances may be referred to Alliance’s Corporate Compliance Committee and may receive a Plan of Correction.
General results from the First Responder Evaluation will be shared with providers and guidance and feedback from providers will be incorporated to future telephonic checks and testing efforts.
Thank you for taking the time to review this information in its entirety. Questions regarding first responder test calls may be directed to Helena Taylor, Clinical Service Evaluator.