PPS Provider Appeals - DY1 Q2

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PPS Provider Name: Nassau Queens PPS Appeal 1 of 1

Conclusion:
Provider unsuccessfully appealed the Independent Assessor's findings relative to the speed and scale requirements for Project 2.b.ii. and Project 2.b.iv. for DSRIP Year 1, Quarter 2.

Independent Assessor initially failed the PPS for Projects 2.b.ii and 2.b.iv. on speed and scale requirements which required the PPS to meet at least 80% of their actively engaged commitment for patient engagement speed as indicated in the project plan application for each project. The Independent Assessor (IA) determined that the PPS did not submit documentation to support that the PPS met at least 80% of their actively engaged commitment for patient engagement speed.

Upon appeal, the PPS wrote that they followed the DOH exception guidance for those PPS without a Business Associate Agreement (BAA) or a Data Exchange Application and Agreement (DEAA) in place. Because of that guidance, the PPS contends that they submitted aggregate Medicaid enrollee counts based on attestations of engagement numbers from those providers with which it did not yet have Business Associate Agreements in place. Relying on the DOH statement that the IA would accept an aggregate count, the PPS was careful to make sure that copies of the attestations were maintained, in case the IA requested them for review. The IA upheld the finding because the PPS did not submit the attestations with the quarterly report. Further, the actively engaged validation process was not subject to remediation. The numbers of Actively Engaged members and the supporting documentation must be accurate at the time of the initial submission of the Quarterly Report. As a result, the Independent Assessor upheld its original determination on appeal.