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Subject Fulfilling scheduled services in accordance with the ASP
Rule 5101:3-45-10(A) ODJFS-administered waiver service providers shall: (7)
Assure consumers receive ODJFS-administered waiver services in
accordance with the all services plan. (a) Medicare-certified home health
agencies and other accredited home health agencies shall assure that
back-up staff will be available to provide services when the provider's
regularly scheduled staff cannot or do not meet their obligation to provide
services to the consumer. (b) Independent nurses, independent daily living
aides and independent daily living non-aides shall assist the consumer,
upon initiation of services, in developing a back-up plan in the event the
regularly scheduled independent provider cannot or does not meet their
obligation to provide services to the consumer.
Interpretation Once a provider has agreed to render services to a consumer and the case
manager has added the provider to the All Services Plan (ASP) to cover
specified hours/shifts, the provider is responsible for making sure the hours
are fulfilled. If a non-agency provider is unable to fulfill a scheduled shift,
(s)he must work with the consumer to identify and secure a replacement.
This back-up person can be another paid provider or a volunteer caregiver
such as a family member, friend, neighbor, etc. and must be capable of
meeting the consumer’s needs. Back-up support options are to be
explored with the consumer when the provider starts working on a case;
before the need for one arises. If the back-up person is a paid provider, it is
necessary for that provider to contact the consumer’s CM for ASP
authorization prior to submitting a claim for the shift(s) covered. If an
agency-employed provider is unable to fulfill a scheduled shift, it becomes
the responsibility of the agency to provide back-up staffing. It is not
acceptable for any provider to simply notify the consumer of unavailability
for a scheduled shift. The provider must go the step of making sure that the
consumer’s needs will be met by someone else in his/her absence. Once
the back-up person has been identified, the provider canceling the shift
should inform the case manager of the staffing change and identify the
replacement paid provider or volunteer caregiver. The case manager will
follow-up with the consumer to verify coverage.
Scenario This is an example of how this rule applies. Jasmine, a non-agency
employed nurse, began working for Consumer, Frankie, 3 months ago.
Jasmine and Frankie established a list of back-up support persons at that
time. The names were listed on a “Consumer Data Sheet”. Frankie
receives one skilled nursing visit three days each week. All of the visits are
assigned to Jasmine on the ASP. Jasmine informs Frankie that she is
unable to work a scheduled shift on next Wednesday and they need to
activate her back-up support system for that day. Kyle is Frankie’s nephew.
Kyle agreed to be one of Frankie’s back-up caregivers. He is very familiar
with Frankie’s care requirements. Jasmine contacted Kyle. Kyle agreed to
cover the shift on next Wednesday. Jasmine contacted the case manger to
update her on the staffing change. The case manager contacted Frankie
who confirmed Jasmine’s report.
Consequences If a provider violates this rule by failing to fulfill a shift to which (s)he was
committed without securing back-up staffing, (s)he may receive a Cease
and Desist Letter for which a written Plan of Correction will be required. If
this behavior is shown to be habitual, recurring after the provider has been
adequately educated, the provider will be in jeopardy of having her/his
Provider Agreement (provider number) inactivated through temporary
suspension or permanent termination. Without an active Provider
Agreement, providers are not permitted to render services to Waiver
consumers or bill for reimbursement for such services.
Test your Directions: Answer the following questions to test your
understanding understanding of the information presented above. The answers are
at the bottom of the page.
Circle one (T = the statement is true, F = the statement is false)
1. T F As long as the provider calls-off to the consumer at least 8 hours
before the scheduled shift time, the provider has not violated any rules and
is not obligated to do anything else.
2. T F If a non-agency provider is scheduled for a shift, only a non-
agency provider can replace her/him.
3. T F Providers must assure that back-up staffing is secured when the
scheduled provider is unable or unwilling to fulfill a shift.
1. False Providers must secure or assist the consumer in securing
back-up coverage. Case Manager needs to be notified, also.
2. False An agency employed provider, non-agency provider or
volunteer caregiver can act as back-up. Paid providers must be authorized
on the ASP before billing. All providers/caregivers must be able to render
competent care to the consumer.